The Transparency in Coverage Final Rules (the "TiC Final Rules") require non-grandfathered group health plans and health plan providers offering coverage to non-grandfathered groups and individual markets to disclose machine- readable files (MRFs) for:
1. In-network provider rates for covered items and services; and
2. Out-of-network allowed amounts and billed charges for covered items and services.
Enforcement for the MRFs begins July 1st, 2022.
The DOL issued an update in FAQ 49 which has postponed the Rx file requirement until December 2022.
As https://www.govinfo.gov/content/pkg/FR-2021-11-23/pdf/2021-25183.pdf states, the Departments will not initiate enforcement action against a plan or issuer that does not report the required information by the first statutory deadline for reporting on December 27, 2021 or the second statutory deadline for reporting on June 1, 2022, and that instead submits the section 204 data submissions for the 2020 and 2021 reference years by December 27, 2022.
What you need to know:
Anchor Benefit Services and ECM Solutions will help all clients comply with this legislation by providing access to the required Machine- Readable Files by the 7/1/2022 enforcement date.
AnchorBenefit Services and ECM Solutions is also working on the Rx requirements in anticipation of the 12/27/2022 deadline
For more information on theTransparency in Coverage legislation, visit: https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage
Employees and Members will be able to access the necessary file(s)and link(s) to network websites to obtain the rate information by visiting:
(*Value Based Pricing plans do not negotiate pricing with providers. Instead, the Plan pays a percentage over Medicare rates. Typically this percentage is 120% - 140% over the Medicare rate but may be adjusted as needed. Medicare rates can be found at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo These rates may be influenced by modifiers, geographic location and changes to the Medicare rates.)