Triple-S Salud, Inc. (Triple-S, hereafter), in compliance with the rules of the Department of Labor, Department of the Treasury, and the Department of Health and Human Services, and requirements established by the Price Transparency Rule must give information about healthcare prices and benefits. Also, it must give access to three (3) machine-readable files, through the web, to policyholders, consumers, and the public. Disclosing of healthcare information and pricing to policyholders and consumers can help them understand the healthcare pricing and help make better choices.
Triple-S discloses and shares the data about healthcare benefit costs and pricing to policyholders and the public by making the data available for the following lines of business, as described below:
- Commercial Groups and Individual health plans and the Federal plan for the Puerto Rico territory
- United States Virgin Islands (USVI)
- BlueCross BlueShield Association (BCBSA)
You may access the following machine-readable files:
- In-Network Provider: participating provider contracted rates or fees for covered services.
- Out of Network Provider: historical allowed amounts and billed charges by non-participant providers.
- Historic covered drug pricing and negotiated fees: This requirement has been deferred by agencies until further notice
- Certain CPT codes are priced manually and based on supporting documents (by report), no negotiated fixed rates.
- The format of these files is not for general consumption. This is a special format whose main intent is to be read by an automated system as required by law.
Understanding the Data
The published machine-readable files confirm the technical implementation guide and schema version 1.0.0 published by CMS at https://github.com/CMSgov/price-transparency-guide.