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.

Bedminster, NJ – May 5, 2022 – Zelis 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 providedimplementation guidancefor 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.

OurS365 MRF Hub solutionwill 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

About Zelis

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of providers and members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process. Follow us on LinkedIn to get the latest news.

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