Machine Readable Files (MRFs)
Table of Contents Files
Files that allow multiple plans with the same rates to reference existing machine-readable files
In-network Rates Files
Files that contain specific information about covered items and services for in-network provider rates
Allowed Amount Files
Files that contain specific information about covered items and services for out-of-network provider rates
These files are not designed as a consumer tool. Members are encouraged to use the more member-friendly price estimator tools available through the health plan's public website. These files are 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 these files, including eligibility, medical necessity determinations, utilization management requirements, exclusions and other plan terms. These files also do not offer any information on a member's out-of-pocket charges. The information in these files is accurate as of the date noted for each file and is subject to change without notice.