DirectTrust prices accreditation from three inputs: the applicant's revenue tier, the number of programs and the number of locations. This page sets out the full schedule as DirectTrust's apply page showed it when IHS opened it on October 3, 2026, and then reads it (DirectTrust, Apply, opened October 3, 2026, accreditation.directtrust.org/apply). IHS's DirectTrust HIE accreditation page covers the exchange program and its process and shows only three tiers.
Last reviewed: October 2026.
What DirectTrust publishes and where
Four DirectTrust pages bear on cost, all opened October 3, 2026. The apply page (DirectTrust, Apply, opened October 3, 2026, accreditation.directtrust.org/apply) holds the tables, definitions, location rotation and notes on travel and resubmissions. The fee calculator (DirectTrust, Accreditation Fee Calculator, opened October 3, 2026, directtrust.org/wp-content/uploads/html/calculator2026versionperyear.html) carries DirectTrust's estimate formula. The process page (DirectTrust, The Accreditation Process, opened October 3, 2026, accreditation.directtrust.org/about/accreditation-process) places payment among the steps, and the programs overview (DirectTrust, Programs, opened October 3, 2026, accreditation.directtrust.org/programs/programs-overview) lists the programs. The apply page shows no effective date or version number in its visible text. Its page markup lists a last-modified date of March 2, 2026, and the calculator's file name carries "2026". Verify current fees with DirectTrust.
The fee tables
Revenue-tier fees
| Revenue tier | Annual Fee | Multi-Program Discounted Fee | Assessment Fee | Assessment Fee for Additional Programs | Additional Location Fee |
|---|---|---|---|---|---|
| Under $3M | $3,100 | $1,550 | $5,500 | $1,500 | $3,500 |
| Over $3M, under $8M (includes federal, state and non-profit organizations) | $4,300 | $2,150 | $6,000 | $2,000 | $4,000 |
| Over $8M, under $20M | $8,700 | $4,350 | $9,500 | $2,500 | $4,000 |
| Over $20M, under $50M | $13,500 | $6,750 | $10,000 | $4,000 | $5,000 |
| Over $50M, under $75M | $22,000 | $11,000 | $13,000 | $4,500 | $5,000 |
| Over $75M | $27,500 | $13,750 | $15,000 | $5,000 | $6,000 |
Program-specific fees tied to certain programs
| Revenue tier | Practices Statement Assessment Fee | Add-on Assessment Fee |
|---|---|---|
| Under $3M | $4,000 | $1,000 |
| Over $3M, under $8M | $4,500 | $1,500 |
| Over $8M, under $20M | $5,000 | $1,750 |
| Over $20M, under $50M | $5,000 | $2,500 |
| Over $50M, under $75M | $8,000 | $3,000 |
| Over $75M | $8,000 | $3,500 |
Program rows with their own fees
DirectTrust lists three programs outside the revenue tiers. A note under the table limits the EPCS multi-program rate to a pairing with another EPCS program.
| Program row | Annual Fee | Multi-Program Discounted Fee | Assessment Fee | Additional Location Fee |
|---|---|---|---|---|
| CARIN Code of Conduct | $3,100 | N/A | $2,500 | NA |
| EPCS | $3,500 | $1,750 (see note below) | $4,000 | NA |
| UDAP Client App, Basic | $1,500 | NA | NA | NA |
Location review rotation for lockbox facilities
If a financial organization runs several lockbox sites that work the same way, this table shows how many of them get a review. DirectTrust labels it a guideline, so the count can rise, for instance after an acquisition or when a site is outsourced.
| Locations | Location reviews |
|---|---|
| 1 | 1 |
| 2 to 4 | 2 |
| 5 to 8 | 3 |
| 9 to 13 | 4 |
| 14 to 19 | 5 |
| 20 to 26 | 6 |
| 27 to 34 | 7 |
| 35 to 40 | 8 |
How the fee structure works
Think of the schedule as a yearly charge plus a larger charge every second year. The Annual Fee is billed every year, rises with revenue, and goes with the first program. A second program takes a discounted rate instead of another full Annual Fee, and that rate is due at enrollment and at each biennial renewal. The Assessment Fee prices the first program at the first location. Each extra program and each extra location adds its own fee.
Two columns apply only to certain applicants. The Practices Statement column is charged per Certificate Authority or Identity Provider accreditation, and also to an applicant that is only a Registration Authority. The Add-on column covers each UDAP Client App, UDAP Identity Provider or UDAP Server accreditation layered onto a program that already carries the full Privacy and Security criteria. Both are charged on top of the Assessment Fee.
Off-cycle years carry the Annual Fee and nothing else on the schedule. The other fees (assessment, location, multi-program and program-specific) land in the year an organization goes through accreditation, which comes every second year. On the process page, paying fees is its own step, and it comes before the self-assessment.
What the schedule does not include
- Travel to on-site location reviews, billed to the organization after the reviews take place.
- Rework time. If documents have to go in again after the location review, each further submission costs $250 for every hour the Assessor spends on it.
