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June 28, 2022

A key provision of the Transparency in Coverage Rule requires health insurers and group health plans to post publicly available machine-readable files (MRFs) of all provider payment information. The MRFs must include in-network (INN) negotiated payment rates based on every provider agreement in force, including INN and extended networks (such as the Blues network) for each group, plan and network offering; and historical out-of-network (OON) reimbursement rates for covered items and services. The MRF data must be updated monthly and made publicly available.

We’re implementing access to Regence MRFs in accordance with the July 1, 2022, deadline. Beginning July 1, users will be able to access the MRF landing page below by clicking on the Transparency in Coverage link at the bottom of every public-facing page on regence.com. Please note that the Transparency in Coverage final rules also require ASOs to provide a link to the MRFs on their own websites. Here is a copy of the link for that purpose: https://www.regence.com/transparency-in-coverage/. Additionally, ASOs may want to consider including a statement near the link similar to the following:

“Machine-readable files are provided in support of the federal Transparency in Coverage Rule and contain in-network negotiated rates and out-of-network allowed amounts.”

Users can search for MRFs by Employer Identification Number (EIN) or Health Insurance Oversight System ID (HIOS-id). When users input their EIN or HIOS-id, the system will generate an MRF matching their search query, which they can download.

Because the MRFs are intended to be used for data aggregation and research purposes, the data will appear like lines of computer code text, and additional coding will be required to make them user friendly. In addition, only medical plans covered under the TIC Rule are included in the MRFs. If a file request by EIN or HIOS-id is out of scope, no search results will be shown. Users can consult the CMS rule for details on which plans are within scope.

For more information and a detailed list of frequently asked questions, please visit. www.regence.com/employer/resources/caa-tic-rule.