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, has 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 website (if you have a website).
We will be sending out the per group/per plan URLs very shortly with guidance on placing them on your public website. These URLs are static – meaning the link won’t change but the information will be automatically updated MONTHLY. Below is a quick FAQ regarding this process.
Employer Group FAQ:
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, please let us know as soon as possible by responding to this email (if you haven’t already responded to an earlier email). In this case, we can post the links on our Diversified Group website which will link to a searchable landing page.
If you do not have a public website, please notify our compliance team (contact information below) as soon as possible so we can ensure that a link for your group will be hosted on our website. Also be on the lookout for further information regarding the machine readable file link.
Dave Follansbee, VP of Operations and Compliance
firstname.lastname@example.org or (860) 295-6531
Laura Williams, Business Development and Compliance Consultant
email@example.com or (860) 612-8644