In 2021, CMS introduced two rules that reshaped healthcare pricing. For the first time, hospitals and insurers had to publish what they actually charge and what they actually pay — not list prices, but the real, negotiated dollars behind every contract.
The Legal Foundation
Together, these federal rules force the real numbers into public view — the foundation everything VeriPath does is built on.
Requires all U.S. hospitals to publicly disclose their negotiated rates, cash-pay prices, and standard charges for every item and service — plus a consumer-friendly display of at least 300 shoppable services.
What must be published
Requires insurers and group health plans to publish in-network negotiated rates, historical out-of-network allowed amounts, and prescription drug pricing — the insurer-side counterpart to hospital transparency.
What must be published
For the first time ever, consumers now have access to the same contract data payers once kept behind closed doors.
The Catch
Payers publish machine-readable files (MRFs) with negotiated rates by CPT code and provider, while hospitals publish charge masters and shoppable services in CSV or JSON formats.
This data contains trillions of rates — more data than Wikipedia, LibGen, and Netflix combined. The raw files are enormous, and often incomplete, poorly structured, or inconsistent.
VeriPath has access to this information from every payer and hospital, refreshed monthly — and presents it to consumers in an easy-to-understand, usable format.