Pride BPO

Transparency in coverage

Critical information about transparency in coverage

This communication is being shared to United Health Care medical clients regarding the standard machine-readable files (MRFs) hosting service. Under the new Transparency in Coverage Rule, we are required to provide you access to information regarding MRFs. This data will include:

In-network services:

Negotiated rates for all covered items and services between the plan or issuer and in-network providers.

Out-of-network services:

Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily. Link: