Over the past few months, we’ve discussed the upcoming Transparency in Coverage (TiC) Schema 2.0 updates. Now that the new schema is live, it’s time to take a closer look at what actually changed in the data.
At first glance, the update introduces six new variable fields: two at the Table of Contents (TOC) level and four at the negotiated rate level. These additions expand the contextual metadata surrounding negotiated rates and improve clarity around plan ownership, provider networks, and hospital billing structure.
New Table of Contents Fields
Two new fields were added at the file-level metadata layer:
- Issuer Name (issuer_name): The name of the plan’s issuing organization, providing clearer attribution of the entity responsible for the plan.
- Plan Sponsor Name (plan_sponsor_name): When the plan ID type is listed as an EIN, this field captures the common business name of the sponsoring employer or organization.
New Rate-Level Fields
Four additional variables were added at the negotiated rate level:
- Business Name (business_name): The common business name associated with the EIN used in the value field.
- Network Name (network_name): The consumer-facing name of the provider network associated with the rate. This helps distinguish between multiple networks offered by the same payer.
- Severity of Illness (severity_of_illness): Some DRG-based negotiated rates depend on the patient’s severity of illness. This field captures that classification when applicable.
- Setting (setting): Specifies whether a negotiated rate applies to inpatient, outpatient, or both settings.
These additions make it easier to distinguish between insurers and employer-sponsored plan sponsors, an important distinction when analyzing plan-level negotiated rates. Together, these variables provide more granular context around negotiated rates, particularly for inpatient billing structures and multi-network payer plans. While many of these fields were already established on our platform within Plan Types selection, we are set to ingest and incorporate these new data such as Severity of Illness as a new data point in the platform.
What Changed Behind the Scenes
Interestingly, despite the addition of these new fields, the overall data footprint has remained relatively stable. Files have been significantly consolidated, meaning fewer files now contain broader coverage. This has resulted in fewer files to load with similar overall data volume and improved data coverage. For Trek Health, the consolidation of files combined with richer metadata allows us to continue ingesting TiC data efficiently while expanding the analytical context around negotiated rates.
Looking Ahead
Most major payers have successfully implemented the CMS Schema 2.0 requirements, though some issuers are still lagging behind in full adoption. As payers fully transition to Schema 2.0, these new variables will unlock deeper insights into network structure, plan sponsorship, and hospital pricing dynamics, bringing even greater transparency to commercial healthcare reimbursement.
