On November 12, 2020, the Federal Government issued the Transparency in Coverage (TIC) Final Rule. Under this Rule, group health plans must create and publish machine-readable files (MRFs) that contain detailed pricing information, including:
1. Network negotiated rates for all items and services.
2. Historical payments to, and billed charges from, out-of-network providers.
A machine-readable file (MRF) is a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention. These files follow the Centers for Medicare & Medicaid Services’ (CMS) defined layout and are in the CMS-approved format (JSON). These files are not meant for a consumer-friendly search of rates, benefits, or cost-sharing.
According to the CMS, the primary intent for releasing these cost data files is to provide opportunities for detailed research studies and data analysis, as well as offer third-party developers and innovators the ability to create private-sector solutions to help drive additional price comparison and consumerism in the healthcare market.
Group health plans are required to make these files available to the public from an open-access internet website effective July 1, 2022.
Please follow this link for details: https://developers.humana.com/Cost-Transparency