Health Plan Machine-readable Files
HR 2471, the Consolidated Appropriations Act, 2021, introduced new federal regulations for health care price transparency. It aims to assist consumers by increasing the availability and transparency of health care price information. The goal is for this transparency to enhance market competition and lower health care costs.
As a group health plan sponsor, the township is required to post the following health care information monthly on a public website:
- In-network provider rates for covered items and services
- Out-of-network allowed amounts and billed charges for covered items and services if 20 or more claims in the 90-day period are included in the file
To access the township’s machine-readable files that contain in-network negotiated rates and out-of-network allowed amounts and historical billed charges, please follow the following link https://Health1.Meritain.com/app/public/#/one/insurerCode=MERITAIN_I&brandCode=MERITAINOVER/machine-readable-transparency-in-coverage?searchTerm=17662&lock=true
- The information contained in this machine-readable file may be difficult to access without certain technology.
- These files may be large and require a computer that can download at least up to 1 TB (terabyte) of data. Most modern hard drives store half of this amount of data. Based on your computer’s storage and hard drive, attempting to open or download large files may cause instabilities in Windows, and cause performance issues resulting in downloads that could take hours, days, or weeks depending on the file size and hard drive combination. For reference: 1TB = 243 high-definition streaming movies (average 2 hours per movie).
- This mandate is a building block for future customer-facing mandates, including a Price Transparency Tool and an Advanced Explanation of Benefits.
- The data in the files may not be useful for the average consumer. For example, facilities that are paid based on a percent of charge will not have a dollar amount representing the amount paid for a service.
- The machine-readable files will be updated monthly to ensure the accuracy of the data and reflect changes in pricing and regulatory requirements.
Once federal regulations are finalized, it is expected that a third set of machine-readable files for negotiated rates and historical net prices for covered prescription drugs will be added.