Pursuant to Centers for Medicare and Medicaid Services (CMS) Transparency in Coverage (TiC) Rule, health insurers and group health plans must create an online tool (Machine-Readable Files or MRFs) that provides members with detailed pricing and cost-share estimates for covered services and items. One of the primary goals of the release of these data files is to provide more transparency across the industry. It is seen as a step toward putting health care price information in the hands of consumers and other stakeholders in an effort to promote more informed health care decisions.
There are three (3) types of MRFs:
|
File Type
|
Medical
|
Behavioral Health
|
Pharmacy
|
|
Negotiated rates for all covered items and services
|
x
|
x
|
|
|
Historical payments to and billed charges from out-of-network providers
|
x
|
x
|
|
|
In-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy location level.
|
|
|
x
|
Currently, MRFs are available for the Medical (Medical and Surgical) and Behavioral Health (Mental Health and Substance Use Disorder) plans. These files are updated monthly.
More Information for the Franklin County Cooperative Plans in the MRFs
Medical (Medical or Surgical)
- For Medical and Surgical services, click on this link: Transparency-in-Coverage.UHC.com.
- Select Ctrl-F on your keyboard to bring up a search bar.
- Type in Franklin County and the associated MRFs will appear.
Example file name: 2022-07-01_customer name_Choice-Plus_in-network-rates.json. Multiple files may appear. Select the files with the Franklin County Cooperative name and the information and area of interests (network rates, allowed amounts, etc.).
Behavioral Health (Mental Health and Substance Use Disorder)
- For Mental Health and Substance Use Disorder (MH/SUD) services, click on this link: Transparency in Coverage (optum.com)
- Select Ctrl-F on your keyboard to bring up a search bar.
- Type in Franklin County and the associated MRFs will appear.
Example file name: 2022-07-01_customer name_Choice-Plus_in-network-rates.json. Multiple files may appear. Select the files with the Franklin County Cooperative name and the information and areas of interest (network rates, allowed amounts, etc.).