MediExcel Transparency in Coverage: Machine-Readable Files

Beginning July 1st, 2022, the Transparency in Coverage Rules (TIC Rules) requires group health plans and health insurance issuers to make available to the public, negotiated rates for all covered items with in-network providers, and historical payments to and billed charges from, out-of-network providers, through machine-readable files (MRFs) posted on their internet website, updated monthly.

To ensure data integrity, all files must conform to a non-proprietary, open standard format and be encrypted for security. MediExcel Health Plan will publish its machine-readable files in the JSON format to its website on or around the first day of every month.

Files include:

• In-Network: negotiated rates for all covered items and services between the plan or issuer and in-network providers.
• Out-of-Network: allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period.

Employer groups can obtain the relevant language and links to the files in MediExcel's Transparency in Coverage flyer, and posting the information on their own public website to satisfy the TIC requirements.

*Note: prior to 7/1/22, the MRFs may not be accessible.

For questions about this requirement, please contact our Compliance Officer Jim Arriola at jarriola@mediexcel.com.