CRITICAL INFORMATION ABOUT TRANSPARENCY IN COVERAGE
Under 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 Treasury and enforced beginning 7/1/2022, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate MRFs (Machine-Readable Files).
- 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 TRANSPARENCY IN COVERAGE RULE
This link leads to the machine-readable files 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 machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
If you have any questions or comments about The Transparency in Coverage Rule, you can contact us at:
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Last Edited on 2022-06-03