If you've ever asked what a medical procedure costs and been told "it depends on your insurance," machine-readable files are the answer to depends on what? They're where insurers publish the prices they've agreed to pay for care.
The short version
A machine-readable file (MRF) is a data file that a health plan must publish under the federal Transparency in Coverage rule. It lists the negotiated rate for every covered service with every in-network provider. Plans update their files every month and post them publicly, with no login required.
Why "machine-readable"?
The rule required plans to publish in a structured format, JSON, that follows a public schema. That makes the data consistent and open to any software. It also makes the files impractical to open by hand: a single in-network file can be many gigabytes, and a large insurer publishes thousands of them every month.
What's in the files
There are three main kinds:
| File | What it contains |
|---|---|
| In-network rates | Every negotiated rate, by billing code and provider |
| Allowed amounts | Historical payments for out-of-network care |
| Table of contents | Which plans use which rate files |
Each rate in an in-network file is tied to a billing code, like a CPT code for a procedure, and to providers identified by their NPI. It also records details that change the price, like place of service and whether it's a professional or facility fee.
What you can learn from them
With the files processed and joined to provider data, you can answer questions like:
- What does my plan pay for a brain MRI at each imaging center near me?
- Is a colonoscopy cheaper at a surgery center than at the hospital?
- How do two insurers' networks compare on price for the services my company uses most?
- How much do prices for the same procedure vary across a state?
That's what we're building at US Health.io: searchable prices for every procedure, provider and area, drawn straight from the files insurers publish.