Achieving Transparency and Compliance with HealthRules® Machine Readable Files

Regulatory compliance and transparency are more than healthcare industry buzzwords: they’re key areas of focus for regulatory agencies and consumers. Staying compliant with shifting state and federal regulations can be a challenge, requiring efficient access to the most up-to-date information available. And pricing transparency has become an essential way for health plan members to make informed care decisions.

At HealthEdge®, we are committed to supporting our customers in achieving and maintaining compliance. Our mission is to empower your organization to become a digital payer, achieving key business goals—like improving the member experience and reducing costs—by leveraging innovative digital technology.

Introducing HealthRules® Machine Readable Files Suite

The HealthRules® Machine Readable Files Suite 3.x stands as a testament to our commitment to innovation, compliance, and transparency in the healthcare industry. Designed to address the requirements of the Transparency in Coverage final rule, our pioneering software solution offers a robust framework for generating machine readable files (MRFs) that detail negotiated rates for in-network providers and allowed amounts for out-of-network providers.

This initiative is not merely about complying with regulations; it’s about ushering in a new era of clarity and trust between health plans and their members.

3 Key benefits of using Machine Readable Files

Real-Time Reporting

Leveraging the power of cloud technology, our solution suite allows health plans to their own reports in real-time, ensuring your team has consistent access to the most up-to-date information.

Intuitive User Interface

The platform’s user interface was designed to make compliance as straightforward as possible and significantly reduce the complexity of generating machine readable files through the HealthRules solution.

Native Integration

As the only machine-readable file generation tool built natively into a Core Administration Platform Solution (CAPS), our MRF suite seamlessly integrates into your existing systems—minimizing disruptions and enhancing operational efficiency.

Key goals of offering an integrated MRF suite within the HealthRules solution are to clarify compliance needs, enhance transparency, and improve the member experience for our health plan customers. This innovative feature is just one representation of our dedication to not just meeting the needs of payers today but shaping the future of healthcare. Partnering with HealthRules can help your team work more efficiently to transform industry challenges and demands into opportunities.

Are you looking for more information on our advanced Core Administrative Processing System (CAPS) and how it can integrate with your health plan’s existing platforms? Visit the HealthRules® Solution Suite.