What Is a Transparency in Coverage File?
A Transparency in Coverage (TiC) file is a machine-readable file that U.S. health plans and insurers must publish every month under the federal Transparency in Coverage rule. It lists the rates the plan negotiated with each in-network provider, for each billing code. These files are the public source of commercial negotiated rates.
People also call them payer MRFs (machine-readable files) or TiC files. They are published by insurers, not hospitals, and they cover what a plan actually pays, not a provider's list price.
Who has to publish them
The Transparency in Coverage final rule was issued in October 2020 by the Departments of Health and Human Services, Labor and the Treasury. It applies to most group health plans and to insurers selling individual and group coverage. Grandfathered plans are exempt, and Medicare and Medicaid are outside the rule.
The file requirement applied to plan years starting on or after January 1, 2022, and enforcement began on July 1, 2022. Since then, insurers such as UnitedHealthcare, Aetna, Cigna and the Blue Cross Blue Shield plans publish new files every month.
The three files the rule requires
| File | What it lists | Status |
|---|---|---|
| In-network rates | The negotiated rate for every covered item and service, for every in-network provider | Published monthly since July 2022 |
| Allowed amounts | What the plan allowed and what out-of-network providers billed, over a 90-day period; omitted when fewer than 20 claims | Published monthly since July 2022 |
| Prescription drugs | Negotiated rates and historical net prices for covered drugs | Enforcement deferred by the departments |
Insurers usually add a table of contents file (also called an index file) that lists which in-network and allowed-amount files apply to each plan. It is the usual starting point when you look for a specific plan's rates.
What is inside an in-network file
In-network files are JSON files that follow a schema published by CMS on GitHub. Each file names the reporting entity (the insurer or plan) and then lists, for each billing code, which providers have which rate.
| Field | What it means |
|---|---|
billing_code_type and billing_code | The code system and code, such as CPT 99214, HCPCS J1885 or MS-DRG 470 |
negotiation_arrangement | ffs (fee for service), bundle or capitation |
provider_groups | The providers the rate applies to: a list of NPIs plus the tax ID (TIN) they bill under |
negotiated_type | negotiated (a dollar amount), fee schedule, derived, percentage (of billed charges) or per diem |
negotiated_rate | The rate itself: dollars, or a percentage when the type is percentage |
billing_class | professional (the clinician's fee), institutional (the facility's fee) or both |
service_code | The CMS place-of-service codes where the rate applies, such as 11 (office) or 22 (outpatient hospital) |
billing_code_modifier | Modifiers that change the rate, such as 26 (professional component of imaging) or TC (technical component) |
expiration_date | When the contracted rate ends |
A trimmed entry looks like this (values are illustrative):
{
"negotiation_arrangement": "ffs",
"billing_code_type": "CPT",
"billing_code": "99214",
"description": "Office or other outpatient visit, established patient",
"negotiated_rates": [
{
"provider_groups": [
{
"npi": [1234567890, 1987654321],
"tin": { "type": "ein", "value": "12-3456789" }
}
],
"negotiated_prices": [
{
"negotiated_type": "negotiated",
"negotiated_rate": 92.5,
"expiration_date": "9999-12-31",
"service_code": ["11"],
"billing_class": "professional"
}
]
}
]
}
To keep files smaller, many insurers list provider groups once in a provider_references section and point to them by ID instead of repeating NPIs in every rate.
Why the files are hard to use
The data is public, but reading it is not simple:
- Size. A large insurer's monthly release runs to many terabytes, split across thousands of compressed files.
- Duplication. The same rate repeats across every plan and network that shares a contract.
- Mixed rate types. Dollar rates sit beside percent-of-charges rates and per diems, so a raw average is meaningless.
- Modifiers. An imaging code can carry three prices: global, professional (26) and technical (TC). Pooling them blends three different services.
- Identifiers. Rates are listed by NPI and TIN, not by provider name, so finding a specific hospital or practice takes a provider lookup first.
Transparency in Coverage vs. hospital price transparency
The two rules are often confused. They regulate different parties and publish different numbers.
| Transparency in Coverage | Hospital Price Transparency | |
|---|---|---|
| Who publishes | Health plans and insurers | Hospitals |
| What it covers | Rates negotiated with every in-network provider: physicians, groups, facilities | One hospital's own charges and negotiated rates |
| Update frequency | Monthly | At least once a year |
| In effect since | July 1, 2022 | January 1, 2021 |
For a full timeline of both rules, see our price transparency law guide.
What the files are used for
- Contract negotiation. Providers compare their own contracted rate with what the same insurer pays others in their market for the same code.
- Finding underpaid contracts. A rate below the market median is often a contract problem no claim denial will ever flag.
- Employer benefits. Employers compare what different networks pay for the same services.
- Research and journalism. Analysts study how much rates vary for identical services.
An example of what the files show: for CPT 99214 (an established-patient office visit) in Texas, the UnitedHealthcare median rate for family medicine is $92.50. Medicare pays $137.41 for the same visit in Houston, so the commercial median is 67% of Medicare. That comes from MedReveal's processed UnitedHealthcare files.
MedReveal reads these files every month, keeps negotiated dollar rates separate from percentage rates, and splits rates by modifier and billing class. You can look up rates by billing code, by specialty or by hospital, or compare your own contract with rate benchmarking.
Frequently asked questions
Are Transparency in Coverage files free to download?
Yes. The rule requires insurers to post them on a public website, free, without an account or login. Most insurers link to them from a "Transparency in Coverage" or "machine-readable files" page.
How often are the files updated?
Monthly. Each release should show the rates in effect that month, so the file you download today may differ from last month's.
Do the files include Medicare or Medicaid rates?
No. The rule covers private health plans and insurers. Medicare rates are published separately in CMS fee schedules such as the Medicare Physician Fee Schedule.
Can I see what a specific hospital is paid?
Yes, if you know its identifiers. Find the hospital's NPI and tax ID, then look for rates listed against them. MedReveal's hospital directory does this matching for every Medicare-enrolled U.S. hospital.
What is the difference between a negotiated rate and a billed charge?
A billed charge is the provider's list price, which almost no insurer pays in full. A negotiated rate is what the insurer agreed by contract to pay. In-network files list negotiated rates; allowed-amount files list out-of-network billed charges and what the plan allowed.
