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What is the Transparency in Coverage (TiC) Rule?

The Transparency in Coverage Rule is a federal regulation designed to empower consumers to shop and compare costs among various providers before receiving care, helping consumers better understand the cost of their health care.  


There are two (2) components to this regulation: 1) the machine-readable files and 2) an Internet-based price comparison tool. 

Machine-readable file (MRF)

Machine-readable file (MRF)

The machine-readable file must conform to a non-proprietary, open-standards format that is platform independent and made available to the public without restrictions.


The machine-readable files consist of an In-Network Rate (rates for all covered items and services between the plan or issuer and in-network providers) and an Allowed Amount (allowed amounts for -- and billed charges from -- out-of-network providers). 


The MRF does not contain any benefit details or member personal health information.


The Departments of Health and Human Services, Labor, and the Treasury envision third-party developers and other entities will download, process, and compile this data, creating more advance price transparency tools. This data is not designed for member or consumer usage. 

Machine-readable files FAQs

Self-funded plan sponsors are responsible for complying with the regulations. Aetna provided a unique URL (link) the plan sponsor could post on their website. The In-Network & Allowed Amount MRF will update monthly.


For fully insured and Small Group Aetna Funding Arrangement, no action is needed. Aetna will post the required data on

Self-funded plan sponsors should retain MRF data according to their data retention policy. For fully insured plan sponsors, Aetna will retain the MRFs according to our data retention policy.

Both MRFs contain the plan sponsor’s plan name, employer identification number (EIN), the reporting entity creating the MRF(s), billing codes, billing code description, CMS 2-digit place of service, provider’s tax identification (TIN), and provider’s national provider identifier (NPI).


In-Network will contain the negotiated rates for covered items services and the end date if applicable for the rate for all participating providers for the plan.


Allowed Amount will contain the allowed amounts for and billed charges from the non-participating providers (out-of-network) to the relevant historical period (90 day of claim history) of the 20-claim threshold should be applied at the billing code level. 

Internet-based price comparison tool

Internet-based price comparison tool allows an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers for 500 covered items and services as of 1/1/23 and all covered items and services as of 1/1/24.

Consolidated Appropriations Act


The Consolidated Appropriations Act (CAA) was established to protect consumers from unexpected costs related to health care billing by offering transparency about health care costs.


The No Surprises Act (NSA) provides protections from surprise medical bills for coverage of emergency services, coverage of non-emergency services performed by out-of-network providers at in-network facilities, prohibits balance billing, establishes special rules for high deductible health plans, and applies external review requirements for surprise billing.


Learn more about the No Surprises Act

Independent Dispute Resolution (IDR) is an arbitration process to resolve NSA-eligible payment disputes. It is required by the NSA and establishes an arbitration process by an external entity that will resolve eligible payment disputes between air ambulance, emergency services or non-emergency medical services provided by an out of network provider at a participating facility and health plans.


Learn more about Independent Dispute Resolution

Aetna’s system is configured to apply Qualified Payment Amount (QPA) to NSA-eligible claims. Claims that apply the QPA have certain action codes to indicate payment. Those action codes are included in our logic to identify the appropriate claims to charge the NSA-eligible per claim fee.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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