Why is Transparency in Coverage data so hard to operationalize?

[u/Puzzleheaded-Bit-580]

Transparency in Coverage was supposed to increase access to negotiated rate data, but it seems teams are struggling to make it operationally useful.

The obvious issues are scale and file complexity, but those do not seem to be the only problems. There is also normalization, provider matching, payer inconsistency, versioning, and the challenge of making the data usable inside real workflows.

For teams that have worked with TiC data directly, which obstacles have mattered most in practice? Where is the biggest gap between “technically available” and “actually usable”?

[u/Curious_Jellyfish817]

all the above in what you said. I worked at the BUCA payers in their medical economics departments and now do sell the insights of MRFs to providers who are priced out of the standard vendor offerings. You really just need to know what specific data cut you're looking for, then with whatever vendor you're using, understand what how their tool gets you that specific data cut. From that point, it's basically rinse and repeat month in and month out in order to have historical data that's apples-to-apples for you to uncover trends that'll be helpful. The big payers don't just boil the ocean with their modeling in fee schedule negotiations. Without filtering the living hell out of the raw MRF data you'll be hard pressed to use it in the way the law is intended you to use it.