TRANSPARENCY IN COVERAGE RULE

Updated: July 8, 2022

In accordance with the Transparency in Coverage Rule, health plans and insurers are required to provide Machine-Readable Files (MRFs) in a location that is publicly available and accessible to all without authentication.

What are in the Machine-Readable Files?

Plans and insurers must provide public disclosure also known as machine readable files of (1) applicable rates with in-network providers (including negotiated rates); (2) charges and allowed amounts a plan or insurer has historically paid for covered items or services furnished by out-of-network providers (including prescription drugs); and (3) negotiated rates and historical net prices for prescription drugs furnished by in-network providers. These files are provided by us, your TPA. 

While these files are accessible to all, the files are large, written in JSON, which is a machine-readable language, and not easily interpreted or searchable. These files are made available on our main website at www.anchorbenefit.com under the Compliance, Transparency in Coverage menu.

Files are updated monthly in accordance with requirements. 

Action to be Taken:

Employers with self-funded plans must post a link to these MRF files via their publicly available website. It cannot be password protected or difficult to locate. As awkward as it may be, plan sponsors may post the link on their careers/recruiting website, as that seems to be the most logical place (as opposed to posting the link on the plan sponsor’s commercial/business website). 

Be sure to share this information with your organization’s team responsible for placing these links on a publicly accessible site. You may want to add the following language when you post the link on your site: 

Through Anchor Benefit Consulting, Inc., machine-readable files are created and published on behalf of the [plan sponsor name employee benefit plan]. To link to the Machine-Readable Files, Please Click Here and then scroll down and click on the appropriate file link. 

Important: Please note that the Transparency in Coverage regulation requires self-funded employers to publish the link on a public site. Therefore, if a self-funded group does not have a publicly available website, we would recommend you discuss your options with your legal counsel. Anchor Benefit does not provide legal advice.