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.