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Suppose a group health plan doesn’t have an internet site to disclose the three machine-readable files publicly by 1/1/22. Could a third party, clearinghouse, or claims administrator post the files to their website to comply with the rule? |
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Replies: 2 comments 2 replies
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Regarding the allowed amount file (out of network) the mandate states that " Nothing in this section prevents the Allowed Amount File from being hosted on a third-party website or prevents a plan administrator or issuer from contracting with a third party to post the file. However, if a plan or issuer chooses not to also host the file separately on its own website, it must provide a link on its own public website to the location where the file is made publicly available." |
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@harntony is correct. If you can point people to where the files are being housed/posted, that will work. |
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Is this also true for the in-network file? Can employers link to the TPA's site where file is housed? |
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If the group health plan does not have it's own dedicated site and the TPA does not want to list all of their clients on their site, would a site that has the group health plan name on the site (thus searchable on the internet) and links to the MRFs suffice? |
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Regarding the allowed amount file (out of network) the mandate states that " Nothing in this section prevents the Allowed Amount File from being hosted on a third-party website or prevents a plan administrator or issuer from contracting with a third party to post the file. However, if a plan or issuer chooses not to also host the file separately on its own website, it must provide a link on its own public website to the location where the file is made publicly available."