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June 2022
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Market Edge
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News for All Segments | AmeriHealth NJ
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Update on the Machine-Readable Files (MRFs) Transparency in Coverage (TCR) Provision for AmeriHealth New Jersey
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The TCR Provision requires health plans and plan sponsors to make in‑network and out-of-network machine-readable files available to the public by July 1, 2022. Here are some updates on the MRFs.
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In‑Network MRFs
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To support the posting of MRFs, AmeriHealth New Jersey is developing a Table of Contents file for our company website AmeriHealthNJ.com. The Table of Contents file will contain the links to our in‑network MRFs by issuing company.
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Posting MRF Links
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(Note, the below links are not yet live)
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Customers will be directed to:
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AmeriHealth NJ Insurance Co, Inc.
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https://www.amerihealthnj.com/transparency-in-coverage?brand=ahnj
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or
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AmeriHealth HMO, Inc.
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https://www.amerihealthnj.com/transparency-in-coverage?brand=ahnjhmo
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which will contain links to all AmeriHealth New Jersey in‑network MRFs, links for Magellan national rates, links to all applicable rental networks, and all OON Allowed Amount MRFs per issuing company. The name of the MRF Table of Contents will follow this format:
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AmeriHealth NJ Insurance Co, Inc.
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yyyy-mm-dd_ahnj_index.json
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or
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AmeriHealth HMO, Inc.
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yyyy-mm-dd_ahnjhmo_index.json
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per CMS requirements and provide an index of MRF links for AmeriHealth NJ Insurance Co, Inc. and AmeriHealth HMO, Inc., respectively.
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If there is a request for customization of either in‑network or out-of-network MRFs, AmeriHealth New Jersey will need the details provided to the sales account executive. The timeline for implementation and cost of customization would be determined from there.
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The customer may post the MRF Table of Contents link to their public website. Please note: Because in‑network rates are provider-specific and not customer specific, all customers will be pointed to the brand and issuing company's in‑network rate MRFs for their respective plans.
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