Transparency in Coverage: The Enforcement Gap and Its Implications
The Transparency in Coverage (TiC) rule, effective since July 1, 2022, requires health insurers to publicly disclose negotiated rates with in-network providers and allowed amounts for out-of-network care. The goal is to empower consumers, employers, and providers with access to actionable pricing data.But access doesn’t always equal clarity. And the rule’s true potential hinges on something many aren’t talking about: compliance and what comes after it.
The Compliance Challenge
While many insurers have technically adhered to the TiC rule by publishing machine-readable files (MRFs), the data quality is inconsistent at best. Files often lack meaningful structure, exclude critical provider information, or include duplicate and “ghost” rates — data entries that are technically compliant but practically unusable.
For most health systems, these massive files (often 60,000+ per payer, up to a terabyte each) are impossible to process without the right tools. That’s where Trek Health comes in.
The Silver Lining: From Compliance to Opportunity
At Trek, we believe the real value of the TiC rule isn’t just regulatory, it’s strategic. The insurers had to share their data. Now it’s your turn to use it.Trek Health transforms the chaos of raw payer files into real, revenue-driving insights. We extract the 5% of data that matters, filter out the noise, and surface clear recommendations health systems can act on — whether that’s benchmarking DRG codes, renegotiating underpaid service lines, or identifying gaps in specific payer contracts.
What This Means for Providers
Compliance is just the start. The opportunity lies in turning transparency into leverage:
- Know where you stand. Are you being reimbursed fairly for high-volume procedures compared to peers?
- Negotiate from a position of strength. Trek equips your managed care teams with rate history, payer plan comparisons, and geographic benchmarking.
- Get proactive. Don’t wait for contract renewals to discover revenue loss. Our heat maps and executive dashboards show exactly where to focus.
Why Trek Health
Unlike generalist platforms that simply surface files, Trek Health is built for providers only — which means every tool is designed with your negotiation strategy in mind. We don’t just hand over data; we partner with your teams to interpret it, act on it, and win.
And unlike some transparency vendors, we don’t repurpose your data for your competitors.
Conclusion
Yes, the TiC rule has an enforcement gap. But for forward-thinking providers, it’s also the biggest opportunity in years to rethink how you negotiate with payers.
The transparency is there. Trek helps you use it.
White Paper
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.
White Paper
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.
White Paper
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.
The Transparency in Coverage (TiC) rule, effective since July 1, 2022, requires health insurers to publicly disclose negotiated rates with in-network providers and allowed amounts for out-of-network care. The goal is to empower consumers, employers, and providers with access to actionable pricing data.But access doesn’t always equal clarity. And the rule’s true potential hinges on something many aren’t talking about: compliance and what comes after it.
The Compliance Challenge
While many insurers have technically adhered to the TiC rule by publishing machine-readable files (MRFs), the data quality is inconsistent at best. Files often lack meaningful structure, exclude critical provider information, or include duplicate and “ghost” rates — data entries that are technically compliant but practically unusable.
For most health systems, these massive files (often 60,000+ per payer, up to a terabyte each) are impossible to process without the right tools. That’s where Trek Health comes in.
The Silver Lining: From Compliance to Opportunity
At Trek, we believe the real value of the TiC rule isn’t just regulatory, it’s strategic. The insurers had to share their data. Now it’s your turn to use it.Trek Health transforms the chaos of raw payer files into real, revenue-driving insights. We extract the 5% of data that matters, filter out the noise, and surface clear recommendations health systems can act on — whether that’s benchmarking DRG codes, renegotiating underpaid service lines, or identifying gaps in specific payer contracts.
What This Means for Providers
Compliance is just the start. The opportunity lies in turning transparency into leverage:
- Know where you stand. Are you being reimbursed fairly for high-volume procedures compared to peers?
- Negotiate from a position of strength. Trek equips your managed care teams with rate history, payer plan comparisons, and geographic benchmarking.
- Get proactive. Don’t wait for contract renewals to discover revenue loss. Our heat maps and executive dashboards show exactly where to focus.
Why Trek Health
Unlike generalist platforms that simply surface files, Trek Health is built for providers only — which means every tool is designed with your negotiation strategy in mind. We don’t just hand over data; we partner with your teams to interpret it, act on it, and win.
And unlike some transparency vendors, we don’t repurpose your data for your competitors.
Conclusion
Yes, the TiC rule has an enforcement gap. But for forward-thinking providers, it’s also the biggest opportunity in years to rethink how you negotiate with payers.
The transparency is there. Trek helps you use it.
