Transparency in Coverage
Under the Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, Department of Labor and Department of the Treasury, effective 7/1/22, health insurance plans are required to publish machine-readable files (MRFs) that include the information outlined below. The MRFs are formatted to allow researchers, regulators, and application developers to access and analyze data more easily. The MRFs will be updated monthly.
In Network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers.
Out of Network: Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period.
The links below lead to the MRFs for the firm’s health insurance plans.
Sharp Health Plan: https://www.sharphealthplan.com/find-your-portal/api-access-for-developers