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As part of the Transparency in Coverage Final Rule set forth by the U.S. Department of the Treasury, the U.S. Department of Labor, and the U.S. Department of Health and Human Services (referred to collectively as the “Tri-Agencies”), group health plans and health insurance issuers are required to make available to the public negotiated rates for all covered items with in-network providers, and historical payments to and billed charges from, out-of-network providers through machine-readable files (MRFs) posted on an internet website, updated monthly. These files will permit the public to have access to health plan payment information that can be used to understand health plan pricing and the cost for health care services.
The files that are posted will include:
To ensure data integrity, all files must conform to a non-proprietary, open standard format, like JSON, XML or YAML, and be made available via HTTPS. The content of the files is formatted to technical standards in guidance published by the Centers for Medicare & Medicaid Services (CMS). See CMS Technical Guidance for reference.
Harvard Pilgrim Health Care will publish machine-readable files in the JSON format to its website on or around the first day of every month.
Harvard Pilgrim Health Care will generate machine-readable files for its various plans and group health plan clients. From the “View Plan List” link below you can choose the plan for which you wish to access machine readable files.
MRFs are files that will be generated on a monthly basis. The Tri-Agencies require that plans and issuers disclose in-network provider negotiated rates and historical out-of-network allowed amounts.
Harvard Pilgrim Health Care is awaiting further guidance from CMS on publication of a prescription drug file.
The consumer, most group health plans, and issuers of group or individual health insurance organizations.
Harvard Pilgrim Health Care will produce the files for self-insured accounts beginning July 1, 2022 and update them monthly thereafter. The files will be available via a link on the Harvard Pilgrim Health Care public website.
On behalf of our self-insured clients, and in accordance with our administrative services agreements with them, Harvard Pilgrim Health Care will produce the required machine readable files for self-insured groups and post them on our public website beginning July 1, 2022. The files will be updated monthly thereafter. Although this type of contractual arrangement is contemplated by the Transparency Regulations to meet the obligations thereof, employer groups may choose to post a notice on their websites directing their employees to the Harvard Pilgrim Health Care website or links to where their plan specific machine readable files will be available thereon. Self-insured groups should consult their own legal counsel to determine their compliance
Harvard Pilgrim Health Care will produce the files for fully insured accounts beginning July 1, 2022 and update them monthly thereafter. The files will be available via a link on the Harvard Pilgrim Health Care public website.
No. The files will be accessible free of charge, without having to establish a user account, password or other credentials, and without having to submit any personally identifying information such as a name, email address or telephone number.
No. Each self-insured account will have a fixed, permalink URL, which will not change from month to month. This permalink URL can be used to link from the self-insured account's web site to the machine-readable files for that account.
Click on the "View Plan List" button above, which will bring you to the list of available machine-readable files.
At this time, a notification mechanism is not available; however, files will be published on a monthly schedule and will comply with regulatory guidelines.
Files are externally available for the current month only. For example, files posted on July 1 will be available until July 31. Updated files will be posted on August 1, replacing the July files. Harvard Pilgrim Health Care will retain all MRFs internally for a period of 24 months. Files are available upon request.
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