Blue Cross Blue Shield/ Blue Choice Health Plan
These files will be accessible through our public websites (i.e., www.SouthCarolinaBlues.com and www.BlueChoiceSC.com). We will publish the direct URL in June. Plan sponsors may link to those files as desired.
UHC/ All Savers
Machine-readable files required on public websites by July 1, 2022, for Transparency in Coverage
- The government requirement applies to plan years beginning on or after Jan. 1, 2022, with an enforcement date of July 1, 2022.*
- Insurers and self-funded plans must publicly post the files by July 1, 2022, which include detailed pricing data for all covered items and services via 3 MRFs. It’s important to note that the third file is delayed pending additional guidance and is not required at this time. The 3 MRFs include:
- In-network negotiated payment rates
- Historical out-of-network allowed amounts
- In-network rates and historical costs for prescription drugs (delayed pending guidance)
- Data in these files must be in the JSON file format and must be updated monthly. Posting Excel documents, PDFs or other non-MRFs are not permitted.
- When are the machine-readable files required to be available? Update 5/11/22 These files are required to be made public for plan years that begin on or after July 1, 2022. The public link to the file is now available but the machine-readable files will not be loaded until July 1, 2022, and then updated monthly. The link is https://transparency-in-coverage.uhc.com/ and will be updated monthly by the first of each month. At this time some fully insured examples are loaded just so self-funded customers can check to see the link is working and prepare to post by July 1 on their own public website. No action or posted is required for fully insured groups.
UnitedHealthcare is committed to Transparency in Coverage Rule compliance by making MRFs available for all UnitedHealthcare commercial platforms, pricing structures and plan designs at the appropriate time. UnitedHealthcare is also committed to helping self-funded customers comply with this new rule and will create and publish MRFs where UnitedHealthcare has access to the data, including integrated customer-specific provider contracting arrangements (GSP, CSP). MRFs will be posted on transparency-in-coverage.uhc.com. For up-to-date details and FAQs about Transparency in Coverage Rule compliance, as well as a link to a dedicated UnitedHealthcare Transparency in Coverage website, visit this page.
- Self-funded customers who opt to suppress files from the public UnitedHealthcare MRF website and post to their own public website may access the MRFs from a dedicated website monthly. The website requires authentication. Please notify your UnitedHealthcare representative by May 15, 2022, if this is your intention. Your UnitedHealthcare representative will provide detailed instructions so the self-funded customer may extract and post the files publicly and update them monthly.
- UnitedHealthcare does not support direct customer-specific provider contracting arrangements where claims are not paid by UnitedHealthcare, nor does UnitedHealthcare accept or provide raw data.
Transparency in Coverage Rule – Machine-Readable Files
- In-Network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers
- Out of Network: Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period
- On 5/16/22, Cigna clients will receive communications that provide the link to the MRFs and the actions they need to take to be compliant under the rule.
- The actual link and recommended verbiage they should include with the link are below. This link will be live as of 7/1/2022, but can be posted on their public websites prior to 7/1/22. Files will also be available on Cignaforemployers.com on or before 6/1/22.
To meet regulatory requirements, Cigna recommends that clients keep the following in mind:
- On or before 7/1/22, most clients will need to copy the link below and post it somewhere on their public website to provide access to the MRFs. The link is https://www.cigna.com/legal/compliance/machine-readable-files.
- Note that prior to 7/1/22, this link will take you to the home page of Cigna.com, but will access the MRFs page after that date.
- Clients can determine where on their public website they want to place this link.
- Per the regulation, anyone in the United States should be able to find this link somewhere on their website without any requirement such as a password, a fee or an age restriction.
- Along with the link, we are asking clients to include the following recommended overview verbiage:
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 more easily access and analyze data.
- Clients need only follow this process once to establish the link. Cigna will update the files each month and the link will remain constant and always access the most up-to-date files.
- For clients who previously indicated that they do not have a public website or clients with client-specific networks, we will communicate the URL of the websites that Cigna has created.
- For clients who have “opted out” of Cigna’s standard hosting services by choosing to host their own files or having a third party host them, we are supplying detailed instructions for how to access the files directly from Cignaforemployers.com.
For more information, visit Cigna Consultant Access to log in or register for the portal. On the portal you can:
- Find links to all of the communications that will be sent to your clients on 5/16/22
- Review the file system requirements and recommendations
Click here to contact Cigna Consultant Access Website Support with any questions you may have during your registration.
We will post the required data on Aetna.com by July 1, 2022.