TRANSPARENCY IN COVERAGE (TCR)
The Transparency in Coverage Rule (TCR) requires that Health plans make available to the public machine readable files with: In-network rates negotiated with providers and historical payments to out-of-network providers and their billed charges. A third requirement to publish machine-readable files for certain prescription drug information has been delayed indefinitely by the federal government as it works to issue additional rules surrounding this requirement.
• The intent of this regulation is to provide health care pricing information that supports more informed decisions for receiving care.
• BCBSND will provide the following machine-readable files, which are files where data is formatted in a way that can be processed by a computer, online:
In-network provider rates for covered services.
Out-of-network allowed amounts and billed charged for covered services.
• This mandate applies to fully insured group health plans, self-funded group health plans and individual policies, with the exception that this mandate does NOT apply to grandfathered health plans.
• BCBSND is committed to sharing information regarding the TCR with our employer groups.
Transparency in Coverage