5 Ways to Stay Compliant with Price Transparency

In today’s healthcare landscape, compliance with the Transparency in Coverage Rule is non-negotiable. Non-compliance results in significant repercussions, so it’s imperative for health plan sponsors and Third Party Administrators (TPAs) to not only understand the impacts of this rule but also implement strategies to stay compliant and mitigate risks proactively.

In this blog, we’ll explore five effective strategies for navigating the complexities of price transparency regulations and upholding transparency in healthcare pricing.


The Transparency in Coverage Rule

The Transparency in Coverage Rule provides members with information about healthcare costs, enabling them to make informed healthcare decisions. It also requires group health plans and insurance issuers to disclose detailed price information on covered items.

By failing to comply with this rule, groups could face tremendous fines of $100 per day, per member.[1]  While your clients face the biggest consequences of failing to stay compliant, TPAs can feel the effects, too.

As your group risks tremendous fines, they will demand accountability from you. Employers may be overpaying for employee healthcare by 40% or more due to significant price variations in the market.[1]

TPAs have a responsibility to help their clients avoid penalties and maximize cost savings. Ensuring your clients stay compliant can help reduce their healthcare costs and improve their satisfaction with your services.

But what are the best ways to do this?


Price Transparency Compliance Strategies for TPAs

Staying compliant with price transparency regulations is important for TPAs to ensure they meet legal requirements and provide transparency to plan sponsors and participants.

Here are five essential strategies to help you stay compliant.

  1. Understand Regulatory Requirements: Stay up to date with price transparency regulations, including the Transparency in Coverage Rule and any state-specific mandates.
  2. Implement Transparent Pricing Practices: Develop and implement transparent pricing practices that comply with regulatory requirements, including disclosing pricing information related to healthcare services in a clear, accessible manner.
  3. Leverage Technology Solutions: Streamline compliance efforts by leveraging healthcare price transparency software platforms and tools like those provided by our partner, TALON. These tools can help you present pricing data, estimate costs, and provide transparency for plan participants.
  4. Educate Plan Sponsors and Participants: Ensure that plan sponsors and participants understand price transparency regulations, their rights to access pricing information, and how to navigate available resources for cost estimation.
  5. Conduct Regular Compliance Audits: Consistently assess adherence to price transparency regulations and identify areas for improvement, including reviewing pricing disclosures, evaluating communication strategies, and addressing compliance gaps proactively.

By implementing these strategies, you can ensure compliance with price transparency regulations, improve transparency in healthcare pricing, and support your members in making informed healthcare decisions.



Ensuring price transparency compliance is important for TPAs to support their clients. By implementing strategies and leveraging technological solutions, TPAs can navigate regulatory complexities effectively and contribute to a more transparent healthcare landscape.

At Hi-Tech Health, we’re here to help you with compliance. To explore how we tailor our software to meet the needs of your business, reach out to us to schedule a free demo.

[1] https://talonhealthtech.com/solutions-for-tpas/