Transparency in Coverage Rule – Machine Readable Files

Under the Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor, and U.S. Department of the Treasury and enforced beginning 7/1/22, health plans (which include clients who sponsor employee benefit plans) and health insurance issuers must publish two MRFs:

• 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 MRFs can be accessed with the below link:
https://www.cigna.com/legal/compliance/machine-readable-files

The above link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. Cigna will update the files each month, and the link will remain constant and always access the most up-to-date files.

If you have any questions, please contact Gretchen Doyle at Gretchen.Doyle@unmfund.org.