Under the Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor and U.S. Department of the Treasury and enforced beginning 7/1/22, health plans and health insurance issuers must publish two separate MRFs.

The MFRs cover:

In Network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers

Out of Network: Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Click here for the download

Technical Requirements:

File Type:

Nested JSON, Compressed with GZip

Hard Drive Space Required:

Compressed files may be up to 600 gigabytes (GB). Uncompressed files may be up to 1.5 Terabytes (TB).
To download and decompress a single file may require up to approximately 2.5 TB of free hard drive storage.

RAM Recommendation:

Cigna utilized 758 GB of RAM to compress the files

With this amount of RAM and the recommended processor (below), expect approx. 1-2 hours to decompress a single file

CPU / Processor Recommendation:

Cigna utilized a 96 core CPU to compress the files

With this amount of cores and the recommended RAM (above), expect approx. 1-2 hours to decompress a single file

Compression Software:

Compression software that can decompress Gzip (i.e. Winzip, 7-zip, default compression libraries in Linux)

File Editor:

A file editor that can accommodate opening a 1.5 TB file is required. Example: EM editor

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