Making Transparency Transparent: The First Update to the Transparency in Coverage Schema
CMS plans a new enforcement timeline for the updated Transparency in Coverage (TiC) schema, giving payers four months to comply. This is the first major schema change since the mandate took effect in 2022, and it represents a massive change to the status quo. While this may sound like a technical adjustment, it represents a meaningful step forward in making price transparency data more usable and actionable for providers and health systems.
What’s Changing
The updated schema introduces several important improvements:
- Consolidation of redundant fields to shrink machine-readable files (MRFs) and reduce noise.
- Clearer identifiers, such as payer business names alongside EINs, to improve mapping accuracy.
- Standardization of severity-related fields, helping explain why some services cost more.
- Streamlined location files to reduce complexity and ease data ingestion.
- Cleaner separation of payer and plan sponsor fields, improving visibility in large group markets.
Currently, these MRFs are clunky and intentionally hard to interpret: insurance companies don’t want you to be able to utilize this data. However, these clear expectations will force commercial payers to show their hand, which is a big win for providers.
Why This Matters For Providers
This amendment to policy will be enacted on February 2, 2026, meaning that providers have a short window to prepare. Those who invest early in tools and processes to interpret the new schema will be able to benchmark rates, identify inequities, and negotiate from a position of strength. By being ahead of the curve with actionable data, providers position themselves to shape contracts on their terms instead of reacting to payer defaults.
Trek Health’s Perspective
Trek Health is ready for these changes - we are poised to ingest and process the new MRF schema immediately upon payer publication. This update transcends just regulatory compliance, it represents a real win for healthcare providers to push for more equitable rates. When data improves, so does negotiating power. With this update, providers have the strategic opportunity for contract realignment: they must seize it now to secure fairer rates, recover lost revenue, and position themselves ahead of the market shift. For providers who act now, this is far greater than political jargon, it is leverage to drive real change in payer negotiations.

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From Transparency to Prediction: Quantifying the Drivers of Physician Reimbursement Variation
This analysis uses Transparency in Coverage data to model how payers behave, not just what they pay. By linking reimbursement rates to physician characteristics, we uncover the patterns behind payment variation and transform transparency data into predictive intelligence. The result: a predictive view of rate dynamics that helps stakeholders anticipate trends and negotiate with data-driven confidence.

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Reimbursement and Reality: The Economics of Breast Cancer Treatment
While breast cancer awareness efforts often focus on screening and treatment, one critical factor remains overlooked: how care is reimbursed. Payment structures shape far more than provider margins; they influence access, equity, and patient outcomes.
In this analysis of payer rates, Trek Health uses its Transparency Platform to analyze how reimbursement for breast cancer care varies across geography, commercial payer behavior, and public policy. The findings reveal a system that rewards disease burden rather than prevention which creates inequities that ripple through the entire care process.
Inside you’ll learn:
- How reimbursement rates differ dramatically by state and payer
- Why higher disease burden correlates with higher payment, but prevention does not
- What these trends mean for provider strategy, patient access, and equity
Download the full analysis to see how transparency data can help reshape breast cancer care—turning financial insight into fairer outcomes.

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The Payer Paradox: When Higher Rates Don’t Mean Higher Reimbursement
This analysis uncovers a critical paradox in commercial healthcare financing: the payers offering the highest contracted rates often deliver the lowest realized reimbursement once denials and administrative friction are accounted for. By introducing the Payer Generosity Index (PGI) and adjusted PGI (aPGI), Trek Health reveals how payer performance varies not only across insurers, but across specialties and service lines. These findings equip healthcare organizations with a clearer, data-driven framework for contracting, revenue optimization, and strategic planning in an increasingly complex reimbursement landscape.

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The Private Practice Playbook: Rate Negotiation Index Rankings for Specialty-Specific M&A Strategy
Physician economics are shifting as private equity and independent platforms redefine the workforce landscape. Trek Health’s Rate Negotiation Index Report quantifies the return on physician labor across states and specialties in a new lens: combining commercial reimbursement, physician salary, malpractice risk, and provider density into a single metric. This data driven foundation for smarter M&A strategy identifies the most economically sustainable opportunities across the U.S. for physician recruitment and network expansion.

Published on
October 3, 2025
Written by
Ryan Kelly
CMS plans a new enforcement timeline for the updated Transparency in Coverage (TiC) schema, giving payers four months to comply. This is the first major schema change since the mandate took effect in 2022, and it represents a massive change to the status quo. While this may sound like a technical adjustment, it represents a meaningful step forward in making price transparency data more usable and actionable for providers and health systems.
What’s Changing
The updated schema introduces several important improvements:
- Consolidation of redundant fields to shrink machine-readable files (MRFs) and reduce noise.
- Clearer identifiers, such as payer business names alongside EINs, to improve mapping accuracy.
- Standardization of severity-related fields, helping explain why some services cost more.
- Streamlined location files to reduce complexity and ease data ingestion.
- Cleaner separation of payer and plan sponsor fields, improving visibility in large group markets.
Currently, these MRFs are clunky and intentionally hard to interpret: insurance companies don’t want you to be able to utilize this data. However, these clear expectations will force commercial payers to show their hand, which is a big win for providers.
Why This Matters For Providers
This amendment to policy will be enacted on February 2, 2026, meaning that providers have a short window to prepare. Those who invest early in tools and processes to interpret the new schema will be able to benchmark rates, identify inequities, and negotiate from a position of strength. By being ahead of the curve with actionable data, providers position themselves to shape contracts on their terms instead of reacting to payer defaults.
Trek Health’s Perspective
Trek Health is ready for these changes - we are poised to ingest and process the new MRF schema immediately upon payer publication. This update transcends just regulatory compliance, it represents a real win for healthcare providers to push for more equitable rates. When data improves, so does negotiating power. With this update, providers have the strategic opportunity for contract realignment: they must seize it now to secure fairer rates, recover lost revenue, and position themselves ahead of the market shift. For providers who act now, this is far greater than political jargon, it is leverage to drive real change in payer negotiations.