Transparency Rule – Machine Readable Files
The federal Transparency in Coverage final rule(CMS-9915-F), jointly issued in October 2020 by the Department of Health and Human Services (HHS), the Department of Labor and the Department of the Treasury, contain requirements that have implications for health insurers, health plans, healthcare providers and consumers.
One provision in the measure’s Transparency of Cost Rule requires group (fully insured and self-funded) and individual health plans to post (by July 1, 2022) three publicly available machine-readable files that include:
- The in-network negotiated rates with their providers.
- The historical allowed amounts for out-of-network providers and their billed charges.
- In-network rates and historical net prices for covered prescription drugs.(Note: This requirement is currently delayed by the Centers for Medicare & Medicaid Service.)
- In adherence to the Transparency in Coverage final rule and requirements for Machine-readable files under CMS-9915-F we have provided the following link to satisfy the aforementioned requirements in full compliance.
Under the regulation, health insurance companies and the sponsors of self-funded health plans have the primary responsibility for publishing these files.