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Machine Readable File Engine for Payers

Accelerate CMS Compliance for Coverage Transparency

 



CMS Requirements & Challenges

In Nov 2020, CMS finalized the Transparency in Coverage Rule to drive transparencies around payer price negotiations with providers and enable members to access pricing information before they agree to a service.         

As per CMS Rule, By 1st of July 2022, Payers are required to disclose provider-specific reimbursement rates via three Machine-Readable Files (MRFs):

 

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However, Payers are facing significant challenges in generating these Machine Readable Files (MRFs) and meeting the compliance date of 1st July 2022:

  • Silos of pricing information in legacy core admin systems
  • Lack of SMEs within payers who understand both the complexity of payer data and CMS mandates
  • Flexibility to adapt to CMS guidelines for schema changes, to be finalized in Mar 2022
  • Accommodating for plan specific contract arrangements

 

How can we help?

MRF Engine is a platform-agnostic SaaS solution that helps payers accelerate CMS compliance for Coverage Transparency, empowering members to make well-informed decisions.

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Highlights

Meet the July 1, 2022 timeline. With ease!
BI-Clinical - hover

Accelerated and accurate generation of negotiated rates in CMS specified format (MRF)

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Platform agnostic SaaS based solution that works with all core administrative platform

BI-Clinical - hover

Accelerated and accurate generation of negotiated rates in CMS specified format (MRF)

writing

Platform agnostic SaaS based solution that works with all core administrative platform

Data aggregation-hover

Scalable data architecture for benefits beyond                     compliance

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BYOD capable and subject matter experts to keep up with CMS changes

Data aggregation-hover

Scalable data architecture for benefits beyond                     compliance

innovation-1

BYOD capable and subject matter experts to keep up with CMS changes

Machine Readable File Engine for Payers: Advantage

MRFE is designed to simplify and accelerate delivery of a very complex and involved process for CMS compliance and help Payers build the foundation to extract value beyond compliance:

One-stop

Accelerate implementation of personalized cost estimator tool integrating quality & cost metrics

Real Time

Accelerate value-based payment models encouraging higher quality care and lower healthcare costs

Support for Quality Programs

Enable analytics on competitive and market prices & resulting adjustments to existing negotiated rates

Rules Manage

Opportunity to differentiate with value-add services beyond the rate & pay equity for providers

One-stop

Accelerate implementation of personalized cost estimator tool integrating quality & cost metrics

Real Time

Accelerate value-based payment models encouraging higher quality care and lower healthcare costs

Support for Quality Programs

Enable analytics on competitive and market prices & resulting adjustments to existing negotiated rates

Rules Manage

Opportunity to differentiate with value-add services beyond the rate & pay equity for providers

Consult our Experts

Get to know more about the products we offer. We are glad to help you.

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* As per regulation § 170.523(k)(1)(iii) of the ONC 2015 Edition Final Rule, the Cost and Limitations and Product Information Statement for BI-Clinical can be found here:  BI-Clinical 18.4, BI-Clinical 18.11, BI-Clinical 2020.1904 , BI-Clinical_BIC2021

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)