The Road to MRFs’ Final Data Schema Has Several Speedbumps
In October 2020, CMS issued the Transparency in Coverage final rule. As part of this rule, health plans are required to publish machine-readable files (MRFs) for their negotiated rates, out-of-network allowed amounts, and prescription (Rx) coverage rates and allowed amounts. On March 1, 2022 approximately 18 months after the rule was issued, CMS locked v1.0.1 of the schema for MRFs. Getting to this “enforcement data schema” wasn’t easy. There were 20 other versions of the schema before it — and CMS may not be finished fine tuning it either.
