Our carrier partners have shared their new dedicated websites for Machine-Readable Files (MRFs). Please note that most MRF links below will either not be available, or may not be fully loaded with all required files, until the required deadline of July 1, 2022.
Customers who have opted out of having their files published to the public website must retrieve their files from a dedicated private website (One Healthcare ID login required).
Western Health Advantage
What is the Machine-Readable Files Requirement?
The Transparency in Coverage (TiC) rule is part of the federal transparency efforts that require insurers and group health plans to provide new information detailing provider reimbursement rates.
Carriers and health plans must make a data file publicly available that provides detailed data on plan reimbursement rates for different providers. Plans must also provide an advanced estimate of the cost to participants for covered medical services covered by the plan.
There are 3 specific files that are required to be made public:
The In-Network Rate File: all applicable rates paid to in-network providers for all covered items and services, including negotiated rates, and underlying fee schedules.
The Allowed Amount File: billed charges and allowed amounts for covered items and services provided by out-of-network providers.
The Prescription Drug File: negotiated rates and historical prices for prescription drugs furnished by in-network providers. – This file has been delayed indefinitely.
What action is needed?
Fully insured plans: If the employer has not already, they will need to connect with their insurer for guidance and instruction. It is recommended to follow the guidance of the carrier.
Self-insured plans: Employers need to connect with their TPA to ensure that there is an available link provided for the files, so that the employer can post them on their public website.
What is the Purpose of the files?
The purpose of these files is not meant for group members, and they are not member-friendly. The machine-readable files are formatted to specifically allow researchers, regulators, and application developers to more easily access and analyze data. Member friendly tools and resources will be provided at a later time.
At this time it is not required for the group health plan to notify its participants of the availability of these files.