Carrier Updates Regarding the Transparency in Coverage Rules and Machine Readable Files
The “Transparency in Coverage” final rules passed on October 28, 2020, requires health insurers and group health plans to create machine readable files (MRF) and member friendly cost estimation tools to be phased in throughout 2022, 2023, and 2024. The timeline is as follows:
- July 1, 2022: Requires carriers, TPAs, and PBMs to publish two MRFs on a publicly available website displaying in-network and out-of-network rates for covered services. These files follow CMS guidance and are not meant for consumer-friendly search, but rather for a computer system to do further processing without human intervention.
- January 1, 2023: Plans and payers must make available an online cost estimation tool for 500 “shoppable” services. Employers will be required to post the information or “link” with their plan’s information.
- January 1, 2024: Plans and payers must make available an online cost estimation tool for all covered services.
We have put together a comprehensive resource with the latest updates and communications from our carrier partners. Click here to download the document.
Please reach out to your Cornerstone representative with any questions.
