Transparency in Coverage Rule Pertaining to Payer Transparency Machine-readable Files (MRF)
On July 1, 2022, the machine-readable file requirements of the federal government’s Transparency in Coverage Rule will take effect. This rule requires health insurers and group health plans to make publicly available machine-readable files for:
- Negotiated rates for all covered items and services between the plan and in-network providers.
- Historical payments to, and billed charges from, out-of-network providers for covered items and services.
- The pharmacy file requirement has been delayed pending additional guidance.
Beginning July 1, 2022, GHS can access our machine-readable files from this page, by clicking the button below:
The data file in a JSON format. There are many open and free applications available to open a JSON file. HAP is not defining or prescribing any particular one and would recommend working with your IT organization as appropriate.
Do you have a question about what the Transparency in Coverage Rule means to you? Click the button below.
Our Healthcare Cost Estimator Tool for members can be accessed by logging into our member portal. This tool will be enhanced to meet the January 1, 2023, Transparency in Coverage requirements for the 500 shoppable services required under the rule.