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Solutions / Member Engagement / MRF Solutions

MRF Solutions

Data Management, Data Analytics, and Member Experience Solutions for Transparency

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MRF Creation

For those who need help with the generation of the Base In-Network MRFs and Base Allowed-Amounts MRFs, Zelis can provide project management and project delivery capabilities to produce those files. For each, the scopes are outlined below:

In-Network MRFs: Includes operational readiness, data and contract analysis, transformation logic design and MRF development and configuration

Out-of-Network/Allowed Amount MRFs: Includes operational readiness, data review and analysis, and MRF development and configuration

The ability to aggregate and host the Zelis generated Base MRFs with additional Host or network partner MRFs is offered through the Zelis MRF Hub and Hosting offering described below.

MRF Hub

Our MRF Hub is purpose-built to manage the complexity of network mappings, aggregation, file size, hosting and archiving requirements, and the infrastructure requirements to allow for downloading of these large files. A web interface and infrastructure to store, aggregate, and generate the home and host MRFs come as a part of the SaaS offering to help organizations streamline the complexity of generating plan specific MRFs.

The MRF Rates Data Service can be used to:

  • End-to-end management of the MRFs
  • Self-service Web Configuration Manager
  • Hosting for the public presentation of the TOCs and MRFs.
  • Utilization reporting

MRF Rates Manager

Plans do not need to develop their own rates-based service offering for delivering cost estimates for their local products. The MRF Rates Manager meets the data requirements for providing rates-based cost estimations for all networks/products and can be used to:

  • Manage the storage and processing of the local product MRFs
  • Performs the combination of the MRF data with ancillary data sources
  • Integrate rates data is with S365 Cost Calculator and benefits systems
  • The MRM solution requires that the client is using S365 and the S365 Cost Calculator.

MRF Data Service

Our MRF Rates Data Service can acquire and process the In-Network MRF files to a standardized format on a regular cadence (monthly, quarterly, etc.). By removing the complexity of handling and processing these large MRFs, the MRF Rates Data Service allows you to focus on the analysis of the data using a simplified format.

The MRF Rates Data Service can be used to:

  • Acquire one or more specific In-Network MRFs from the Payer
  • Acquire all In-Network MRFs within the Payer’s TOCs
  • In-Network MRF files that are made available by the Payer Rates Data Service are provided in the in an open-source column-oriented data file format designed for efficient data storage and retrieval.

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