Employer Direct Contracts Machine Readable Files
Last updated: 10/4/2024 3:49:56 PM
- CUSTOM NETWORK_341240178.zip
- CUSTOM NETWORK_550477361.zip
- CUSTOM NETWORK_341613103.zip
- CUSTOM NETWORK_132799255.zip
- CUSTOM NETWORK_871230291.zip
- CUSTOM NETWORK_436003377.zip
- CUSTOM NETWORK_431741457.zip
- CUSTOM NETWORK_756001727.zip
- CUSTOM NETWORK B_460563027.zip
- CUSTOM NETWORK A_460563027.zip
- CUSTOM NETWORK_750383870.zip
- CUSTOM NETWORK_556000526.zip
- CUSTOM NETWORK_550629032.zip
- CUSTOM NETWORK_260212001.zip
- CUSTOM NETWORK_311144772.zip
- CUSTOM NETWORK_351741803.zip
- CUSTOM NETWORK_340905407.zip
In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524), The Health Plan has made public the In-Network rate file and Out-of-Network Allowed file, as defined by CMS, in a machine-readable file format (MRF). “Machine-readable” is a digital representation of data or information in a file that can be imported into or read by a computer system for further processing. The MRFs below, listed by network, provide the negotiated rates with in-network providers and the historical billed charges and allowed amounts for out-of-network providers. Actual provider charges and actual member cost sharing may vary depending upon, for instance, a member’s healthcare needs, treatments received, and specific terms of a member’s plan, including deductible, co-payment and co-insurance.
To view or download a MRF:
Locate the Network for your plan
Click the link associated with your Network
MRFs can be very large files. The amount of time required to download will depend on a variety of factors, including your home internet speed, browser, and computer hardware.
These MRFs are published as required by the Transparency in Coverage Final Rule. They are compressed and the data is published in a standardized format – e.g., native json – in compliance with the regulatory requirements.
For questions related to MRFs, please email: mrf@healthplan.org
For additional information about the No Surprises Act and Price Transparency in Coverage Rule please click this link to be taken to the CMS (Centers for Medicare and Medicare Services) webiste https://www.cms.gov/nosurprises/consumers/new-protections-for-you