Meritain Health Machine Readable Files (MRFs)

Please use the following link to access MRFs - https://health1.meritain.com/app/public/#/one/insurerCode=MERITAIN_I&brandCode=MERITAINOVER/machine-readable-transparency-in-coverage?reportingEntityType=TPA_15858&lock=true

*Consistent with the requirements of the federal Transparency in Coverage final rule, the Plan Sponsor machine readable pricing file for in network rates is publicly available and accessible free of charge without any condition. This file displays negotiated rates for all covered items and services for the health plan and in-network providers for the plans indicated. Some in-network provider arrangements do not prescribe rates for all covered items and services. In those cases, the provider’s reimbursement might be determined in several different ways, but this file would not contain that information. This file is not designed as a consumer tool. This file is 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 this file, including eligibility, medical necessity determinations, utilization management requirements, exclusions, and other plan terms. This file also does not offer any information on a member’s out-of-pocket charges. The information in this file is accurate as of the date immediately prior to the “last updated on” date stated in the MRF file and is subject to change without notice. This file contains information for participating (In-Network) or non-participating (Allowed Amount) providers over a broad geography. The members in the plan indicated may not access providers in this entire geographic area. Consistent with the requirements of the federal Transparency in Coverage final rule, the Plan Sponsor machine readable file for non-participating providers is publicly available and accessible free of charge without any condition. This file displays both billed charges and allowed amounts for all covered items and services of the non-participating providers for the plans indicated using the criteria established under the rule.