Machine Readable File Mandate
Machine-Readable Files Content for the Transparency in Coverage Final Rule
As required by the Transparency in Coverage Final Rule, plans and issuers are required to publicly display in-network provider negotiated rates, historical out-of-network and allowed amounts through Machine-Readable Files on an internet website. The Departments of Health and Human Services, Labor, and Treasury have delayed enforcement of this Final Rule until July 1, 2022.
In accordance with this mandate, the following files are available for use:
In-network rate files are identified by the words "in-network" in the description field of the file. Out-of-network files are identified by the words "allowed amount" in the description field. These definitions were defined by the CMS specifications on GitHub.
To access the files for a specific plan:
- Download the appropriate Table-Of-Contents (TOC) file from the list above
- Open the TOC file in an application that is compatible with the JSON file format
- Press Ctrl F and enter the plan EIN to search for URLs for the applicable plan
- Locate the desired URL(s) and copy it into a web browser to download the file(s)
- Open and extract the file
REMINDER: These files are meant to feed technology-based tools and are not meant to be used by individual consumers.
The information displayed in the files represents the rate Blue Cross Blue Shield Licensees have negotiated with their in-network providers for all covered items and services. This is not, however, an estimate of the cost patients will be responsible for paying for such item or service. Individual cost will vary depending upon the terms of the individual’s specific health insurance coverage and the structure of the reimbursement arrangement, if applicable. Blue Cross and Blue Shield Licensees have made reasonable efforts to ensure that the data displayed in the files is complete and accurate at the time it is published. The data is refreshed each month.