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Procedure
Transparency in Coverage
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 includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate 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
To access the documents detailing rates and coverage, please click the appropriate link:
- SELECT HEALTH: https://selecthealth.org/machine-readable-data
- CIGNA: https://www.cigna.com/legal/compliance/machine-readable-files
- Please Note: Prior to 7/1/22, this link will take you to the home page of Cigna.com, but will access the coverage page after that date.
These links lead 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.