Critical Information about Transparency in Coverage
The Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor, and U.S. Department of the Treasury and enforced beginning 7/1/22, health plans (which include clients who sponsor employee benefit plans) and health insurance issuers must publish two separate Machine-Readable Files (MRFs) :
•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
The below link leads to the MRFs that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The MRFs are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.