01 — HOSPITAL PRICE TRANSPARENCY · 45 CFR PART 180

Your percentile allowed amounts don't live in your chargemaster.

Since 1 January 2026, every hospital machine-readable file must carry the median, 10th percentile and 90th percentile allowed amounts — plus the count behind each — for every item, service and payer plan. CMS requires those figures be computed from EDI 835 remittance data over a 12–15 month lookback. That is a claims-data job, not a pricing export, which is why an EHR pricing module cannot produce it. We build that piece. Three to six weeks, fixed fee.

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CMS began enforcing the CY2026 requirements on 1 April 2026 and has issued more than 1,200 noncompliance warning letters to date.

Six new obligations. Three of them need a data pipeline.

The CY2026 OPPS/ASC final rule retired the old "estimated allowed amount" and the old affirmation statement, and replaced them with the following.

Required element	Where it comes from
Median allowed amounthard	EDI 835 remittance advice, 12–15 month lookback
10th & 90th percentile allowed amountshard	Same source. Ties round to the next highest observed value
Count of allowed amountshard	Must accompany every median and percentile figure
Percentage & algorithm rates in dollars	"120% of Medicare" must also carry the actual dollar figure
Organizational Type 2 NPI	General data elements — administrative
Attestation + named senior official	General data elements — administrative

Required element

Where it comes from

Median allowed amounthard

EDI 835 remittance advice, 12–15 month lookback

10th & 90th percentile allowed amountshard

Same source. Ties round to the next highest observed value

Count of allowed amountshard

Must accompany every median and percentile figure

Percentage & algorithm rates in dollars

"120% of Medicare" must also carry the actual dollar figure

Organizational Type 2 NPI

General data elements — administrative

Attestation + named senior official

General data elements — administrative

The first three require joining a year of remittance data to chargemaster codes and payer plans, then computing a distribution per code per plan across millions of lines. Most hospitals never had a reason to build that — and many vendors kept generating on the pre-2026 schema, which still produces a valid-looking file.

Three to six weeks, start to conforming file.

01 — Week 1

Audit and data map

We test your published file against every CY2026 element and show exactly what's missing, with the CFR citation for each. Then we map where your 835s actually live — clearinghouse, revenue cycle system, or archive.

02 — Weeks 2–4

Build the pipeline

Extract the remittance history, normalize it, join to chargemaster and plan, and compute the median, percentiles and counts per code per plan — applying the next-highest rule CMS specifies for values falling between two observations.

03 — Weeks 4–6

Emit, validate, attest

Generate the conforming file in your chosen CMS template, validate against the CMS tool, fix the naming convention and cms-hpt.txt marker, and hand back the attestation package ready for signature.

The pipeline is yours. We document it and hand it over, so the quarterly refresh is a re-run rather than a re-build. If you would rather we ran it, we do that too.

Published, because it would be strange not to.

Free

File audit

Every CY2026 element tested against your published file, with evidence and citations. No commitment, no call required. We send the report and leave you alone.

$6,500

Audit + remediation plan

The full analysis plus a written plan: which 835 sources you need, what shape they are in, what the build involves, and a fixed quote for it.

$18k–$32k fixed

Full remediation

Pipeline built, conforming file generated and validated, attestation package delivered. Range depends on payer count and how your remittance data is stored. Quarterly refresh from $1,800/month.

We'll test your file and send you what we find.

Give us your hospital's website and we run the full CY2026 check — every element, with the evidence and the citation behind each finding. You will be able to verify every line against your own site in about two minutes. If your file is already compliant, we tell you that and go away.

Got it.

We'll run the check and send your report within two business days.

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Why we do it free

The audit is automated. It costs us almost nothing to run and it is the honest way to start a conversation — you can check every finding against your own website before you ever talk to us.

Prefer email?

Reach us directly:

hello@capyboost.com