In earlier communications from Diversified Group, you were notified of the requirements of the Transparency in Coverage (TiC) Rules that will be enforced beginning on July 1, 2022. The rules require plan sponsors to create two files — one to disclose in-network provider rates for covered items and services and another to disclose out-of-network allowed amounts and billed charges for covered items and services. Both files must be machine-readable, meaning they must conform to an open standard format such as XML or JSON and be made available from a searchable, secure link on the internet. These files do not contain PHI or specific, identifiable claim data, but pricing data from networks and other healthcare providers.
Diversified Group, along with our partner TALON, have been working on creating and hosting these files on your behalf to ensure you meet your compliance obligation. However, plans/plan sponsors are required to provide a link to the file on their public facing website (if you have a website).
On June 23rd or 24th 2022, you were sent the attached email with your plan’s individual machine-readable file link embedded. This is a reminder that if you have a public facing website, the URL link, per the Transparency in Coverage Rules (TiC), must be posted on that public facing site; the compliance date was July 1, 2022. Please note that this link is static, you only have to place it once. Behind the scenes, Diversified Group and TALON will ensure that the files are updated monthly in accordance with the TiC Rules.
Employer Group FAQ:
We have an internal intranet site, is that sufficient for the link?
An internal intranet/employee site is not considered compliant; machine-readable files are NOT intended for employees. Machine-readable files are required to be public and searchable so that health policy analysts/any interested public party can access them for research. They do not contain any identifiable information but instead are intended to provide network and OON reimbursement rates for targeted services to aid in healthcare/policy and research.
Where do I put the link?
The link must be placed on a public-facing website. This can be your main company website. The link CANNOT be placed anywhere access needs to be granted or where username/passwords are required.
What do I title the area where I put the link?
There is no mandate around what to call it, so something as simple as “Group Machine-Readable Files” will suffice.
What if a group doesn’t have a public-facing website?
Diversified Group and TALON will provide the URLs for all groups/plans. In the event you do not have a public-facing website, and you notified us of this in response to prior communications, Diversified Group has posted the links on our Diversified Group website which will link to a searchable landing page.
If you do not have the attached email with your group’s specific URL link, please notify our compliance team (contact information below) as soon as possible and we can forward over the link.
Dave Follansbee, VP of Operations and Compliance
email@example.com or (860) 295-6531
Laura Williams, Business Development and Compliance Consultant
firstname.lastname@example.org or (860) 612-8644