- Calculator pricing for CARIN Code of Conduct, EPCS and UDAP Client App Basic, which it excludes.
On the process page, a reaccreditation can bring a different price or a different count of in-scope locations than the prior cycle, depending on what the organization discloses.
Reading the schedule
This is arithmetic on the published figures and not a quote or an estimate of any bill. The calculator's formula, written out: on-cycle total = Annual Fee + (programs - 1) x Multi-Program Discounted Fee + Assessment Fee + (programs - 1) x Assessment Fee for Additional Programs + (locations - 1) x Additional Location Fee + any program-specific fees. Off-cycle total = Annual Fee.
For one program at one location, that gives these totals:
| Revenue tier | On-cycle year (one program, one location) | Off-cycle year | Two-year cycle |
|---|---|---|---|
| Under $3M | $8,600 | $3,100 | $11,700 |
| Over $3M, under $8M | $10,300 | $4,300 | $14,600 |
| Over $8M, under $20M | $18,200 | $8,700 | $26,900 |
| Over $20M, under $50M | $23,500 | $13,500 | $37,000 |
| Over $50M, under $75M | $35,000 | $22,000 | $57,000 |
| Over $75M | $42,500 | $27,500 | $70,000 |
Add a second program and a second location at the Over $3M, under $8M tier, and the same formula gives $4,300 + $2,150 + $6,000 + $2,000 + $4,000 = $18,450 for the on-cycle year, and $4,300 off-cycle. Travel, resubmission time and any program-specific fee are extra. The process page also describes an optional Midterm review in the years between, and the apply page prints no fee row for it. For lockbox sites, the apply page charges the location fee per location reviewed while the calculator multiplies it by locations beyond the first, and neither works an example of the rotation table.
Revenue sets the tier, and the process page asks each applicant for a Financial Attestation of that revenue.
Which rows apply to which programs
The apply page names no program beside the revenue-tier columns. Programs appear only in the three program rows, the Practices Statement and Add-on wording, and the lockbox rotation. The programs overview lists 21 programs, among them HIE, HISP, Management Service Organization, Outsourced Services, Health App and Digital Therapeutics, and none of those six has its own fee row. DirectTrust's own pages differ on who pays the Practices Statement fee. The apply page names Certificate Authorities and Identity Providers, plus an applicant that is only a Registration Authority. The calculator's help text names Certificate Authorities and Registration Authorities, while its tooltip and definition name Certificate Authorities and Identity Providers. Ask DirectTrust which rows apply to your program.
Where this fits
The parent, DirectTrust HIE accreditation, covers the exchange program and its process. Other IHS pages cover one program each: HISP, Financial Services and lockbox, identity and trust services, including the UDAP tracks, Management Service Organization, Outsourced Services, e-prescribing and EPCS, and Health App, Digital Therapeutics and CARIN.
What this is not
- It is not a quote or a bill estimate. DirectTrust sets and invoices its fees.
- It is not IHS pricing. IHS does not set or collect DirectTrust's fees. IHS scopes each engagement after a free introductory call.
- It does not say which program or tier fits an organization. DirectTrust decides that.
Frequently asked questions
What does DirectTrust charge every year, and what is added in an assessment year?
The Annual Fee is due from every accredited organization, every year. In the year an organization goes through accreditation, which comes every second year, the schedule adds assessment and location fees, plus multi-program and program-specific fees where they apply. In the years between, nothing else on the schedule is due. Verify current fees with DirectTrust.
Which revenue tier does a non-profit or government organization use?
A footnote on DirectTrust's table places federal, state and non-profit organizations in its Small tier. On the page as opened October 3, 2026, that tier lists a $4,300 Annual Fee and a $6,000 Assessment Fee. Verify current fees with DirectTrust.
Is there a different fee for HIE, HISP, MSO, Outsourced Services or Health App accreditation?
The tables as opened on October 3, 2026 do not list those programs by name. They name only CARIN Code of Conduct, EPCS and UDAP Client App Basic as program rows. Ask DirectTrust which rows apply to the program you are pursuing.
Are travel costs included in the published fees?
No. Travel to location reviews is billed separately after the reviews take place. A self-assessment that has to be resubmitted after the location review adds $250 per hour of Assessor time for each extra submission. Verify current fees with DirectTrust.
How are extra locations counted?
The Assessment Fee covers the first location. Each other location adds an Additional Location Fee, and a location that takes more than one day to review can add it again. For lockbox operations with several like sites, DirectTrust publishes a rotation table as a guideline for how many are reviewed.
Can DirectTrust's fee calculator price every program?
No. The calculator leaves out CARIN Code of Conduct, the EPCS programs and UDAP Client App Basic, and its disclaimer describes the result as approximate. Verify current fees with DirectTrust.
Does IHS set or collect DirectTrust's fees?
No. DirectTrust sets and invoices its own fees, and this page only reorganizes the figures DirectTrust publishes. IHS scopes each engagement after a free introductory call.