Transparency in Coverage

The U.S. Departments of Health and Human Services (HHS), Labor and Treasury issued “Transparency in Coverage” (TiC) Final Rule in October 2020 to deliver on President Trump’s executive order - Improving Price and Quality Transparency in American Healthcare to Put Patients First. TiC is meant to put health care price information in the hands of consumers to empower them to make informed health care decisions, and to bring greater competition to the private health care industry.

The first part of the TiC rule will be effective July 1, 2022, requiring the public posting of the negotiated rates between the plan/issuer and in-network providers and the out-of-network allowed amounts in the form of machine-readable files (MRF's). These two MRFs are documents with content that can be readily processed by a computer - not necessarily readable to a human.

What is a machine-readable file (MRF) requirement?
A machine-readable file is a digital representation of a data or information in a file that can be imported or read by a computer system for further processing without human intervention. In this case, the MRFs contain pan pricing data and the files conform to non-proprietary, open standard format.

This is stage #1 – Federal Transparency in Coverage (TiC)
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