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Meritain Health Machine Readable Files (MRFs)

Please follow this link to access the MRFs

Consistent with the requirements of the federal Transparency in Coverage Final Rule, the Plan Sponsor machine-readable pricing file for in-network rates is publicly available and accessible free of charge without any conditions. This file displays negotiated rates for all covered items and services for the health plan and its in-network providers. Some in-network provider arrangements do not prescribe rates for all covered items and services. In those cases, the provider’s reimbursement may be determined in several different ways, but this file would not include that information. This file is not designed as a consumer tool. It is not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in this file, including eligibility, medical necessity determinations, utilization management requirements, exclusions, and other plan terms. This file also does not include information on a member’s out-of-pocket costs. The information is accurate as of the date immediately prior to the “last updated on” date stated in the MRF file and is subject to change without notice. This file contains information for participating (in-network) and non-participating (allowed amount) providers across a broad geographic area; however, members in the indicated plans may not access providers across this entire area. Consistent with the Transparency in Coverage Final Rule, the Plan Sponsor machine-readable file for non-participating providers is also publicly available and accessible free of charge. It displays billed charges and allowed amounts for all covered items and services of non-participating providers for the indicated plans using criteria established under the rule.