Machine Readable Files & Cost Transparency
As part of the No Surprises Act and Transparency in Coverage Final Rule set forth by the U.S. Department of the Treasury, the U.S. Department of Labor, and the U.S. Department of Health and Human Services, group health plans and health insurance issuers are required to make available to the public negotiated rates for all covered items with in-network providers, and historical payments to and billed charges from, out-of-network providers through machine-readable files (MRFs) posted on an internet website, updated monthly. These files will permit the public to have access to health plan payment information that can be used to understand health plan pricing and the cost for health care services.
All files must conform to a non-proprietary, open standard format, like JSON, XML or YAML, and be made available via HTTPS. The content of the files is formatted to technical standards in guidance published by the Centers for Medicare & Medicaid Services (CMS).
Access to Machine Readable Files
Negotiated Rates for In-Network Providers
To access the machine-readable files for CBA Blue providers for our products, please select the “In Network” option below. Please be aware that these are potentially extremely large files and ensure that you have the appropriate network capacity before attempting to download.
Please Note: The information displayed in the files represents the rates CBA Blue and/or Other Blue Cross Licensees have negotiated with their in-network providers for covered items and services. This is not, however, an estimate of the cost patients will be responsible for paying for such item or service. Individual cost will vary depending upon the terms of the individual's specific health insurance coverage and the structure of the reimbursement arrangement, if applicable. CBA Blue and/or Other Blue Cross Licensees have made reasonable efforts to ensure the data displayed in the files is complete and accurate at the time it was published. This data is refreshed each month.
HISTORICAL ALLOWED AMOUNTS AND BILLED CHARGES FOR OUT-OF-NETWORK PROVIDERS
To access the machine readable files for out-of-network providers, which are based on historical claims data, please select the "Out-of-Network" option below. If the file contains no data, it means that the threshold of having twenty out-of-network provider claims for the same procedure and product within the defined historical look back period was not met. This data is refreshed each month.