Independence Edge – TCR Provision MRF Update

INDEPENDENCE EDGE

Transparency in Coverage Rule (TCR) provision: Update on machine-readable files (MRFs)

Dear 1199c Team,

The TCR requires health plans and plan sponsors to make in-network and out-of-network machine-readable files available to the public by July 1, 2022. Here are some updates on MRFs.

In-network MRFs

To support the posting of MRFs, Independence Blue Cross (Independence) is developing a Table of Contents file for our company website, ibx.com. The Table of Contents will contain the links to our in-network MRFs by issuing company (e.g., PPO plans point to QCC, Inc., HMO plans point to Keystone Health Plan East, Inc., etc.). Self-funded customers will be provided links via email to a customer-specific Table of Contents file with the appropriate links for each of their plans.

Out-of-network MRFs

Independence will produce an out-of-network allowed amount file per self-funded customer that will contain the required reporting for their business. Independence shall report self-funded out-of-network rates using the self-funded customer’s EIN and client name (customer-specific file).

Action needed: Self-funded MRF link notification

Independence will send a monthly email to the self-funded customer’s mandate email address, a new contact type, with the links you can post to your public website. To send the monthly emails, Independence will need an email address on file as the mandate contact for your account. This email address is needed by June 17, 2022, otherwise the mandate contact will default to the contact in Independence’s customer files (CRM). Please send your mandate contact to your account management team.

Posting MRF links – Self-Funded

(Note, the links below are not yet live)
Each self-funded customer will be sent customer specific links that follow this pattern:

QCC, Inc.
https://www.ibx.com/transparency-in-coverage/12345?key=xxxxxxx

Keystone Health Plan East
https://www.ibx.com/transparency-in-coverage/12345?key=xxxxxxx

Blue Cross Hospital Indemnity, Inc.
https://www.ibx.com/transparency-in-coverage/12345?key=xxxxxxx

By clicking the customer specific link, the customer will navigate to their specific MRF Table of Contents file link. The name of the customer specific MRF Table of Contents will follow this format:

QCC, Inc.
https://storage.googleapis.com/ihg-dart-edw-mrf-prod-public/qcc/YYYY-MM-DD_12345_index.json

Keystone Health Plan East
https://storage.googleapis.com/ihg-dart-edw-mrf-prod-public/khpe/YYYY-MM-DD_12345_index.json

Blue Cross Hospital Indemnity, Inc.
https://storage.googleapis.com/ihg-dart-edw-mrf-prod-public/bc/YYYY-MM-DD_12345_index.json

and contain a series of links to in-network MRF json files specific to their plans and out-of-network MRFs for their business. The customer would then copy the links and post on their public website. The customer will receive a monthly notice that the data at the links has been updated.

If there is a request for customization of either in-network or out-of-network MRFs, Independence will need the details provided to your account management team. The timeline for implementation and cost of customization would be determined from there.

You may post the MRF Table of Contents link to your public website. Please note: Because in-network rates are provider specific and not customer specific, all customers will be pointed to the brand and issuing company in-network rate MRFs for their respective plans.

Please reach out with any questions.

Yours in good health,
Dan O’Connor
484.792.1115 (m)
215.241.0122 (w)