At After Transparency, we place a strong focus on payor price transparency data. It’s a cornerstone of our business and a key asset for our provider clients. We diligently consider all the ways we can improve our understanding of this data so we can interpret and utilize it in actionable ways. 

Along with this effort comes a responsibility: ensuring that payors make all required data available in the first place. We do this, primarily, because we believe it’s the right thing to do. But we also recognize that because we work exclusively on behalf of providers, we can hold payors accountable without fear of repercussions. 

Someone needs to be watching, and After Transparency is uniquely positioned to do just that, since we won’t work with or sell to any payors. That is why we closely monitor the data that payors publish, looking for gaps, inconsistencies, and potential non-compliance. Recently, we saw just how quickly that vigilance can make a difference.

Same Day Response: From Non-Compliant to Correct in a Matter of Hours

Recently, After Transparency founder Pete Brumm identified an issue with Wellsense Health Plan’s published price transparency data. Rate updates that should have been available were missing, directly impacting the data available to one of After Transparency’s provider clients.

Rather than simply working around the missing data, Pete set out to determine what had gone wrong and to get the issue corrected.

He filed a complaint with the Centers for Medicare & Medicaid Services (CMS) and checked with other healthcare price transparency data companies to confirm what he was seeing. One had identified the same issue but found and implemented a workaround. That prompted Pete to dig deeper, looking for a file name change, alternate point of entry, or anything else that might explain the missing rates. He found none.

With the issue confirmed, Pete continued pursuing a correction through CMS. Then, one morning while traveling for work, he reached out to Wellsense directly to notify them of the error and call them out on their non-compliance. That outreach landed in the right hands. 

Later that same afternoon, Pete checked the Wellsense data again, on the off chance something had changed. Shockingly, it had. Within approximately six hours of his outreach to Wellsense, the issue was corrected, and the updated rate data was available.

Pete immediately pulled the newly available data and processed it. By the time his plane landed back home that evening, the corrected Wellsense data was already live in After Transparency’s system.

Payor Price Transparency Data Necessitates Accountability

Federal price transparency mandates have opened the door to unprecedented opportunities, especially for healthcare providers. Today, like never before, providers can see negotiated rates across their markets and use those insights to improve their competitive position and remain financially viable. 

But this ability depends on a few fundamental first steps: the data has to be accurate and published on a reliable schedule. When expected information is missing, incomplete, out of date, or otherwise unavailable, the value of price transparency is limited. That’s why After Transparency doesn’t take a passive approach to payor compliance. 

We actively monitor the data our provider clients depend on. When we identify potential non-compliance, which is often the case, we investigate it. And when appropriate, we file complaints with CMS, notifying them of out-of-date, corrupt, or missing data, broken URLs, and other issues that make the data inaccurate and unhelpful. We also bring issues directly to the payor’s attention, giving them an opportunity to correct it promptly, just as Wellsense did. But it’s worth noting that identifying a problem is only the beginning. True accountability requires knowing what to look for, documenting the issue, escalating it through the appropriate channels, and following up until it is addressed. In this case, Wellsense responded quickly. That isn’t always the case, which is precisely why active oversight matters.

This Wellsense example demonstrates why our efforts matter and how active oversight can make a difference. After Transparency identified and verified the issue, we escalated it through CMS, brought it directly to the payor, and continued monitoring for a resolution. In this instance, the response came remarkably quickly: by that afternoon, the problem had been corrected. The newly available data was then immediately incorporated into the intelligence we provide our clients.

Giving Providers More than Just Access to Data

A key reason we’re able to approach payors with such assertiveness is that After Transparency works exclusively on behalf of providers. We don’t sell our services to payors while simultaneously advising providers on how to negotiate with them. That means we won’t hesitate to point out when we see a payor failing to provide the information providers are entitled to access. 

We can advocate for the transparency these federal regulations were designed to create. We can hold payors accountable because it’s the right thing to do, and because our allegiance is clear.

Providers need data that is complete, current, accurate, and usable. They also need someone paying attention when it isn’t. Behind the scenes, After Transparency is continually monitoring the payor price transparency landscape, identifying problems, working through massive data files, and ensuring our clients have access to what they need. 

This was far from the first time we’ve identified a payor non-compliance issue that needed to be corrected. Nor was it the first time we’ve reached out to CMS and a payor to resolve a problem. Unfortunately, we also know it won’t be the last. Filing CMS complaints on non-compliant payors is just part of a regular week here at After Transparency. This kind of oversight isn’t an occasional effort for our team; it’s an ongoing part of the work we do on behalf of providers.

When we say we’re a CMS watchdog, we mean it! Monitoring payor price transparency data for accuracy is just one of many ways we’re working to help providers negotiate from a position of strength, make well-informed decisions about growth, and steer their operations with the best possible intelligence. 

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Let’s Talk: After Transparency is a Nashville-based analytics firm that decodes federally legislated payor transparency data—transforming massive, complex datasets into precise intelligence. We’re an analytics partner, not a data dump. We work directly with clients to understand their strategic priorities, payor mix, geography, and key codes, then deliver clear, decision-ready insights clients can act on immediately. Book a meeting with us today to learn how we can put payor price transparency data to work for you.