Transparency in Coverage
Transparency in Coverage Rule Requires Rate Information to Post Starting July 2022
Insurers and group health plans are required under the Transparency in Coverage Rule to make rate information available for both members and non-members. Medical Mutual will post this information starting July 2022:
- Negotiated rates for in-network providers
- Allowed amounts and historical billed charges for out-of-network providers
Per the mandate, the information must be:
- Provided in a CMS-approved format.
- Updated monthly.
- Hosted publicly (not behind log in).
How We’ll Execute This Requirement
- Medical Mutual will share rate information in a machine-readable file (MRF) format for Medical Mutual contracted providers.
- The information will be posted to a dedicated MRF landing page accessible from MedMutual.com starting July 2022.
The Transparency in Coverage Rules under the No Surprises Act requires health plans to disclose on their public website information regarding in-network medical provider rates, out-of-network allowed amounts, and in network negotiated drug files. The link below leads to the machine readable files in response to this Act.
https://www.medmutual.com/For-Employers/Employer-Resources/No-Surprises-Act-Legislation.aspx