Transparency In Coverage

Transparency in Coverage
Posted on 09/29/2022

Transparency in Coverage
Quick Reference

Machine-Readable Files

EFFECTIVE DATE: In-network rates and out-of-network charges files delayed to 7/1/22. Prescription drug file delayed indefinitely pending further rule making.

WHO NEEDS TO TAKE ACTION: Health plans

DESCRIPTION: Requires insurers/health plans to create and post machine-readable files (MRFs) that can be read by other computer systems, including detailed pricing data regarding:  
1. Network negotiated rates for all items and services
2. Historical payments to, and billed charges from, out-of-network providers (must have a minimum of twenty entries to protect consumer privacy) 

READ THE FEDERAL GUIDANCE

READ OUR BROKER ARTICLE

Link for Machine Readable File: https://www.anthem.com/machine-readable-file/search

Use Employer Identification Number 464105444 for your search.

OR 

See Anthems Meaningful Transparency booklet for further assistance. 


Member Cost Transparency Tool

EFFECTIVE DATE: 1/1/2023

WHO NEEDS TO TAKE ACTION: Health plans

DESCRIPTION: The Price Transparency tool is an internet tool (paper form upon request) that members can use to see personalized, real-time, cost-share estimates for covered services and items, including pharmacy for 500 designated items/services in 2023 and all items/services in 2024. Due to the duplication of the CAA Cost Comparison Tool requirement. The CAA Cost Transparency Tool requirement is a similar tool that now aligns with the Transparency in Coverage timeline. The CAA requirement is being merged into the member cost tool requirements of the Transparency in Price regulation.

READ THE FEDERAL GUIDANCE

Anthem Meaningful Transparency