Transparency in Coverage is all about making healthcare costs clear and easy to understand. Health insurance companies and group health plans must share information about prices, like monthly costs, deductibles, and how much you pay for doctor visits. This information needs to be shared with the government, the Health Insurance Marketplace, and even made available to the public. By making costs transparent, it helps people shop for the best plans and make smart choices about their healthcare.
Highmark understands the importance of providing access to useful information about your coverage so that our members are able to make informed decisions. Below is a link for you to understand an overview of our claims payment and other helpful policies.
The Transparency in Coverage Final Rule, issued on Nov. 12, 2020, sets forth requirements for group health plans and health insurance issuers to produce machine-readable files (MRFs) that disclose in-network negotiated rates and historical out-of-network allowed amounts by July 1, 2022.
The Transparency in Coverage (TiC) Claim Data is like a report card for health plans, showing important information about healthcare costs. It includes details on how many claims the plan paid and why some claims might have been denied, like if the service wasn't considered medically necessary. This information helps people see how the plan handles costs and make better choices about their healthcare.
