The Transparency in Coverage Final Rules (and related sub-regulatory guidance (see Q&A-1 and 2)) require non-grandfathered group health plans to disclose on a public website information regarding: (1) the in-network provider rates for covered items and services (see “in-network-rates” in filename); and (2) the historical out-of-network allowed amounts and billed charges for covered items and services (see “allowed-amounts” in filename) in two separate machine-readable files (MRFs). The files must, in part, also include plan option/coverage identifier information; billing codes to identify items and services for claims processing; and all applicable rates.
The MRFs for the benefit package options under the Midwest Public Risk Employee Benefits Program. are linked below:
