Human Resources

The Federal Transparency in Coverage Rule requires that non-grandfathered group health plans and insurance carriers to publicly disclose in-network provider rates for covered items and services and out-of-network allowed amounts and billed charges for covered items and services. This information must be disclosed in machine readable files.

The link provided below leads to the machine-readable files that are made available in response to the transparency rules and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers.  An Employer Identification Number will be required to search for the Machine-Readable File specific to your plan.  You can use 06-6001874.  The link will NOT be activated until 7/1/2022.

• NOTE: For access to MRF’s, Anthem is requiring an Employer Identification Number (EIN), also known as a TIN.  Anthem has stated that the EIN requirement is not a security measure, but is the only way to obtain a MRF specific to their plan/s.  Unfortunately Anthems only recommendation as a workaround to this requirement is to include the EIN as a note where the link will be posted.  

• 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. <Optional: An Employer Identification Number will be required to search for the Machine-Readable File specific to your plan.  You can use 06-xxxxxxx.>

  Let us know if you have any questions or concerns.  

https://anthem.com/machine-readable-file/search

As an update to the Surprise Medical Billing Legislation, the Federal Government is requiring group plan sponsors to post the attached model notice on their intranet site where medical coverage is addressed or where employees may go for medical benefits information. This notice explains both federal and applicable state surprise billing protections (about 33 states have their own surprise billing protections, typically affecting insured coverage in the state but sometimes allowing self-funded employers to opt in).

The notice obligation is effective for plan years beginning in or after 2022; so it’s effective July 1, 2022 for your group.

This notice will review the rights and protections against surprise medical bills, or unexpected balanced bills received after certain medical services. Specifically, when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

The Surprise Billing Model notice explains both federal and applicable state surprise billing protections.  This notice will review the rights and protections against surprise medical bills, or unexpected balanced bills received after certain medical services.  Specifically, when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

Please review and let me know if you have any questions regarding this guidance.

Surprise Billing Model Notice