Transparency in Coverage

As part of the Consolidated Appropriations Act (CAA), new Transparency in Coverage rules have been established by the Centers for Medicare & Medicaid Services (CMS), including a multi-year initiative that requires health plans to share contracted prices for all health care items and services. 

To comply with the Transparency in Coverage rule, Excellus BlueCross BlueShield (BCBS) has provided a link where the following information will be available:

  • In-network provider contracted rates for items and services
  • Out-of-network allowed amounts and billed charges for items and services

The rates are for commercial products only and for plan/policy years beginning on or after January 1, 2022. At this time, rates are for medical items and services only and will not include pharmacy costs.

Machine-readable files are designed for a machine (i.e., computer) to read and will not be user-friendly for members.
The best user experience for Excellus BCBS members will be to login to their online account to access our cost estimation tool.

Transparency in Coverage Machine-Readable Files