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):
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.
Accelerated and accurate generation of negotiated rates in CMS specified format (MRF)
Platform agnostic SaaS based solution that works with all core administrative platform
Accelerated and accurate generation of negotiated rates in CMS specified format (MRF)
Platform agnostic SaaS based solution that works with all core administrative platform
Scalable data architecture for benefits beyond compliance
BYOD capable and subject matter experts to keep up with CMS changes
Scalable data architecture for benefits beyond compliance
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:
Accelerate implementation of personalized cost estimator tool integrating quality & cost metrics
Accelerate value-based payment models encouraging higher quality care and lower healthcare costs
Enable analytics on competitive and market prices & resulting adjustments to existing negotiated rates
Opportunity to differentiate with value-add services beyond the rate & pay equity for providers
Accelerate implementation of personalized cost estimator tool integrating quality & cost metrics
Accelerate value-based payment models encouraging higher quality care and lower healthcare costs
Enable analytics on competitive and market prices & resulting adjustments to existing negotiated rates
Opportunity to differentiate with value-add services beyond the rate & pay equity for providers
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