Get a demo of our S365™ MRF Hub for Health Plans and TPAs

Ingest, aggregate and manage the In-Network, Allowed Amount, and Table of Content (TOC) Machine Readable Files for Transparency in Coverage compliance by 7/1/2022 and beyond.

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.

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:

  1. In-Network file: Negotiated rates for all covered items and services between the plan and their in-network providers
  2. Allowed amount file: Allowed amounts and billed charges for out-of-network providers
  3. 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.

Request a meeting to learn more about S365 MRF Hub

Our self-service web administration tool simplifies the management of complex plan mappings and automates the publishing and hosting of the MRFs required by our Plan and TPA partners. Request a meeting to learn more about:

  • End-to-end management of the MRFs
    Discuss our method of the ingestion, aggregation, and management of Home in-network MRFs and Host in-network MFTs.
  • Self service Web Configuration Manager
    See a demonstration of our methods to manage the configuration rules used to generate the Home plan or ASO specific MRFs. Rules can be automated and submitted via files and/or a web form.
  • Hosting for the public presentation of the TOCs and MRFs.
    See examples of TOCs and MRFs files public for plan policy years beginning with 2022 through a hosted, compliant site.
  • Utilization Reporting
    Learn more about hosted file consumption monitoring.

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