Price Comparison Tool, Cost Sharing Estimator Tool, and Machine Readable Files [CAA/TCFR, Transparency Provision]

Price Comparison Tool, Cost Sharing Estimator Tool, and Machine Readable Files [CAA/TCFR, Transparency Provision]

This provision overlaps with CAA Price Comparison Tool and TCFR Cost Sharing Estimator Tool.

TFCR Machine Readable File provision requires in-network rates and out-of-network allowed amounts to be available in a machine readable file format. 

• These files will be hosted through an external vendor and available through this link: ​​​​​Blue Shield of California – Machine Readable Files
• A webpage for MRF, publicly available to anyone visiting the Blue Shield home page, is available here.

TCFR Cost Sharing Estimator Tool requires that group health plans and insurance issues make available to members, personalized out-of-pocket cost information for covered items and services, through a self-service tool and in paper within 2 days upon request. 

CAA Plan Comparison Tool section 114 requires that group health plans and insurance issuers maintain a “price comparison tool” available via phone and website that allows members and participating providers to compare cost-sharing for items and services by any participating provider.

Market impact of this provision effects Individual Family Plan (IFP), Small Business Markets (SBM), Core, Premier, Administrative Services Only (ASO) and Shared Advantage (SA) lines of business.