Employer Direct Contracts Machine Readable Files

Last updated: 11/5/2024 11:24:48 AM

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