Transparency in Coverage Machine-Readable Files

In compliance with The Transparency in Coverage Rule, issued in 2020 and effective July 1, 2022, health plans and health insurance issuers must publish two Machine-Readable Files (MRFs) containing In-Network and Out-Of-Network details. Planstin Administration is pleased to provide the following information to participants.

 

The Transparency in Coverage Rule requires most health insurance issuers and group health plans to disclose pricing and cost-sharing information to participants, enrollees, and beneficiaries. Pricing information includes billed charges, negotiated rates, allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs using two Machine-Readable Files (MRFs).

 

The MRFs are formatted to allow researchers, participants, regulators, and application developers to access and analyze data easily.

• 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

We are happy to continue to be part of the healthcare evolution, and happy to answer any questions you have regarding our MRFs.

Transparency in Coverage Machine-Readable Files

In compliance with The Transparency in Coverage Rule, issued in 2020 and effective July 1, 2022, health plans and health insurance issuers must publish two Machine-Readable Files (MRFs) containing In-Network and Out-Of-Network details. Planstin Administration is pleased to provide the following information to participants.

 

The Transparency in Coverage Rule requires most health insurance issuers and group health plans to disclose pricing and cost-sharing information to participants, enrollees, and beneficiaries. Pricing information includes billed charges, negotiated rates, allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs using two Machine-Readable Files (MRFs).

 

The MRFs are formatted to allow researchers, participants, regulators, and application developers to access and analyze data easily.

• 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

We are happy to continue to be part of the healthcare evolution, and happy to answer any questions you have regarding our MRFs.