As required by the Transparency in Coverage (TiC) final rule of the Affordable Care Act (ACA), administrators of non-grandfathered group health plans (CareFirst on behalf of Venable) must post machine-readable-files (MRF) to a publicly available website.
The MRF must include the following:
- In-Network Rate File: Applicable in-network provider rates, including negotiated rates, derived amounts, and underlying fee schedule rates for all covered items.
- Out-of-Network Rate File: Historical data outlining the different billed charges and allowed amounts a plan or issuer has paid for covered items or services furnished by out-of-network providers.
A machine-readable file is a digital representation of data that can be imported or read by a computer system without human intervention. Data in these files must be in the JSON file format and updated monthly.
Machine-readable files are meant to feed technology-based tools. They are NOT meant to be used by members to look up pricing.
Thus, CareFirst is pointing enrollees to My Account to utilize the Treatment Cost Estimator Tool as this is the member-friendly tool. If you wish to access the MRFs, they can be accessed here: https://individual.carefirst.com/individuals-families/mandates-policies/machine-readable-file.page