Transparency in Coverage Rule

Critical information about transparency in coverage

Under the Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor and U.S. Department of Treasury and enforced beginning 7/1/2022, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate MRFs (Machine-Readable Files).

• In-network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers.
• Out of Network: Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period.

UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of Alcami.