Transparency in Coverage

Purpose

Beginning in July 2022, Payors and TPA's will need to comply with the Transparency in Coverage final rule, released by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury. While all aspects of this rule are ultimately the responsibility of the Payor, Arizona Foundation supplies the Network (and contracts) of providers, and therefore will support our payors by providing the in-network file portion of this rule.

For each plan a payor has active with Arizona Foundation, we offer a CMS standard JSON machine-readable-file (MRF) which contains all of our contracted rates for in-network providers. Payors may publish these files as-is, and/or import them into their own systems as necessary. If you have not already set up a Payor account with us, you may register now.

Technical Information

• Once decompressed, these files are very large and are not meant for average users to work with. Please contact your IT department for assistance if you are unsure of how to use this data.
• The published data file format is JSON, compressed with 7-Zip. 7-Zip yields a dramatically smaller file than zip, therefore 7-Zip (.7z) is the only format we will offer. 7-Zip is free (see links below).
• After logging in, files will be shown below for each of the products your active policies are associated with.
• Updated files will be available by the 5th of each month.

Links

• CMS github project for all file formats, examples, schemas, and technical information
• CMS Technical Clarifications for Health Plan Price Transparency
• Transparency in Coverage (TiC)
• Transparency in Coverage final rules (85 FR 72158)
• 7-Zip compression format

Data Files

Login to view available files.