From Petabytes to Practicality: Navigating the New CMS Transparency Rule 

The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower costs. Five years later, health plans are faced with an overwhelming amount of data, but not necessarily the actionable insights they need.

Hospitals alone generate more than 50 petabytes of data every year (about 50 million gigabytes). But because this is unstructured data and difficult to organize, 97 percent goes unused by hospitals and their partners.

Release of the Transparency in Coverage proposed rule (CMS-9882-P) marks a pivotal point for the industry. This isn’t merely a regulatory update—it’s a fundamental restructuring of the way healthcare organizations deliver pricing transparency. For health plan leaders, this moment demands a strategic shift from simple compliance to data stewardship.

In this guide, we offer a breakdown of the proposed changes and how healthcare payers can prepare.

The Data Deluge: Solving the Petabyte Problem

For health plans, the current system of data collection and management is buckling under its own weight. In-network rate files have ballooned to terabyte sizes, creating significant barriers:

• Files generated by payer systems are too large for most researchers and developers to process.
• Raw data lacks the context needed to understand the causes behind rate changes and other trends.
• Disconnected initiatives between hospital and payer transparency rules prevent meaningful cross-system analysis.

The proposed rule addresses these barriers directly, aiming to transform raw data into actionable intelligence.

Strategic Shifts: Key Changes in the Proposed Rule

The new proposed rule introduces transformative changes designed to make data more manageable and useful, if finalized.

1. From Monthly to Quarterly Reporting

The Change: Reporting for in-network rate files and out-of-network allowed amounts shift from a monthly to a quarterly cadence.

The Impact: This is intended to reduce the operational burden of file generation. It allows payer teams to focus on data quality assurance rather than constant production cycles. However, it may also introduce a lag in pricing visibility that could impact competitive strategy.

2. Network-Level Organization

The Change: Files must be organized by provider network rather than by individual plan.

The Impact: This helps eliminate data duplication for plans that share provider networks across multiple products. While this will significantly reduce file sizes, it requires a major architectural overhaul to aggregate data correctly. You will need to map your product portfolio against provider networks to ensure accurate enrollment reporting.

3. Contextual Intelligence: The “Legend” for the Map

The rule introduces new file types to provide critical context:

• Text File (within 7 calendar days of a change to any information): Includes the URL of the page hosting the machine-readable files, a direct link to the machine-readable files themselves, and contact information for the individual responsible for the machine-readable files.
• Change-Log File (Quarterly): Identifies changes from previous reporting period to current, allowing users to identify which files changed without downloading or analyzing all files.
• Taxonomy File (Quarterly): Standardizes how providers are categorized, based on internal organizational logic for matching services to specialties.
• Utilization File (Annual): Identifies which provider-service combinations actually occurred, eliminating “ghost” data.

These files assist with converting raw numbers into meaningful insights but could require payers to formalize and disclose internal processes that were previously proprietary.

4.  Exclude Clinically Implausible Rates

The Change: Machine-readable files must exclude provider-rate combinations where reimbursement is unlikely based on provider specialty.

The Impact: This approach is expected to help reduce file sizes and improve data quality by eliminating rate distortions from implausible combinations of provider specialty, billing code, and service rates.

5. Streamlining Cost Transparency: Harmonizing Duplicate Federal Requirements

The Change: Requires phone-based disclosures under the No Surprises Act to match the comprehensive information already mandated for internet tools under Transparency in Coverage rules.

The Impact: This consolidation is expected to eliminate regulatory redundancy while creating operational consistency for health plans and ensuring consumers receive equivalent cost-sharing information regardless of their preferred communication channel.

Strategic Action Plan: Preparing for Implementation

While the final rule is anticipated later in 2026, the complexity of these changes requires health plan leaders to take immediate action. Here are recommendations from HealthEdge® Regulatory experts:

Immediate Actions (Early 2026)

• Assess Network Structure: Map health plan products to provider networks immediately. Identify where reorganization is needed to meet the new disclosure requirements.
• Audit Taxonomy Systems: Review how internal systems categorize providers. Inconsistencies here will be exposed by the new Taxonomy File requirement.
• Analyze Out-of-Network Data: The proposed rule lowers the claim threshold from 20 to 11. Run scenarios on health plan data to see how this impacts disclosure volume.

Medium-Term Actions (Mid to Late 2026)

• Architect Your Data: Begin designing the infrastructure to aggregate data at the network level and track changes for the required logs.
• Prepare Customer Service: Design training programs for phone-based pricing support including scripted decision trees and quality assurance considerations.

The Opportunity in the Obligation

It is easy to view these changes as just another compliance hurdle. However, forward-thinking health plans will see the strategic opportunity. The organizations that thrive will be those that use this data not just to check a box, but to optimize network contracting, enhance employer relationships, and drive innovation.

By treating transparency as a core business asset rather than a regulatory burden, you position your health plan as a market leader. We must move beyond petabytes of noise to practicality and precision.

To learn more about the regulatory and cost pressures most heavily impacting health plan leaders, download the 2026 HealthEdge Annual Payer Report, “The Great Rebalancing: Inside the New Realities Shaping Health Plan Performance.”

About the Author:

Bettina Vanover, HealthEdge Regulatory Compliance Principal, brings over two decades of leadership experience in healthcare compliance, regulatory strategy, and government program oversight.  Her expertise spans enterprise risk management, audit readiness, and the integration of regulatory frameworks into scalable, tech-enabled solutions.

At HealthEdge, Bettina plays a pivotal role in shaping regulatory strategy. She helps ensure that our solutions empower payer organizations to meet evolving standards, while driving efficiency, transparency, and better care delivery.