CMS Just Raised the Bar on Price Transparency. Hyve Is Ready.
The new CMS rule raises the bar on accuracy and accountability. Here’s what hospitals need to know, and how Hyve helps organizations get ready fast.
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CMS Just Raised the Bar on Price Transparency. Hyve Is Ready.
The Centers for Medicare & Medicaid Services (CMS) has released the CY 2026 OPPS and Ambulatory Surgical Center Final Rule, and it marks one of the biggest shifts in hospital price transparency since the policy began. Enforcement starts April 1, 2026, and the message is clear: transparency is moving from estimated data to verified, claims-based reality.
For hospitals, this introduces new work, new expectations, and new accountability.
For Hyve, it aligns with what we have been building toward from day one.
The Rule Brings Transparency Into a New Era
CMS is asking hospitals to ground their public disclosures in actual payment experience. Hospitals must now calculate:
- Median allowed amounts
- 10th percentile allowed amounts
- 90th percentile allowed amounts
- Counts of allowed amounts for payers whose negotiated charges are based on percentages or algorithms
These calculations must be based on 12 to 15 months of remittance history from EDI 835 ERA or equivalent data sources, providing unprecedented insight into actual healthcare costs.
CMS also raised expectations around accuracy and alignment:
- A senior executive must now attest to the accuracy and completeness of these public files
- Hospitals must include organizational NPIs in their machine-readable files
- Multi-percentile pricing will give patients, payers, and policymakers a clearer picture of actual healthcare costs
This moves transparency away from approximations and toward real-world numbers.
Some Vendors Will Need to Adapt. Hyve Is Already Built for This.
The shift to claims-based reporting is significant. Many vendors in the transparency space do not work deeply with 835 or 837 data today. The Final Rule now requires hospitals to calculate percentile-based payment values directly from remittance history. That means large-scale ingestion, normalization, and analysis of claims and remits.
Hyve has operated this way from the very beginning.
Whether a hospital uses Hyve Insight or Vitality Payer Scorecard, we already hold the raw 835 and 837 files CMS now requires. Our customers are not starting from scratch. Their foundational data is already in place, already standardized, and already flowing through our platform.
And the scale behind that platform is real. Today, Hyve has processed:
- More than 779 million individual claims
- Over 1 billion individual remits
- More than 598,000 mapped payers
These numbers reflect the operational maturity needed to support hospitals through this regulatory shift.
A Tight Timeline, But A Real Opportunity
Although the rule takes effect January 1, 2026, CMS will begin enforcement on April 1, 2026. Guidance will continue to evolve, but the expectations are clear now: hospitals must validate their claims data, prepare accurate calculations, and publish updated disclosures with confidence.
Hospitals that start early avoid rushed timelines and reduce compliance risk. They also strengthen trust by sharing accurate, meaningful price information with the communities they serve.
Hyve Helps Hospitals Step Into This Change With Confidence
Price transparency has grown from a compliance requirement into a strategic priority. The 2026 Final Rule reinforces what many leaders already know: clarity matters, accuracy matters, and real claims data is the path forward.
Hyve’s foundation in 835 and 837 data means our customers are already ahead. And for hospitals preparing for the new rule, we are here to guide every step — from data readiness to confident compliance.
Call us. Let’s get you ready.
Hyve Health is already powering price transparency for more than 1000 hospitals, and we are just getting started. We help organizations navigate complex requirements with clarity and confidence, turning detailed regulatory expectations into a simple experience your team can trust.
If you are already using Vitality Payer Scorecard, your transition to Hyve Health is straightforward and efficient. Most customers go live in a matter of weeks. And if you are new to Hyve, you are not adopting a tool. You are choosing a partner built on real claims data, proven operational scale, and a commitment to keeping you ready for whatever CMS does next.
If you want to move forward with clarity, reach out. We are here to help you strengthen your compliance performance and stay ahead of every regulatory shift.