Machine-readable files required on public sites by July 1, 2022, for Transparency in Coverage
Transparency in Coverage enforcement for health insurers, group health plans and self-funded clients is quickly approaching
- All states
- Regulatory and compliance
As the initial enforcement date approaches for posting the machine-readable files (MRF) under the Transparency in Coverage Rule, UnitedHealthcare is providing a quick reminder of requirements for health insurers and group health plans, including self-funded clients.
- The government requirement applies to plan years beginning on or after Jan. 1, 2022, with an enforcement date of July 1, 20221.
- Insurers and self-funded plans must publicly post the files by July 1, 2022, which include detailed pricing data for all covered items and services via 3 MRFs. It’s important to note that the third file is delayed pending additional guidance and is not required at this time. The 3 MRFs include:
- In-network negotiated payment rates
- Historical out-of-network allowed amounts
- In-network rates and historical costs for prescription drugs (delayed pending guidance)
- Data in these files must be in the JSON file format and must be updated monthly. Posting Excel documents, PDFs or other non-MRFs are not permitted.
UnitedHealthcare is committed to Transparency in Coverage Rule compliance by making MRFs available for all UnitedHealthcare commercial platforms, pricing structures and plan designs at the appropriate time. UnitedHealthcare is also committed to helping self-funded customers comply with this new rule and will create and publish MRFs where UnitedHealthcare has access to the data, including integrated customer-specific provider contracting arrangements (GSP, CSP). MRFs will be posted on transparency-in-coverage.uhc.com. To comply with the Transparency in Coverage Rule, self-funded customers must link to transparency-in-coverage.uhc.com on their own public website.
- Self-funded customers who opt to suppress files from the public UnitedHealthcare MRF website and post to their own public website may access the MRFs from a dedicated website monthly. The website requires authentication. Please notify your UnitedHealthcare representative by May 15, 2022, if this is your intention. Your UnitedHealthcare representative will provide detailed instructions so the self-funded customer may extract and post the files publicly and update them monthly.
- UnitedHealthcare does not support direct customer-specific provider contracting arrangements where claims are not paid by UnitedHealthcare, nor does UnitedHealthcare accept or provide raw data.
Consumer Price Transparency Tool (CPTT)
Under the Transparency in Coverage Rule, health insurers and group health plans, including self-funded groups must create an online tool that provides members with personalized, real-time, cost-share estimates for all covered services and items, including prescription drugs, with paper versions available upon request. This CPTT requirement is effective for plan years beginning on and after Jan. 1, 2023, for 500 designated services, and for plan years beginning on or after Jan. 1, 2024, for all services.
UnitedHealthcare is working on the tool and will share more information as the implementation date approaches.
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