The U.S. Departments of Health and Human Services (HHS), Labor and Treasury issued “Transparency in Coverage” (TiC) Final Rule in October 2020 to deliver on a presidential executive order – Improving Price and Quality Transparency in American Healthcare to Put Patients First. TiC is meant to put health care price information in the hands of consumers to empower them to make informed health care decisions, and to bring greater competition to the private health care industry.
The rules for TiC will be implemented in phases over the course of about three years. The first part of the TiC rule will be effective July 1, 2022, requiring the public posting of the negotiated rates between the plan/issuer and in-network providers and the out-of-network allowed amounts in the form of machine-readable files (MRF’s). These two MRFs are monthly documents with content that can be readily processed by a computer – not necessarily readable to a human.
Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Environmental Systems Design, Inc. (ESD).