The Transparency in Coverage (TiC) regulations provide further clarification for the use of Machine-Readable Files (MRFs) for the health insurance industry. These rules require that healthcare plans and issuers offering health insurance coverage in individual and group markets disclose in-network provider-negotiated rates through MRFs. The outcome will be increased data transparency for payers, providers, and members and improved accessibility and usability for member-facing transparency tools.
One of the challenges with MRF files is that they are typically very large and require significant computing power to download, which makes it difficult for members to access them. To overcome this challenge third-party tools have been developed that provide an infrastructure to host the data so that it can be readily available. Both payers and providers can use the payer rate data to evaluate their competitive pricing position and improve provider contracting efforts.
These were the key themes of our recent Future Healthcare Today podcast about how TiC regulations have affected the use of MRFs. Host, Lucas Hunsicker, talked with Dennis Charland, Senior Vice President, Transparency and DaaS Sales at Zelis, about the recent release of MRF rate-based files and how they will change the market.
“The rates data itself has never, ever been available before in the market. There is a huge opportunity to use this data to a payer’s, provider’s, and facility’s advantage if they can add the right data sets to it in order to make it actionable. This is transformative for the business. I can’t stress enough how amazing this opportunity is if used correctly.”
Listen to the full podcast below: