Machine Readable Files
The Departments of Health and Human Services, Labor, and the Treasury finalized the Transparency in Coverage Rule requiring non-grandfathered health plans to create and post publicly-available machine-readable files free of charge and without any condition. These files must include in-network negotiated payment rates and historical out-of-network charges for covered items and services. This file is not designed as a consumer tool and is for information only.
This file is not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in this file, including eligibility, medical necessity determinations, utilization management requirements, exclusions, and other plan terms. This file also does not offer any information on a member’s out-of-pocket charges.
The information in this file is accurate as of the date immediately prior to the “last updated on” date stated in the MRF file and is subject to change without notice.
Marpai Health will update machine-readable files monthly.
Understanding the Data
Machine-readable files published by Marpai Health conform to the technical implementation guide and schema version 1.0.0 published by CMS at https://github.com/CMSgov/price-transparency-guide