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Transparency in Coverage Regulation and Consolidated Appropriations Act

MACHINE READABLE FILES

Beginning July 1, 2022, as a part of the Transparency in Coverage regulation, the Tri-Agencies (U.S. Departments of Health and Human Services, Labor, and Treasury) require health plans (including self-funded group health plans and insurers offering coverage in the individual and group markets) to publish negotiated rates for all items and services for Commercial coverage (In-Network files) and historical payments to, and billed charges from, out-of-network providers (Out-of-Network Files) in the form of machine-readable files made publicly available on an internet website.

HealthLink will only be supplying In-Network files and those will be updated monthly. HealthLink assumes no responsibility for how the information in these files is used or interpreted by third parties.

Access machine readable files

For more information, read the Machine Readable Files FAQs.


CAA Gag Clause Compliance Requirements

The Consolidated Appropriations Act (CAA) gag clause provision prohibits group health plans and health insurance issuers offering group health insurance coverage from entering into an agreement between a plan or issuer and a healthcare provider, network or association of providers, third-party administrator, or another service provider offering access to a network of providers that would directly or indirectly restrict a plan or issuer from disclosing or accessing certain price and quality information.

Group health plans and issuers are required to submit an attestation each year to confirm compliance with the prohibition on gag clauses. This year it is due by December 31, 2023. We are providing you with this confirmation of compliance for the business and information that we administer and maintain.

HealthLink represents that the participation agreements with the healthcare providers in its networks are consistent with the requirements set forth in Section 201 of the Consolidated Appropriations Act, 2021.

This confirmation of compliance allows group health plans to complete the attestation on the CMS HIOS portal by the December 31, 2023, deadline. The portal provides submission instructions to complete the attestation.