Small Business/Large Group
Machine Readable Files Requirement Goes into Effect July 1
Effective July 1, 2022, payers must meet the Machine Readable File (MRF) requirement for Transparency in Coverage (TiC). All Humana Commercial groups are impacted by the Transparency in Coverage rule, regardless of funding type (fully insured or self-funded).
Exceptions to the TiC rule are:
- Grandfathered plans
- Excepted benefits
- Short-term & limited-duration insurance
- Health reimbursement arrangements, or
- Other account-based group health plans
- Publicly accessible website with all required MFR will be active on July 1, 2022
What you need to know:
Payers must make available online to the public the following two types of MRF that include detailed price information about in-network and out-of-network medical services:
A rate file for all covered items and services negotiated between the payer and in-network providers
An allowed-amount file showing historical payments to out-of-network providers
Humana’s current focus is on the data infrastructure of cost-estimation tools and building accurate, real-time MRFs that will cover our 70,000+ provider contracts
Humana provides greater price transparency and tools that enable members to make informed decisions about their healthcare, which benefits their health and financial outcomes.