In October 2020, the Departments of Treasury, Labor, and Health and Human Services finalized the Transparency in Coverage (TIC) Rule.  Under this rule, group health plans and carriers are required to post in and out-of-network pricing information to a public website.

The TIC Final Rules require non-grandfathered group health plans (including fully insured, level funded, and self-insured plans) and health insurance issuers to post certain pricing information on three “machine-readable” files to a public website.

The “machine readable files” have specific formatting and content requirements and must include information on:

1.      In-network provider negotiated rates for covered items and services;

2.      Historical out-of-network allowed amounts and associated billed charges for covered items and services; and

3.      Negotiated prices and historical net prices for covered prescription drugs.

The files must be publicly available and accessible to any person, free of charge and without conditions, such as the establishment of a user account, password, or other credentials, or submission of personally identifiable information to access the file, such as name, email address, or telephone number.  The machine-readable files must be updated monthly and clearly indicate the last time they were updated.

Blue Cross Blue Shield of NC intends to fully comply with requirements.  We will host files for group customers on its publicly available website, at https://www.bluecrossnc.com/about‐us/policies‐and‐best‐ practices/transparency‐coverage‐mrf#.  (This website will be live on July 1, 2022.)  This 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.