Jun 03, 2022
The deadline for Transparency in Coverage Machine-Readable Files is July 1, 2022
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.
With the deadline approaching there are a few things to keep in mind. 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?
For fully insured plans: If the carrier has not already contacted the group, the group will need to connect with the carrier for guidance and instruction.
For 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.
If you have questions about the Transparency in Coverage Rule, Kaiser Permanente has an upcoming webinar on the topic!
Feel free to contact your Amwins Connect Sales Representative for more information.
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