Transparency in Coverage

The below links* lead to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule effective July 1, 2022 and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files (MRF) are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.  They are not meant for a member-friendly search of rates, benefits or cost sharing.  Members should continue to refer to the member resources available through anthem.com or capbluecross.com. 

As a reminder, 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 the Treasury and enforced beginning 7/1/22, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate MRFs:

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

*Note that prior to 7/1/2022, the link will take you to either the Anthem or Capital Blue Cross home page but will access the MRFs page after that date.