Effective July 1, 2022, SISCO will be posting Machine-Readable Files (MRF) in compliance with the Transparency in Coverage rule.
A QUICK RECAP
The Federal Government issued the Transparency in Coverage (TiC) Final Rule on November 12, 2020, and subsequently the Consolidated Appropriations Act (CAA) 2021 included additional provisions regarding TiC. Under TiC, group health plans must provide machine-readable files (MRFs) that contain pricing information, including: In-Network allowable rates for items and services.
Out of Network allowed amounts and billed charges for items and services It is important to note that the point of the release of these cost data files has nothing to do with employee or plan participant communication, but rather, this rule requires insurance companies and self-insured plans to publicize what they pay providers for medical services and make that available to the public. One of the primary goals of this requirement is that the information can then be gathered broadly, and data analytics run to provide more transparency across the industry.
A machine-readable file is a digital representation of data or information that can be imported by a computer system without any intervention. These files must be in a Center for Medicare & Medicaid Services approved format and are not consumer-friendly or intended for consumer use.
Who is impacted? All group health plans and issuers offering group or individual health insurance coverage.
What is needed? The rule requires group health plans and health insurance issuers to publicly post machine-readable files for 1) in-network rates and 2) out-of-network allowed amounts and billed charges. This provision previously included prescription drug negotiated rates and historical prices, but this portion of the provision has been delayed until December 27, 2022.
What action is SISCO taking? SISCO is partnering with each network partner to make in-network rates available, as well as making our own network and out-of-network rates publicly available for our health plan partners.
By July 1, 2022, SISCO will publish MRFs for the medical plans administered by SISCO. It is important to note that the networks that manage the allowable rates for in-network services accessed by each health plan are providing these files. Once the networks release the files, SISCO will post them to ensure each plan is in compliance.
SISCO will host the files on behalf of our clients on a publically accessible site at http://sisconosurprise.com/
As more information becomes available, we will communicate directly with our clients and brokers in the event there are changes to this link.
NOTE: The site will not be active and fully populated until July 1, 2022.
YOUR OBLIGATIONS AS AN EMPLOYER GROUP
To ensure compliance with the TiC MRF Requirements, Employer Groups should post a link to the SISCO publicly accessible site http://sisconosurprise.com/ on their public website and not their private intranet.