Employer FLASH: Transparency in Coverage

Your health plan* is committed to helping you understand the costs associated with the healthcare services and items your group utilizes – and to helping you comply with the Transparency in Coverage Rule (CMS-9915-F), which was finalized on November 12, 2020. As part of this rule, health plans and health insurers are required to publish two separate machine-readable files (MRFs):

• An MRF that includes in-network payment rates; and
• An MRF that includes allowed amounts paid to, and charges billed from, out-of-network providers for covered items and services.

As your partner in health, we will create and generate these MRFs for the plans we provide, at no cost to you. To access your most current files, go to hally.com/transparency-in-coverage. This website will include the two MRFs mentioned above, and it will be updated monthly. You can click on each file to download them, or copy and paste the link and save it to your company website as required by the rule. If you have additional questions, a Frequently Asked Questions document is provided on the website or by following this link.

In order to conform to the required nonproprietary, open-standard format, these files are saved in JSON format. Because they’re MRFs, they may be large and require considerable time and space to download. You may also need third-party decompression software to open them.

The files will be effective for plan years on and after January 1, 2022. You’ll be able to access these files in July, 2022, and – since they’re updated monthly – on the first of each month thereafter. Please reach out to your client consultant if you have additional questions. We’re always happy to help.

*Statements in this email are applicable to most commercial health plans issued or administered by Health Alliance™, Health Alliance Northwest™ and FirstCarolinaCare. Please contact your client consultant or see our Frequently Asked Questions document for additional information related to the Transparency in Coverage Rule.