What is the Transparency in Coverage Rule?
The Transparency in Coverage Rule was issued in 2020 by the U.S Department of Health & Human Services, Department of Labor, and Department of the Treasury and enforced beginning 7/1/22. It requires health plans, (which includes employers who sponsor employee benefits plans) and health insurance issuers to publish two separate machine readable files (MRFs) as follows:
- 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.
To meet this requirement, MRFs are posted on https://www.cigna.com/legal/compliance/machine-readable-files. 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.
