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The Transparency in Coverage Final Rules require health insurance issuers and plans to disclose detailed pricing information on a public website. The three machine-readable files (MRFs) that must be posted include:
- In-Network Rate File: In-network provider negotiated rates for covered services and items.
- Allowed Amount File: Historical payments to and billed charges from out-of-network providers.
- Prescription Drug File: In-network negotiated rates and historical net prices for covered prescription drugs. This MRF requirement is delayed until further notice.
The MRF requirements were supposed to go into effect for plan years beginning on or after January 1, 2022, but now the first two requirements will be enforced starting July 1, 2022.
For 2022 plan years beginning after July 1, 2022, MRFs must be posted in the month in which the plan year begins (for example, September 1, 2022, for a plan year that is from September 1st to August 31st).
Employers should confirm that written agreements addressing MRFs are in place with their carriers and TPAs and that these files will be available by the applicable deadline.
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