We have the data! Converting Machine Readable Files to Human Readable Files! – News

The second Trump era Transparency in Coverage (TiC) rule released in 2020 focused on insurance companies and require that insurers make machine readable files (MRFs) of negotiated in-network rates and out-of-network allowables publicly available on their websites by July 1st, 2022. Going one step further, by January 1st, 2023, plans must make cost-sharing information available for 500 defined items and services. Estimates must be specific to a covered members’ insurance plan and in-network or out-of-network benefits. Beginning in 2024, the 500 items and services will be expanded to include all items and services except prescription medications. The requirement to publicize medication costs has been delayed indefinitely.


While many insurance plans are posting MRFs on their site, they seem to be trying to obtain a grade of D-: doing just enough to achieve compliance, but making the MRFs very difficult to work with. 


Example of Machine Readable File (MRF)


This is what one would call, “hiding in plain sight.” The data files are there for the taking. However, extracting data from these gigabyte and terabyte-sized files is a herculean task. The effort to unlock this large trove of pricing data, and place it in a usable format, will lead to several benefits: Greater transparency and increased competition, leading to lower rates for consumers and the ability to know costs ahead of time allowing them to financially plan for their healthcare needs.


But before consumers benefit from the lower costs associated with greater price transparency, providers, health systems and corporate entities must access the data. No small feat.


Example of Human Readable File (HRF) by BuildMyHealth

After much effort, coding and utilization of additional server space, our team at BuildMyHealth has “cracked the code” and created a reproducible way to extract data from these MRF’s and turn them into HRF’s (Human Readable Files)!




In the example above, you can see the comparison of negotiated rates for several procedures between Aetna and three facilities all within the city of Baton Rouge, Louisiana. For the parent companies of each facility – USPI, SCA Health and Surgery Partners – this information is helpful in determining how their negotiated rates compare amongst competitors.

Other actionable reports that can be gleaned from the insurance companies’ MRFs include:

  • Rate comparisons based on CPT code and facility
  • Rate comparisons based on CPT code and physician
  • Comparison of intra-city rates
  • Comparison of intra and interstate rates
  • Comparison of in-network and out-of-network allowables
  • Any customized report based on CPT, NPI, location and insurance carrier


Armed with these reports, benefits for providers include:

  • Greater leverage in negotiating your next payor contract as a provider or small group practice
  • More accurately assess valuation of a potential acquisition target
  • Check intra-city, intra or interstate rate variation
  • Determine which procedures are more suitable as an out-of-network provider


And benefits to the consumer include:

  • Ability to get pre-procedure total cost of care estimates with professional, institutional, ancillary and technical components included
  • As providers and insurers negotiate, the most expensive rates will become non-existent, lowering costs for Americans!


Contact us at to request a customized report to address your reimbursement rate comparison needs.

Post Views:

Source link

Back to top button