Transparency in Coverage
Summary of Mandate
According to the Federal Government’s Transparency in Coverage rule, plans and issuers must make public machine-readable files containing certain pricing information. These machine-readable files include negotiated rates for in-network providers and allowed amounts and historical billed charges for out-of-network providers.
To access Wolverine’s machine-readable files, click the link below to download the table of contents that contains web addresses for the .Json format files with in-network negotiated rates and out-of-network allowed amounts and historical billed charges. You will need to copy the URLs in the table of contents and paste in your browser to download the machine-readable files.
- The information contained in this Machine-Readable File may be difficult to access without certain technology.
- These files may be large and require a computer that can download at least up to 1TB (terabyte) of data. Most modern hard drives store half of this amount of data. Based on your computer’s storage and hard drive, attempting to open or download large files may cause instabilities in Windows, cause performance issues resulting in downloads that could take hours, days or weeks depending on the file size and hard drive combination. For reference: 1TB = 243 high-definition streaming movies (average 2 hours per movie).
- This mandate is a building block for future customer-facing mandates, including the Price Transparency Tool and the Advanced Explanation of Benefits.
- The data in the files may not be useful for the average consumer. For example, facilities that are paid based on a percent of charge will not have a dollar amount representing the amount paid for a service.
- The machine-readable files will be updated monthly to ensure accuracy of the data and reflect changes in pricing and regulatory requirements.