Denniston Data Inc. (DDI) launched the Official Healthcare Pricing Guide™ (HPG), U.S. Medical Benchmark Prices from Transparency in Coverage and Medicare Data, with the largest and most accurate data available on negotiated medical prices in the U.S.
The Consolidated Appropriations Act, 2021 (CAA) established protections for consumers related to surprise billing and transparency in health care. It created a unique opportunity by establishing the Transparency in Coverage (TiC) requirements, making available all negotiated prices from every healthcare payer to every medical provider for every service in the U.S., beginning in the latter half of 2022. These rules provided unprecedented access to proprietary price information. The resulting data can transform how payers and providers negotiate, and it can result in the elimination of unwarranted price variability. However, the datasets are massive and messy, and the value is contingent upon making the data interpretable and actionable, which DDI has done.
CAA also included the No Surprises Act (NSA), which provided a new basis for out-of-network price negotiation, also included in HPG. Under CAA, self-insured employers have increasing fiduciary responsibility to their employees to ensure their healthcare prices are reasonable. This responsibility also applies to how health plans or TPAs bargain for their employer clients.
The Official Healthcare Pricing Guide™ (HPG) is available for public use after January 31, 2023, from all official US Government mandated data. Not only does it provide price transparency, but it uses a transparent process, unlike past healthcare pricing services, which may have been based on guesstimates or confidential sources. HPG provides tools for negotiating a “Fair Price.” It covers all reimbursement codes, easily searchable: DRG (hospitals), HCPCS (doctors & other providers, including CPT & CDT), ICD codes, & RC (revenue codes), based on tens of billions of U.S. negotiated prices, after thorough quality control checking, using over 50,000 health plan non-duplicate files.
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