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The TCR 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 MRFs.
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In‑network MRFs
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To support the posting of MRFs, Independence Blue Cross (Independence) is developing a Table of Contents file for our company website, ibx.com. The Table of Contents will contain the links to our in‑network MRFs by issuing company (e.g., PPO plans point to QCC, Inc., HMO plans point to Keystone Health Plan East, Inc., etc.). Self‑funded customers will be provided links via email to a customer‑specific Table of Contents file with the appropriate links for each of their plans.
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Out‑of‑network MRFs
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Independence will produce an out‑of‑network allowed amount file per self-funded customer that will contain the required reporting for their business. Independence shall report self‑funded out‑of‑network rates using the self‑funded customer’s EIN and client name (customer‑specific file).
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Action needed: Self‑funded MRF link notification
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Independence will send a monthly email to the self‑funded customer’s mandate email address, a new contact type, with the links the customer can post to their public website. To send the monthly emails, Independence will need an email address on file as the mandate contact from each self‑funded customer. This email address is needed by June 17, 2022, otherwise the mandate contact will default to the contact in Independence’s customer files (CRM). Please send the mandate contact for your self‑funded customers to your account management team.
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Posting MRF links - Fully Insured
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(Note, the links below are not yet live)
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Fully insured customers will be directed to:
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QCC, Inc.
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https://www.ibx.com/transparency-in-coverage?brand=qcc
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Keystone Health Plan East
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https://www.ibx.com/transparency-in-coverage?brand=khpe
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Blue Cross Hospital Indemnity, Inc.
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https://www.ibx.com/transparency-in-coverage?brand=bc
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which will contain links to all Independence in‑network MRFs, all Blue Host Plan in‑network MRFs, 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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QCC, Inc.
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YYYY-MM-DD_qcc_index.json
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Keystone Health Plan East
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YYYY-MM-DD_khpe_index.json
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Blue Cross Hospital Indemnity, Inc.
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YYYY-MM-DD_bc_index.json
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per CMS requirements and provide an index of MRF links for QCC, Inc., Keystone Health Plan East, and Blue Cross Hospital Indemnity, Inc., respectively.
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Posting MRF links - Self‑Funded
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(Note, the links below are not yet live)
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Each self‑funded customer will be sent customer specific links that follow this pattern:
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QCC, Inc.
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https://www.ibx.com/transparency-in-coverage/12345?key=xxxxxxx
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Keystone Health Plan East
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https://www.ibx.com/transparency-in-coverage/12345?key=xxxxxxx
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Blue Cross Hospital Indemnity, Inc.
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https://www.ibx.com/transparency-in-coverage/12345?key=xxxxxxx
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By clicking the customer specific link, the customer will navigate to their specific MRF Table of Contents file link. The name of the customer specific MRF Table of Contents will follow this format:
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QCC, Inc.
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https://storage.googleapis.com/ihg-dart-edw-mrf-prod-public/qcc/YYYY-MM-DD_12345_index.json
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Keystone Health Plan East
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https://storage.googleapis.com/ihg-dart-edw-mrf-prod-public/khpe/YYYY-MM-DD_12345_index.json
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Blue Cross Hospital Indemnity, Inc.
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https://storage.googleapis.com/ihg-dart-edw-mrf-prod-public/bc/YYYY-MM-DD_12345_index.json
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and contain a series of links to in‑network MRF json files specific to their plans and out-of-network MRFs for their business. The customer would then copy the links and post on their public website. The customer will receive a monthly notice that the data at the links has been updated.
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If there is a request for customization of either in‑network or out‑of‑network MRFs, Independence 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 in‑network rate MRFs for their respective plans
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