Federal regulations require non-grandfathered group health plans and health insurance issuers in the individual and group markets to disclose certain pricing information, like in-network negotiated rates and out-of-network-allowed amounts through machine-readable files. While these files are available to the public, they are technical in nature and may be most helpful to data analysts for education or research purposes.
The machine-readable files follow a format set out by the Centers for Medicare & Medicaid Services (CMS) and are updated monthly. They are presented in a JSON format and are made available to the public in good faith without restriction. They may be downloaded for reuse. Our employer customers may link to this page to provide access to the files via their website. CMS provides additional technical information about machine-readable files at github.com/CMSgov/price-transparency-guide.
The machine-readable files contain information generated from our systems and from our vendors. While we believe the information to be accurate, we can’t guarantee that the information is error-free, complete, or will operate without interruption. Any use by a third party of the pricing information within the files and any liability attached thereto is at the risk of such third party. Rates represented in the files do not guarantee that items or services described in the files will be covered under any particular benefit plan. Members can access cost estimates for services under their plan through a cost-estimator tool located on our member website. CMS will release updated versions of the file requirements. As additional guidance is released, EmblemHealth will update the files within a commercially reasonable time frame.
TO THE MAXIMUM EXTENT ALLOWED BY LAW, EMBLEMHEALTH MAKES NO WARRANTY, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION, ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE REGARDING HOSTED MACHINE-READABLE FILES (INCLUDING BUT NOT LIMITED TO USE OF DATA IN ANY THIRD-PARTY DATABASE OR PRODUCT), UNDERLYING SOFTWARE OR DATA, OR THE NON-INFRINGEMENT OF THIRD-PARTY RIGHTS. EMBLEMHEALTH SPECIFICALLY DISCLAIMS ANY WARRANTY OR GUARANTEE THAT ANY PARTICULAR DATA OR THE DATA OF ANY PARTICULAR PROVIDER IS AVAILABLE OR MAINTAINED IN SAID FILES.