The Transparency in Coverage rules require that self-funded group health plans make machine-readable files (MRFs) available that disclose in-network rates and out-of-network allowed amounts and billed charges for plan or policy years that start on or after January 1, 2022.
Congress and federal agencies intended these MRFs to be used by researchers, regulators, lawmakers, patient and consumer advocates, etc., in order to develop tools and information to support consumer choice.
Our health plan carriers are creating and publishing these required MRFs on our behalf.
Please note: Because of the size of the files, you may need special computer software/speed to open the files.
This price information contained in these large files is NOT an estimate of the costs that you are responsible for paying. These files are not intended for patients and do not reflect your out-of-pocket costs. If you are a patient, you can request a cost estimate by your health insurance provider.
Downloading these files requires you to have sufficient storage space and the capability to read JSON files on your device:
In-network care:
- Mass General Brigham Health Plan machine-readable file
- UHC out-of-area machine-readable file
- Optum Health behavioral services machine-readable file
Note: Expand the section titled "Machine-readable files" and click the first sentence to generate the zip file. Within the zip file, search for "MGB" to find the URLs/files associated with MGB’s plans.
How can I access machine-readable files?
In compliance with regulatory guidelines, machine-readable files are available through a public link on the Mass General Brigham Health Plan website. The files can be accessed using a JavaScript Object Notation (JSON) viewer. For additional information on formatting and accessing machine-readable files, please visit the GitHub on the Centers for Medicare & Medicaid Services (CMS) website.
How can I identify different providers in machine-readable files?
Through these machine-readable files, users can find information for a variety of our plans, including Health Maintenance (HMO), Preferred Provider Organization (PPO), and high-performance network products. To locate specific providers, users can reference providers based on their National Provider Identifiers (NPI) code, which can be found on the CMS website: https://npiregistry.cms.hhs.gov/.
What are the system and browser requirements for accessing machine-readable files?
Machine-readable files can be accessed using any internet-based browser with download capabilities. These files are highly complex, comprehensive, and can exceed 1 gigabyte in file size, which may require a computer software with higher Random Access Memory (RAM) or storage.
- In-network care machine-readable file (please use EID: 042807148)
- Out-of-network care machine-readable file
In the "Table of Content Files" field, select "Self-Insured TOC", then click Download. In the file, search for "043230035" to locate the in-network rates file URL and navigate to the end of the file to locate the allowed amounts file.
Per BCBSMA’s FAQs: The table of contents file combines multiple in-network/allowed amounts rate files into a single index file. The Plans that have same negotiated data (allowed amounts) can be grouped into a single array within the table of content file.
OR
In the "Select Plan Type" drop-down, choose "EIN" and enter 043230035. Download all files or choose just the PAR Providers In-Network Rates File for in-network care and scroll to the bottom of the list to choose the PAR Providers Allowed Amount Allowed Amount File for out-of-network care.
There are a large number of out-of-state providers that will appear in the results.
Per BCBSMA’s FAQs: Our members receive provider services both in and out of state. We recommend including out-of-state providers for completeness so that accounts/members can understand the cost of their healthcare services regardless of where the service is being provided. Although not recommended, users who do not wish to see costs related to Out-of-State provider will be able to uncheck the relevant files prior to downloading the MRF’s.
In-network care
Out-of-network care
Note: In the "Access the machine-readable files" section, click "View Plan List" and then scroll down to find Mass General Brigham.
Note: In the "Access the machine-readable files" section, click "View Plan List" and then scroll down to find Mass General Brigham.