At Payorology, our medical price transparency data originates primarily from the payors themselves — the organizations that negotiate contracts and issue reimbursements. Under the Transparency in Coverage Final Rule, all commercial insurance companies and group health plans are legally required to publish their in-network negotiated rates and out-of-network allowed amounts in a standardized, machine-readable format.

These payor-reported files are updated monthly, ensuring the data remains current and reflective of the most recent reimbursement structures.

In addition, Payorology also integrates hospital price transparency files when applicable. Hospitals are required to publish their pricing data under a separate federal mandate, though these hospital-reported files are typically updated only once per year.

By combining and analyzing both sources, Payorology delivers the most comprehensive view of medical price transparency data available—providing medical groups, investors, and advisors with unparalleled insight into real reimbursement rates. This enables smarter strategies in contract negotiation, market expansion, M&A, and provider recruitment.

The Transparency in Coverage Final Rule, issued by the Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury, took effect on July 1, 2022. It requires most health insurers and employer group health plans to publicly disclose:

• In-network negotiated rates for all covered services

• Out-of-network allowed amounts and billed charges

• Monthly updates to all machine-readable files

This rule serves as the foundation of modern medical price transparency, giving providers, employers, and patients access to accurate, payor-level pricing data. The result is a more transparent, competitive, and data-driven healthcare ecosystem that supports informed decision-making across all stakeholders.