Insurers and group health plans must create and publish machine-readable files with rate information per the Transparency in Coverage (TIC) rule.
These files will be updated monthly and include negotiated rates for all in-network providers, and allowed amounts and historical billed charges for out-of-network providers. At this time, the TIC rule’s requirement to post pharmacy cost information has been deferred to an undetermined time.
Due to the methodologies used to capture this data, and the complex required format, these Machine Readable Files are intended for use in technical analysis rather than by consumers in making decisions. Further, the methodology used to prepare these files may be different than that of other payers with the same requirements.
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.
The files pertaining to the university's health plans can be identified by the following titles:
- Cle-Care_Medical-Mutual-Of-Ohio-INN
- Cle-Care_Medical-Mutual-Of-Ohio-ONN
- SuperMed_Medical-Mutual-Of-Ohio-INN
- SuperMed_Medical-Mutual-Of-Ohio-ONN