Welcome to Cloud Transparency in Coverage and No Surprise Service

The Cloud Transparency in Coverage and No Surprise service is a cloud solution that allows payers to deliver cost transparency to their members that would prevent members from receiving surprise bills as required by the CMS Transparency in Coverage Rule and the No Surprises Act.

Under the final rules, payers are required to:

• Generate Advanced Explanation of Benefits (AEOB) with the cost for medical services (including the amount covered by a plan and the estimated cost to be payed by the member) upon request. This information must be provided prior to scheduled services, for a member to understand their out-of-pocket expenses,
• Disclose their in-network and out-of-network rates, as well as drug pricing information through machine-readable files (MRFs) and make them publicly available via HTTPS to any third parties. This would allow members, for example, to find alternatives for care which are more cost-effective.

The purpose of the Cloud Transparency in Coverage and No Surprise service is to help you as a payer to meet these rules requirements.

In the current release, the service allows you to provide the up-to-date information in form of machine-readable files on:

• In-network provider negotiated rates for all services and procedures,
• Billed and allowed amounts for out-of-network providers.

With the Cloud Transparency in Coverage and No Surprise service, you can easily generate machine-readable files from the data you upload to the service and publish these files on the service's web page. The service provides a mechanism that converts flat files data to a structured JSON format and publishes the generated files to a URL that you can share with your members, providers, and any third-parties. For instructions on how to provide this information in form of machine-readable files and make them available to anyone through a public URL, view Get Started.

In future releases, the Cloud Transparency in Coverage and No Surprise service is planned to include the following major functionality:

• A user-friendly cost estimator where members can search for medical services in specific locations and compare prices from different providers,
• An interactive form for providers to submit Good Faith Estimates (GFEs) for their services in order to get Advanced Explanation of Benefits (AEOB) from a payer,
• The ability for payers to generate machine-readable files with the prices for covered prescription drugs.