Machine-Readable File Requirements
| File Type | Content | Status |
|---|---|---|
| In-network rates file | Negotiated rates for all covered items and services from in-network providers | Required — operative since July 1, 2022 |
| Out-of-network allowed amounts file | Allowed amounts and billed charges for out-of-network services | Required — operative since July 1, 2022 |
| Prescription drug file | Negotiated rates for prescription drugs | Enforcement deferred — not currently operative |
Online Cost Estimator
Plans must provide an online cost estimator tool that allows members to estimate their cost-sharing for covered items and services before receiving care. The tool must cover all covered items and services (since January 1, 2024) and must provide personalized cost estimates based on the member's specific plan and cost-sharing.
Carrier Responsibility
IQ Insight
For fully insured plans, the carrier is responsible for MRF and cost estimator compliance. For self-funded plans, the employer is responsible — but typically delegates compliance to the TPA or carrier. Confirm your TPA or carrier is meeting MRF and cost estimator requirements and obtain written confirmation of compliance.