SISCO Federal Transparency in Coverage Machine Readable Files

Federal Transparency in Coverage (TIC): Machine Readable Files

Network-Specific Transparency in Coverage Machine Readable Files

Federal Transparency in Coverage (TIC) regulations require group health plans to make publicly available machine readable files (MRFs) that contain the negotiated rates for in-network providers and allowed amounts derived from historical claims for out-of-network providers. These regulations call for making these files publicly available with an open access website effective July 1, 2022.

A machine readable file is a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention. These files follow the Centers for Medicare & Medicaid Services (CMS) defined layouts and are in the CMS approved format(s) (like XML or JSON). These files are not meant to be a consumer-friendly search of rates, benefits, or cost sharing which is intended to come later.

Please note: The vendor referenced under this organization's EIN number is applying referenced-based pricing, which they are indicating excludes them from the Pricing Transparency Machine Readable Files regulations.

SISCO is monitoring this and other vendors and seeking regulatory guidance as necessary to ensure that our group health plans have the most up-to-date and complete information. Please check back on this claims pricing entity in the future, as this may be subject to change as the Federal Transparency in Coverage (TIC) regulations' intent is clarified.