An integrated, AI-powered solution supporting your organization's internal implementation of federal price transparency requirements.
The CMS Hospital Price Transparency Rule requires hospitals to publish their standard charge information in both:
These requirements can involve extensive operational work, including data consolidation, formatting, mapping, and ongoing maintenance. They also present an opportunity for hospitals to understand pricing variation, strengthen rate strategies, and improve visibility into their managed care performance.
PayerAnalytics delivers an integrated solution that supports your organization's internal workflow for preparing CMS-aligned pricing files, organizing remittance data, and powering consumer-facing shoppable services. Our platform is designed to help hospitals streamline operational activities, reduce manual steps, and enhance data-driven insight.
This page summarizes publicly available CMS materials and is intended for informational purposes only. This content does not interpret regulatory requirements or constitute legal or compliance advice. All implementation approaches should be reviewed with your organization's compliance and legal teams.
Hospitals must publicly provide:
Beginning January 1, 2026, hospitals will be expected to include additional pricing-related elements for payer-specific negotiated charges that are based on percentages or algorithmic methodologies. These include:
CMS references a 12–15 month lookback period for producing the required allowed-amount values.
These elements will be subject to CMS enforcement beginning on this date.
Producing complete, accurate, and CMS-aligned pricing files involves cross-departmental work, including:
An effective implementation requires a clear process, consistent data structure, and repeatable workflows.
CMS has recently updated several public resources that support implementation of the CY 2026 changes:
CMS has refreshed its templates (CSV tall, CSV wide, and JSON formats) in the publicly available GitHub repository. The templates include updated fields that correspond to the 2026 requirements.
The CMS Online Validator now allows hospitals to select which version of the Hospital Price Transparency requirements to validate against, including the version aligned with the 2026 changes. Earlier versions from 2025 and 2024 remain available as archived references.
These CMS tools continue to be available to help structure associated files in the required layout.
CMS finalized a policy that allows a 35 percent reduction in the civil monetary penalty (CMP) in certain circumstances if a hospital accepts CMS's penalty determination and waives its right to an Administrative Law Judge (ALJ) hearing. CMS stated that this reduction does not apply to "core" requirement violations, including situations where required MRF information or shoppable services are not made public. This represents an enforcement policy update and does not change the underlying transparency requirements.
PayerAnalytics is an integrated, AI-powered solution purpose-built to support the operational work associated with Hospital Price Transparency requirements. Whether handled internally or supported by a partner, having a clear and repeatable process can support the implementation of the 2026 updates. Our platform enables hospitals to reduce manual burden, strengthen internal data workflows, and gain visibility into their pricing information.
Your organization maintains full control of validation, review, governance, and publication of all materials and disclosures.
Our solution supports your MRF-related workflow by providing:
This component helps reduce manual file handling, data mapping, and spreadsheet-driven processes.
For organizations that manage most HPT activities internally but need help with remittance-based calculations, we offer a focused service that includes:
This component helps teams incorporate remittance-based data elements without redesigning internal infrastructure.
Our hosted solution creates the consumer-friendly shoppable services display directly from the MRF:
This component supports your organization's consumer-facing transparency display.
PayerAnalytics also provides analytics based on publicly available payer and hospital files. These insights can help internal teams identify:
These analytics supplement your managed care, contracting, and revenue cycle teams with data-driven context.
Our platform uses machine learning to support operational efficiency by:
These capabilities complement internal compliance and legal review.
CMS may impose Civil Monetary Penalties (CMPs) for non-compliance with Hospital Price Transparency requirements. Based on publicly available CMS materials:
CMS policies and penalty structures can change over time. Hospitals should rely on the latest CMS materials and consult with their compliance and legal teams for current details.
Similar info can be embedded on hospitals' websites using PayerAnalytics technology.
| Charge Type | Price |
|---|---|
| Gross Charge | $2,500 |
| Discounted Cash Price | $1,200 |
| Payer-Specific Negotiated Charges |
Payer A: $1,800 Payer B: $1,950 |
| De-Identified Minimum Negotiated Charge | $1,700 |
| De-Identified Maximum Negotiated Charge | $2,100 |
| Charge Type | Price |
|---|---|
| Gross Charge | $1,800 |
| Discounted Cash Price | $900 |
| Payer-Specific Negotiated Charges |
Payer A: $1,400 Payer B: $1,500 |
| De-Identified Minimum Negotiated Charge | $1,300 |
| De-Identified Maximum Negotiated Charge | $1,600 |
| Charge Type | Price |
|---|---|
| Gross Charge | $3,000 |
| Discounted Cash Price | $1,500 |
| Payer-Specific Negotiated Charges |
Payer A: $2,200 Payer B: $2,400 |
| De-Identified Minimum Negotiated Charge | $2,000 |
| De-Identified Maximum Negotiated Charge | $2,600 |
Interested in learning how PayerAnalytics can support your organization's internal workflow for price transparency? Contact us to schedule a demo and discuss how our platform can help streamline operational activities.
The federal Hospital Price Transparency rule requires hospitals to make their standard charge information publicly available. This includes payer-specific negotiated rates and other types of standard charges, published in both a Machine-Readable File (MRF) and a consumer-friendly display or price estimator for shoppable services. The overall goal is to provide more accessible information about the cost of care.
Hospitals are currently expected to:
Under the CY 2026 OPPS/ASC Final Rule, beginning January 1, 2026, hospitals will be expected to include additional pricing-related elements for certain payer-specific negotiated charges, such as median allowed amounts, 10th and 90th percentile allowed amounts, and the count of allowed amounts used in these calculations. CMS has indicated that these elements will be subject to enforcement beginning in April 2026.
Organizations should review regulatory details with their internal compliance and legal teams to confirm how these requirements apply to their specific circumstances.
CMS may impose Civil Monetary Penalties (CMPs) for non-compliance with Hospital Price Transparency requirements. Penalties are generally calculated on a per-day basis and can reach significant annual amounts for larger hospitals. CMS may also publicly post the names of hospitals that are out of compliance, which can have reputational implications.
CMS policies and penalty structures can change over time, so hospitals should rely on the latest CMS materials and consult with their compliance and legal teams for current details.
Benchmarking negotiated rates using transparency data can help provider organizations:
These insights can complement internal revenue cycle, managed care, and strategic planning activities.
PayerAnalytics provides an integrated, AI-powered solution that supports hospitals with the operational work associated with Hospital Price Transparency. The platform is designed to:
The solution is intended to support internal workflows. PayerAnalytics does not provide legal or regulatory advice, and use of the platform does not guarantee compliance. Hospitals remain responsible for reviewing all disclosures with their compliance and legal teams.
You can contact our team to schedule a demo. We will walk you through the solution and discuss how it can support your organization's Hospital Price Transparency implementation efforts.
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