Group health plans and health insurers must make three separate machine-readable files publicly available. These files have been formatted for ease of discovery and are updated monthly to include detailed pricing information for our in-network (INN) providers, out-of-network (OON) providers, and INN negotiated rates and historical net prices for our drug formularies. In accordance with this requirement, we have the following files available for use: index data, INN medical provider data and OON medical provider data. The requirement to post a machine-readable file (MRF) containing the in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level has been deferred until further notice.
A machine-readable file is defined as a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention and without changing its meaning. The Transparency in Coverage (TiC) rule specifies that insurers/plans must create and publicly post MRFs with detailed in-network and out-of-network pricing data. TiC requires each MRF to use a nonproprietary, open format.
An in-network file has been created for each network a group uses and will include a separate file for each Blue® Plan nationwide. The out-of-network file is a single file.
Files are in JSON format.
Anyone can visit our public website and download files based on employer group EIN. However, these files are not intended for member consumption. These files are for a computer application that members may use. Members who wish to review pricing for specific providers or procedures can visit our Find Care tool available in the member portal.
Price transparency requirements can result in very large file sizes that may, in turn, cause issues while downloading them. If you are experiencing problems, please try a different web browser or check your internet and Wi-Fi speed.
For questions about an issue with this site or downloading files, please contact us for support by emailing MRF.Support@NationalAlliance.comor by calling
Please include this information in your email: