Transparency In Coverage Machine Readable Files

CMS-9915-F Machine Readable Files

Prairie States Enterprises, Inc. is an independent third party administrator of self funded health plans for our clients and members.

Our clients, who are plan sponsors, contract with regional and national Preferred Provider Organizations (PPOs) for negotiated rates with hospitals, doctors, and clinics.

We have created this portal as a service to those plan sponsors, and PPOs to host the machine readable files that plans are required to publicly provide to facilitate the transparency in coverage rule as mandated by federal law (https://www.cms.gov/healthplan-price-transparency). The files provided here contain in-network negotiated payment rates and historical out-of-network charges for covered items and services, in machine readable file formats as required by CMS-9915-F (https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CMS-Transparency-in-Coverage-9915F.pdf). These files are derived from files generated by the PPOs, and reflect their negotiated rates that are managed on behalf of the Plan Sponsor. Prairie States Enterprises, Inc. uploads these machine readable files on behalf of plan sponsors. In most cases, these files are provided in the CMS sample file formats as outlined at https://github.com/CMSgov/price-transparency-guide.