Transparency in Coverage

What this is

The federal Transparency in Coverage rule requires non-grandfathered group health plans and health insurance issuers to publish machine-readable files (MRFs) that disclose pricing information to the public. The files must be freely accessible, without a login, gateway, or any personal information.

What the files contain

• In-network rate file: negotiated rates for covered items and services between the plan and in-network providers.
• Allowed amount file: historical out-of-network allowed amounts and billed charges for covered items and services.

These files are formatted to a federal technical standard for use by researchers, regulators, and application developers. They are large and are not intended to be read directly by members. If you are a member looking for what a specific service will cost you, please contact us instead and we will help.

Access the machine-readable files

[ADD MACHINE-READABLE FILE INDEX URL]

The public link to the machine-readable file index has not been added yet. Set legal.mrfUrl in lib/site.ts once the plan, carrier, or network partner provides the URL, and this section will link to it automatically.

Which plans this applies to

Applicability depends on the type of plan. The requirement generally applies to non-grandfathered group health plans. Responsibility for publishing the files may rest with the plan, its issuer, or a third party acting on the plan's behalf, depending on the arrangement in place. If you administer a plan with Bedrock and are unsure which files apply to you, contact us and we will point you to the right location.

Questions

[LEGAL ENTITY NAME, e.g. Bedrock TPA, LLC]
Email: info@bedrock-tpa.com
Phone: 424-835-1391

This page is provided for informational purposes and is not legal advice. Confirm with counsel or your compliance advisor which Transparency in Coverage obligations apply to each plan and who is responsible for posting the files.