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Providing in-network provider negotiated rates and historical out-of-network allowed amounts through machine-readable files.

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FilesCompany NameFile NamePlan NamePlan ID TypePlan IDActions
Fallon Health2024-04-01_fallon-health_index.json

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On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to disclose certain pricing information. Under the rule, plans must disclose in-network negotiated rates and billed and out-of-network rates through machine-readable files on a website. Plans and issuers are required to make these files public for plan policy years beginning with 2022. These machine-readable files are updated monthly, and the pricing information included is accurate as of the date it is pulled from system files and may be subject to change between the date the pricing data is pulled and the next update of the files. These files and the included pricing information is not a guarantee of payment and may not always reflect amounts on final claim processing documentation. Eligibility and benefit determinations are made when the claim is processed. This material is for information only. The machine-readable files may be very large, which may, in turn, cause issues while downloading them. If you are experiencing problems, please try a different web browser or check your Internet/Wi-Fi speed.
About the Transparency in Coverage ActCMSGov Technical Implementation Guide

Website published on: Sun Mar 31 2024 22:45:21 GMT+0000 (Coordinated Universal Time)

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