Machine Readable Files
What exactly is the Transparency in Coverage – Public Access Requirement?
The Public Access Requirement is the first of three specific requirements that must be implemented. Group health plans and issuers must make three separate machine-readable files (MRF) publicly available, free of charge by the enforcement deadline of July 1, 2022. The files must be updated monthly and include the following detailed pricing information:
- In network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers.
- Out of network: Historical payments to, and billed charges from, out-of-network providers. Files are not required if there are fewer than 20 claims for a service for a provider.
- Prescription drugs: In-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy location level (this requirement is delayed pending further rulemaking).
Purpose of the machine-readable files (MRF)
- To provide raw data in a specific format that can be read by machines without requiring manipulation or other human intervention.
- They are not intended to be user friendly or easily understood by the average consumer; however, they are an intermediate step that lays the groundwork for a consumer-facing experience, powered by this data, to inform your employees’ decision making.