What are Machine Readable Files (MRF) and why are they required by TiC?

Created by Kelly Knudsen, Modified on Fri, 19 Jan at 9:58 PM by Kelly Knudsen

The Transparency in Coverage rule (TiC) mandates the production and public posting of Machine Readable Files (MRF) containing both in-network rates for all covered items and services, and allowed amounts for out-of-network providers. This requirement is in place to foster a new era of transparency and data-driven decision-making within the realm of healthcare coverage. It stems from the recognition that the complexity of healthcare pricing and billing can often create confusion and hinder individuals' ability to make informed choices about their healthcare options. By introducing MRF, the TiC rule aims to address this challenge by providing easily accessible, standardized, and comprehensible data that empowers consumers, employers, researchers, and regulators to navigate the intricacies of healthcare costs more effectively.

Health plans and health insurance issuers are required to provide two documents:

In-Network Rate File: containing rates for all covered items and services between the plan or issuer and in-network providers
Allowed Amount File: containing allowed amounts for, and billed charges from, out-of-network providers

Furthermore, the requirement for public availability of MRF on designated websites is a critical element of the TiC rule. This accessibility empowers consumers to explore and evaluate various healthcare coverage options and make informed decisions aligned with their preferences and financial considerations. It also promotes competition among health plans and providers, encouraging them to offer more competitive pricing and higher-quality services to attract consumers. Ultimately, the introduction of Machine Readable Files under the TiC rule represents a transformative step toward creating a healthcare system that is more transparent, accountable, and responsive to the needs of individuals and families seeking comprehensive and affordable coverage.

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