Health Plan Price Transparency

Transparency in Coverage: Machine-Readable Files

Federal law (the Transparency in Coverage rule issued pursuant to the Affordable Care Act) requires that certain group health plans and health insurance issuers make certain pricing information publicly available via “machine-readable files” (MRFs). The information relates to in-network provider-negotiated rates and historical out-of-network allowed amounts and billed charges.

The link below leads to the MRFs that are made available in response to the federal Transparency in Coverage Rule and include negotiated service rates and out-of-network allowed amounts between health plans and health care providers. The MRFs are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

NOTE: The information in the MRFs is published in a federally-prescribed layout and format. The information included in the MRFs is not primarily aimed at individual enrollees but rather at other health care stakeholders, such as researchers, regulators, lawmakers, and patient and consumer advocates. This is an effort to strengthen America’s health care system by providing information to develop tools and gather information to support consumer choice. As a result, the MRFs may not be reader-friendly for individual health plan participants.

Here is the link for our Fathom 4 health plan: