GOV
Transparency in Coverage
The Transparency in Coverage Rules require certain group health plans to disclose information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services.
The Transparency in Coverage Final Rules require certain group health plans to disclose on a public website information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services in two separate machine readable files (MRFs).
- Federal Register, Transparency in Coverage Final Rule
- Transparency in Coverage Final Rule Fact Sheet
A machine readable file is a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention.
These files follow the Centers for Medicare & Medicaid Services (CMS) defined layout and are in the CMS approved format (JSON) and are not meant for a consumer-friendly search of rates, benefits, or cost sharing. Please refer to the member resources available through anthem.com for this information.
Plans and issuers will display these data files in a standardized format and will provide monthly updates. This data will provide opportunities for detailed research studies, data analysis, and offer third party developers and innovators the ability to create private sector solutions to help drive additional price comparison and consumerism in the health care market. These files are required to be made public for plan years that begin on or after January 1, 2022.
When using the search option, the page linked above will display links to several files, including:
- In-Network Negotiated Rate Files
- Out-of-Network Allowed Amount Files
- Blue Cross Blue Shield Association Out of Area Rate Files (applicable when members use providers in non-Anthem states.)
