The link below leads to machine readable files (MRF) that are made available due to the federal Transparency in Coverage Rule, effective July 1, 2022. The link includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The MRFs are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
The Transparency in Coverage Rule was issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor and U.S. Department of the Treasury and will be enforced beginning 7/1/22. Health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate MRFs:
- 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
United Way of Berks County is making this link publicly available as mandated by the Transparency in Coverage Rule. Capital Blue Cross is responsible for all data and information contained in the link.