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Transparency in Coverage Data

Helping you understand your healthcare costs

You may have heard about the federal Transparency in Coverage Rule, which is intended to help commercial members understand healthcare costs. AllWays Health Partners is committed to this rule and shares its goal of empowering our members.
 
In alignment with the Transparency in Coverage rule, AllWays Health Partners publicly displays information, called machine-readable files. These files are updated on a monthly basis and include in-network negotiated provider rates and out-of-network provider allowed amounts.

  • Additional resources
    For additional information about the Transparency in Coverage Rule, please visit the Centers for Medicare and Medicaid Services website. You can also review our Frequently Asked Questions (FAQs) below.
     
    In addition, AllWays Health Partners commercial members have access to a variety of resources for understanding healthcare costs. This includes our cost estimator tool for tracking cost-sharing and viewing payments within your plan, which can be accessed through the AllWays Member app and member portal. Please note, machine-readable files can include provider reimbursement rates for services that may have restrictions within your specific plan.
  • Machine-readable files
    Click here to access machine-readable files for AllWays Health Partners plans. Please note, to use the machine readable files, the member should use an appropriate online JSON tool to format the data. 


     *Multiplan (PHCS) wrap provider in-network only applies to the state of New Hampshire therefore please refrain from using this file in its entirety and use these rates for providers in the state of New Hampshire only.

     

    **Multiplan/Data iSight out-of-network provider network only applies to the states of Massachusetts and New Hampshire therefore please refrain from using this file in its entirety and use these rates for providers in Massachusetts and New Hampshire states only.
  • FAQs
    What are machine-readable files?
    As part of the federal Transparency in Coverage Rule, health insurers and self-funded group health plans or employer-sponsored plans are required to publicly display information, called machine-readable files. These files are updated monthly and include in-network negotiated provider rates and out-of-network provider allowed amounts.
     
    What is an in-network rate?
    An in-network rate is the amount that a health insurer has agreed to pay a contracted provider for  healthcare services. As part of the Transparency in Coverage Rule, these rate files include negotiated rates, underlying fee schedule rates used to determine cost-sharing, or derived amounts, according to the rate that is applicable to the health insurer’s reimbursement model.
     
    What is an out-of-network allowed amount?
    An out-of-network allowed amount is the maximum payment that a health insurer will pay for a healthcare service from a non-participating provider. As part of the Transparency in Coverage Rule, these rate files include the allowed amount for those items and services, including each unique amount associated with the individual provider.
     
    When will machine-readable files be available?
    In compliance with federal guidance related to the Transparency in Coverage Rule, machine-readable files will be publicly available starting on July 1, 2022, and updated on a monthly basis.
     
    How can I access machine-readable files?
    Machine-readable files must conform to a non-proprietary, open standards format that is platform independent and made available to the public without restrictions that would impede the re-use of that information (such as JSON and XML). These files are highly complex and comprehensive; the AllWays Health Partners files require an appropriate online JSON tool to format the data. 
     
    To help members understand their healthcare costs, AllWays Health Partners members have access to a variety of resources, such as our cost estimator tool to track the status of claims and cost-sharing within your plan through the AllWays Member app and member portal. Please note, machine-readable files can include provider reimbursement rates for services that may have restrictions within your specific plan.
     
    How can I identify different plans and providers in machine-readable files?
    Through these machine-readable files, users can find information for a variety of our plans, including Health Maintenance (HMO), Preferred Provider Organization (PPO), and high-performance network products. To locate specific providers, users can reference providers based on their National Provider Identifies (NPI) code, which can be found on the CMS website: https://npiregistry.cms.hhs.gov/.
     
    What should I do if I notice an issue or need assistance?
    We are committed to the federal Transparency in Coverage rule and providing high-quality information. If you experience any technical issues or need additional support, please contact us at 866-414-5533 or CustomerService@AllWaysHealth.org, and a representative will be able to assist you.

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