Transparency In Coverage

Transparency In Coverage Public Disclosure637916814532500000

Starting July 1, 2022
, employers that maintain group health plans (plans) and health insurance issuers (issuers) will be required to disclose pricing information on a public website in the form of three machine-readable files (MRFs). This requirement is one of the Transparency in Coverage Final Rules (the Rules) released by the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (collectively, the Departments) in November 2020.

Under the Rules, the three MRFs must disclose:

  1. In-Network Rates – the in-network provider negotiated rate for all covered items and services.
  2. Out-of-Network Amounts – the historical out-of-network allowed amounts for covered items and services.
  3. Prescription Drug Costs – the negotiated rates and historical pricing information for covered prescription drugs.
The Departments will begin enforcing the disclosure requirements regarding the first two MRFs for in-network rates and out-of-network amounts on July 1, 2022. Enforcement for disclosure regarding covered prescription drugs has been delayed indefinitely.

*MRF's or Machine Readable Files, are digital representations of data or information in a file that can be imported or read by a computer system for further processing without human intervention while ensuring no semantic meaning is lost. 


To comply with the new rules, the Town of Smyrna is providing a link for you to view these MRF's here --->>>

This link leads to the machine readable files which 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.