Client Alert: Transparency in Coverage Rule
In accordance with the Transparency in Coverage Rule, health plans and insurers are required to provide Machine-Readable Files (MRFs) in a location that is publicly available and accessible to all without authentication.
What are in the Machine-Readable Files?
Plans and insurers must provide public disclosure also known as machine readable files of (1) applicable rates with in-network providers (including negotiated rates); (2) charges and allowed amounts a plan or insurer has historically paid for covered items or services furnished by out-of-network providers (including prescription drugs); and (3) negotiated rates and historical net prices for prescription drugs furnished by in-network providers. These files are provided by us, your TPA.
While these files are accessible to all, the files are large, written in JSON, which is a machine-readable language, and not easily interpreted or searchable. These files are made available on our main website at: https://www.anchorbenefit.com/ under the Compliance, Transparency in Coverage menu. Files are updated monthly in accordance with requirements.
Through Anchor Benefit Consulting, Inc., machine-readable files are created and published on behalf of Technical Maintenance, Inc.