Ingest, aggregate and manage the In-Network, Allowed Amount, and Table of Content (TOC) Machine Readable Files for Transparency in Coverage (CMS-9915-F) compliance by 7/1/2022 and beyond.
Sapphire is pleased to announce the availability of the S365 MRF Hub to assist Plans and TPAs to meet the Transparency in Coverage Regulations requirements for making their Machine Readable Files (MRFs) publicly available.
As part of the Transparency in Coverage Regulations, Centers for Medicare and Medicaid (CMS) has provided implementation guidance for plans and TPAs to generate three MRFs:
- In-Network file: Negotiated rates for all covered items and services between the plan and their in-network providers
- Allowed amount file: Allowed amounts and billed charges for out-of-network providers
- Table of Content (TOC) Files: Optional file to group multiple plans together with the same negotiated rates or allowed amounts
The regulations require that the MRFs include all applicable rates to ensure that the rates upon which consumer cost-sharing liability is determined are disclosed. This would include rates from both the Home/Local plan and the additional Host/Partner plans.
However, due to the complexity of creating the In-Network and Allowed Amount MRFs, most plans and TPAs have rightly focused mainly on the creation aspects, but creation is only one aspect of meeting the regulation since these files must be made publicly available with free and unfettered access.
Our S365 MRF Hub solution will meet the needs of these requirements by ingesting, aggregating and managing the Plan’s/TPA’s in-network MRFs, the Host/Partner plans in-network MRFs or external link files, and the Plan’s/TPA’s Allowed Amounts file. All of the local files are hosted by Sapphire and made publicly available via URLs presented by the web application.
The key feature of the S365 MRF Hub solution is the self-service web administration tool that allows users to easily map the required information, including reporting entities, reporting plans, and provider references, to generate the MRFs and TOCs required for the individual payers/issuers.
The S365 MRF Hub solution key features include:
- End-to-end management of the MRFs
- Support for local and/or externally hosted MRFs
- Support for internal and/or external Provider reference objects
- Aggregation of local and partner MRFs for network and/or ASO specific requirements
- Support for archiving of previously published MRFs
- Self-service Web Configuration Manager
- Administration of business rules for MRF aggregation and TOC generation
- Mapping of reporting entities, reporting plans and payer
- Configuration management for product, network, and link files
- Generation of TOCs for based on payer, issuer and ASO/ASC requirements
- Hosting for the public presentation of the TOCs and MRFs.
- White labeled website
- Search capabilities based on payer, EIN, HIOS, etc.
- ASO TOC Integration options
- Utilization Reporting
- Management of the TOCs and MRFs
- Storage and Egress reporting on consumption
Now as a part of Zelis, we are poised to deliver on these promises as a strategic technology and strategy partner to heath plans, employers, third party administrators and their membership by bringing payers, providers, and consumers together into one efficient system.
For more information on how Zelis+Sapphire can help, contact your sales representative or Account Manager.