Employers have a new tool to ensure they are paying fair prices for medical services. The Consolidated Appropriations Act of 2021 (CAA) established protections for consumers related to surprise billing and transparency in healthcare. It created a unique opportunity by establishing the Transparency in Coverage and No Surprises Act requirements, making available all negotiated prices from every healthcare payer to every medical provider for every service in the U.S., beginning in the latter half of 2022, updated monthly.
These rules provided unprecedented access to proprietary price information. The resulting data can transform how payers and providers negotiate, and it can result in the elimination of unwarranted price variability. However, the datasets are massive and messy, and the value is contingent upon making the data interpretable and actionable. Accessing this data requires transparent data sourcing, selection, cleaning and quality control, with considerable experience in working with large healthcare data.
