Under the Transparency in Coverage Rule, issued in 2020 by the US Departments of Health and Human Services, Labor, and the Treasury, enforced beginning 7/1/22, health plans and health insurers must publish two separate machine-readable files (MRFs) as follows:
- 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 rules require that plans (including clients who sponsor employee benefit plans) post these MRFs on their own public-facing website. However, the regulations allow for a third party to host files on their clients’ behalf.
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and include negotiated service rates and out-of-network allowed amounts between health plans and health care providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.