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U.S. Transparency in Coverage

Transparency in Coverage - U.S. health plan information

In compliance with The Transparency in Coverage Rule, issued in 2020, effective beginning July 1, 2022, health plans and health insurance issuers must publish two separate Machine-Readable Files (MRFs) containing In-Network and Out-Of-Network details. KUKA is pleased to provide the following information.


The federal Transparency in Coverage Rule released by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury delivers on Improving Price and Quality Transparency in American Healthcare.

 
The Transparency in Coverage mandate requires certain U.S. group health plans to disclose on a public website information regarding in-network provider rates, historical out-of-network allowed amounts, and billed charges for covered items and services in two separate machine-readable files (MRFs).  To access Blue Cross Blue Shield of Michigan's machine-readable files for the benefit package options under the KUKA US Holdings Health & Welfare Benefit Plan, click the link to download: https://bcbsm.sapphiremrfhub.com/tocs/current/kuka_us_holdings_company_llc

 

Important Notes regarding MRFs

  • The information contained in this Machine-Readable File may be difficult to access without certain technology.

  • These files may be large and require a computer that can download at least up to 1TB (terabyte) of data. Most modern hard drives store half of this amount of data. Based on your computer's storage and hard drive, attempting to open or download large files may cause instabilities in Windows, cause performance issues resulting in downloads that could take hours, days or weeks depending on the file size and hard drive combination. For reference: 1TB = 243 high-definition streaming movies (average 2 hours per movie).

  • This mandate is a building block for future customer-facing mandates, including the Price Transparency Tool and the Advanced Explanation of Benefits.

  • The data in the files may not be useful for the average consumer. For example, facilities that are paid based on a percent of charge will not have a dollar amount representing the amount paid for a service.

  • The machine-readable files will be updated monthly to ensure accuracy of the data and reflect changes in pricing and regulatory requirements.

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