HealthEdge® Machine Readable Files Suite for HealthRules® Payer

Healthcare Data Management with HealthEdge MRF Suite

The HealthEdge® Machine Readable Files (MRF) Suite 3.x is a cutting-edge cloud-based SaaS solution designed to enhance the efficiency and accuracy of health plans in publishing Machine-Readable Files of their negotiated rates and allowed amounts. By leveraging advanced technology, the MRF Suite ensures compliance with the Centers for Medicare & Medicaid Services (CMS) mandate for Transparency in Coverage and MRF Requirements, making the process faster and more reliable than ever before.

Key Benefits

Industry-Leading Accuracy

The MRF Suite calculates negotiated rates based on actual Supplier Contract Agreements and historical billing code combinations, ensuring precise and comprehensive data through a partial adjudication process.

Faster Execution Time

Optimized processing techniques reduce execution time by 25%, and intelligent rate processing features deliver up to 40% improvement in performance. This allows health plans to publish accurate MRF files promptly and efficiently.

Flexible Web-Based Interface

With an intuitive, access-controlled web interface, health plans can easily configure, manage, and track MRF generation. The platform offers versatile configuration options to cater to different customer needs and simplifies monthly operational tasks.

CMS-Compliant Output

The MRF Suite produces files that comply with CMS schema requirements through JSON output for negotiated rates, allowed rates, and table of contents files, ensuring seamless compliance.

Key Features

Intelligent Rate Processing

• Calculates negotiated rates for up to 4.8 million provider billing code combinations daily.
• Performs incremental runs using historical negotiated rates to refresh changing rates as configured.
• Reuses and maps existing negotiated rates when applicable.

Optimized Data, Processing, and Access

• Stores and reuses generated data for optimized processing, reducing execution time.
• Scheduled incremental runs for data accuracy and auto data cleanup ensure storage optimization.
• On-demand machine-readable files guarantee timely compliance adherence.

Next-Level Performance

• Avoids reprocessing of rates in case of MRF run failures.
• Generates more comprehensive billing code sets with incremental rate updates.
• Simplifies and automates monthly operational tasks with a web-based UI.
• Achieves faster completion of MRF runs with a 70% reduction in time through incremental runs.