The Departments of the Treasury, Labor, and Health and Human Services (the Departments) issued the Transparency in Coverage Final Rules (85 FR 72158) on November 12, 2020. The final rules, requiring payers to publish machine-readable files containing in-network and out-of-network rates for providers in North Carolina and other states, went into effect for non-grandfathered group health plans and health insurance issuers in the individual and group markets (plans and issuers) on July 1, 2022.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to consumer transparency and agrees that transparency can help consumers. In compliance with the federal Transparency in Coverage rule enforcement deadline, Blue Cross NC published machine-readable files on July 1, 2022.
Blue Cross NC will update machine-readable files monthly.
Last updated 07/01/2023.
Select one of the groups below to view the list of links:
The requirement to provide machine-readable files is not a consumer-friendly solution and will not help people better understand the cost of their health care services.
The machine-readable files are intended for use by health care application developers to create tools and databases that will assist consumers in understanding health care costs across providers and health plan issuers.
Machine-readable files published by Blue Cross NC conform to the technical implementation guide and schema version 1.0.0 published by CMS in their price transparency guide.
The machine-readable files do:
The machine-readable files do NOT:
Blue Cross NC has an online tool designed specifically for consumers that includes cost estimates for the entire episode of care. Beyond what is available publicly, Blue Cross NC customers can use the tool to access specific, transparent pricing information based on their individual plans. This allows customers to see what they will pay for a procedure and compare prices by location and provider, so they can make informed health care decisions.
Price transparency can add significant value, but more action is needed to make quality, equitable health care more affordable. That is why we stay focused on developing and building on existing tools, like our cost estimator tool, to improve access to quality care, lower costs and provide members with meaningful information so they can make the best choices for their health care.
For member-specific benefit information, view our Transparency of Coverage information.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.