Colorado Division of Insurance to Enforce Federal and State Transparency in Coverage Rules

Thursday, December 18, 2025

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Colorado Division of Insurance to Enforce Federal and State Transparency in Coverage Rules

State-required Transparency in Coverage data submissions now available for review

DENVER - Today, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), announced that it was granted enforcement authority over federal Transparency in Coverage (TiC) requirements by the Center for Consumer Information and Insurance Oversight within the Department of Health and Human Services. The move comes after Governor Polis and Commissioner Conway announced that Colorado became the first state in the country to successfully collect state-specific federal TiC data in August.

“We appreciate the federal government entrusting Colorado to review compliance of both federal and state Transparency in Coverage data submissions,” said Colorado Insurance Commissioner Michael Conway. “At the end of the day, we all want data that consumers and policymakers can ultimately use to make more informed health care decisions.”

Colorado being granted enforcement authority means that the federal government is allowing Colorado DOI to monitor whether carriers are meeting state and federal TiC data rules, and to issue penalties, fines, and other enforcement actions on carriers who are not compliant.

“Based on the survey response and CMS communications with the Colorado Division of Insurance staff, CMS understands that Colorado has the authority and intention to enforce section 2715A of the PHS Act and implementing regulations at 45 CFR 147.211 and 147.212 and the applicable definitions at 45 CFR 147.210 regarding price comparison tools and machine-readable files, and therefore will generally defer to Colorado,” the letter from the Center for Consumer Information and Insurance Oversight read, in part.

Federal Transparency in Coverage standards went into effect in 2022, requiring health insurance carriers to report on their websites the underlying negotiated rates for all health care services and items, including prescription drugs, as well as three separate machine-readable files that include detailed pricing information.

In 2024, the Colorado General Assembly passed SB24-080, which strengthens the federal rules and improves data collection for Colorado in three main ways:

• It requires Colorado-specific information
• It requires carriers to limit the files based on what codes providers actually use in an attempt to remove “ghost codes.” A ghost-code is when there is a medical billing code for a service or procedure that was likely never actually performed. For example, data showing that a podiatrist delivered a baby
• It requires that carriers provide price information for the most frequently used prescription drugs on their plans Colorado TiC data was first collected from carriers in August. The data can be viewed on DOI’s TiC webpage.

The next round of Colorado TiC data is due from carriers on January 1, 2026.

DOI is continuing to look to information-share with researchers who may be interested in using this data for their academic pursuits that would help Coloradans better understand the data. Interested researchers should email dorainsdata@state.co.us.

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