Health Plan Sponsors Publishing Machine-Readable Files
The Affordable Care Act contains numerous provisions requiring medical care and services to be delivered more transparently. The Transparency in Coverage (TiC) rules specifically target public disclosure of plan costs, including in-network and out-of-network pricing data. The TiC rules require plans to disclose in-network provider negotiated rates, historical out-of-network allowed amounts for providers, and in-network negotiated rates and historical net prices for all covered prescriptions.
A plan must disclose information via a website in a standardized MRF as follows:
- In-Network Rate File. The in-network rate file must show negotiated rates for all covered items and services between the plan and in-network providers.
- Allowed Amount File. The allowed amount file must show both the historical payments to, and billed charges from, out-of-network providers.
Down East Community Hospital
Calais Community Hospital
Health Plan Files: