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Critical Information about Transparency in Coverage

Action required for 7/1/2022 compliance:

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 enforced beginning 7/1/22, requires health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers to publish two separate MRFs (machine readable files).

  • 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

To meet regulatory requirements, Cigna + Oscar:

 

https://www.cigna.com/legal/compliance/machine-readable-files 

 

"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."