Transparencia en la cobertura
Machine-readable files (MRFs)
On November 12, 2020, the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury issued a Final Rule entitled Transparency in Coverage (the Final Rule). The Final Rule applies to non-grandfathered group health plans and health insurance issuers offering non-grandfathered coverage in the group and individual markets. The Final Rule requires that plans and issuers post publicly available MRFs which contain in-network rate and out-of-network allowed amount data for the applicable policies, and that this information be regularly updated.
Additional information and resources regarding the Transparency in Coverage Final Rule can be found here:
Looking for QHP transparency information?
Quartz is also required to share certain details about Qualified Health Plans (QHPs) offered through state or federal exchanges (also referred to as “transparency in coverage”). This information can be found here:
Accessing Files
Quartz produces and posts the required MRFs on a third-party website on behalf of all fully-insured groups.
Files are publicly-accessible and free of charge. No user account, password, credential or identifying information is required to access the files.
Files will be released every month and will be stamped with the latest file update date. The updated file(s) will also replace the previous file. Pricing included in posted machine-readable files is accurate as of the date it is extracted, but may change before the next update of the files.
Identifying Applicable Files
In-Network Rates & Allowed Amounts Files: In order to identify the correct MRF for your plan’s in-network rates and allowed amounts, use the Table of Contents Files or “Search MRFs” feature. You will need to know your plan name or Quartz Plan ID, which can be found on your Quartz ID Card. Once you filter by your Quartz Plan ID, the In-Network Rates & Allowed Amounts files that apply to your plan will be returned. Note that more than one group or policy may share that plan ID, so you may have to select the MRF that applies based on your group name. If you need assistance identifying your plan name or ID, contact Quartz Customer Success at (800) 362-3310.
Note: Allowed Amount MRFs are generated regardless of whether the group has met applicable claims thresholds during the look-back period. In the event the claims threshold was not met, the group-specific Allowed Amount file will be empty.
Disclaimer
MRFs are not designed as a consumer tool. Members are encouraged to use the more member-friendly price estimator tools available through your Quartz MyChart account. These files are not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in these files, including eligibility, medical necessity determinations, utilization management requirements, exclusions and other plan terms. These files also do not offer any information on a member’s out-of-pocket charges. The information in these files is accurate as of the date noted for each file and is subject to change without notice.
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