Transparency in Coverage: Machine-Readable Files
In late 2020, federal agencies responsible for overseeing the implementation of the Affordable Care Act (ACA)—the Departments of Labor, Health and Human Services (HHS) and Treasury (the Departments)—issued the Transparency in Coverage (TiC) rule. The rule requires insurers and self-funded plans to post the following machine-readable files (MRF) to a publicly available website:
- In-Network Rate File: Applicable in-network provider rates, including negotiated rates, derived amounts, and underlying fee schedule rates for all covered items.
- Out-of-Network Rate File: Historical data outlining the different billed charges and allowed amounts a plan or issuer has paid for covered items or services, including prescription drugs, furnished by out-of-network providers (minimum of 20 entries).
A machine-readable file is a digital representation of data that can be imported or read by a computer system without human intervention. Data in these files must be in the JSON file format and updated monthly. For more information, click here or click the following link: https://individual.carefirst.com/individuals-families/mandates-policies/machine-readable-file.page.