Supporting Materials Available for Machine-Readable Files
Applies to ASO Groups
The Transparency in Coverage Final Rule requires insurers and group health plans to publish machine-readable files starting July 1, 2022. The files contain in-network rates and out-of-network allowed amounts.
What’s new: Blue Cross and Blue Shield of Texas (BCBSTX) is providing supporting materials on machine-readable files to ASO groups.
Sample machine-readable files are available in a staging environment. The files may help groups understand what information will appear in the final files. Instructions to access their sample files are available for ASO accounts. These sample materials are for informational purposes only and should only be used prior to July 1, 2022.
What’s next: As we continue to monitor further regulatory developments related to the machine-readable files, the approach below may be subject to change based on any such developments.
BCBSTX will aim to make machine-readable files available on a publicly accessible site for ASO groups by June 25, 2022, for plan years starting on or before July 1, 2022, and then upon plan year renewal after July 1, 2022. These files will be posted separately from the Fully Insured files.
BCBSTX will host machine-readable files for benefits that we manage via a link on bcbstx.com for both Fully Insured and Self-insured Groups.
Self-insured Groups may choose to direct individuals to this website via a link or opt to download the file from this site to host in an alternative location.
However, if a group doesn't host through the bcbstx.com link, BCBSTX is not liable for any inaccurate information.
Additional information: Below are answers to some frequently asked questions that may assist with accessing the machine-readable files for your group. If you do not find the answer to your question, please contact your BCBSTX representative or account executive.
Q.An Employer Identification Number (EIN) is required to access my group’s sample machine-readable file. How do I find my group’s EIN? A. The EIN appears on the employer Benefit Program Application (BPA). If you need further assistance finding your EIN, please contact your BCBSTX representative or account executive.
Q.Will the machine-readable files be the same for Fully Insured and Self-insured (ASO) clients? A. BCBSTX will follow the standard schema for standard Fully Insured plans. The pricing data and format will be consistent and based on the plan. If the same network and negotiated rates apply, then the files will be the same.