Federal Transparency In Coverage Rule
Under the “Transparency in Coverage” Final Rule (TiC), issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor, and U.S. Department of the Treasury, effective 7/1/22, health plans (which include employers who sponsor employee benefit plans) and health insurance issuers must publicly post pricing data known as the “machine-readable files” or (“MRFs”). In the name of health cost transparency, this rule requires insurance companies and self-insured plans to publicize what they pay providers for medical services and make that available to the public.
One of the requirements is that the data must be made available on a publicly available website. The TiC rules require the group health plan to post links to the machine-readable files containing the TiC pricing information.
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.