As part of the Transparency in Coverage (TiC) Final Rule, which was finalized on November 12, 2020, clients are required to post and make publicly available the following Machine-Readable Files, no later than July 1, 2022:
1)In-Network Rate File; and
2)Out-of-Network Allowed Amount File
The TiC Final Rule originally required plans to also publish a Prescription Drug File, with a deadline of January 1, 2022. On August 20, 2021, the tri-agencies delayed the deadline for the In-Network and Allowed Amount Files until July 1, 2022, and deferred enforcement of the Prescription Drug File indefinitely.
Plans & Issuers Must Publicly Disclose The Following
•Negotiated rates for in-network providers for each covered item or service.
•Historical allowed amounts and billed charges for covered items or services furnished by out-of-network providers.
•File-specific information as specified in the TiC Final Rule.
•Files must be updated on a monthly basis and must clearly state when they were last updated.
•Files must be accessible to the public, free of charge, and without any requirement that individuals create any sort of account.
Maestro Health’s Response
•Maestro Health is creating an index for the Machine-Readable Files and will provide a link from the Maestrohealth.com home page directly to the data on the mybenefits portal.
•The Machine-Readable Files will be updated as we receive them from our network partners.Each file will be dated to ensure that you are viewing the most recent data.
•If a network partner fails to send the files, they will not be posted,however, to date most networks have agreed to provide this information timely.
•Maestro Health is developing an out-of-network report to post on our clients’ behalf by July 1, 2022.
Maestro MRF Site
Questions? Contact us. | maestrohealth.com