The Transparency in Coverage Rule issued by the federal government requires health insurers and group health plans to provide detailed pricing data for all covered items and services to the public in the form of Machine Readable Files (MRFs).
Highmark is committed to helping self-funded customers comply with this new rule and will create and publish the MRFs on your behalf. Highmark will make this information available through the link: https://mrfdata.hmhs.com.
Information will be updated monthly. The detailed pricing information must include:
- In-Network Rates for all covered in-network items and services
- Out-of-Network historical rates for all covered items, services and prescription drugs
- In-Network negotiated rates and historical net prices for all covered prescription drugs by plan at the pharmacy location level. This prescription drug information has been delayed pending additional rules.
This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
For additional information, see the guide below:
User Guide - Navigation of Machine Readable Files Resource - 2022