Machine Readable Files
The Departments of the Treasury, Labor, and Health and Human Services issued the Transparency in Coverage final rules (85 FR 72158) on November 12, 2020. These rules require non-grandfathered group health plans and health insurance issuers, including Providence Health Plan, to disclose certain pricing information like in-network negotiated rates, billed amounts and out-of-network allowed dollars through machine-readable files posted on an internet website.
We are committed to ensuring that machine readable file data is produced consistently and correctly. This is important data, and we take our responsibility not only to produce it but to do so accurately very seriously. Like nearly all insurers across the healthcare industry, we have come up against significant technical and logistical difficulties to make these files accessible and are continuing to work through some of these challenges.
Below you will find Machine Readable Files for our fully insured and administrative services only customers. We will update these files regularly.
Document list title
Consumer Price Transparency Tool
Updated January 2023
The Providence Health Plan Treatment Cost Estimator is available here. The tool contains codes for the most common medical procedures. Using historical claims data, deductible accumulation and out-of-pocket maximums, members get a customized and reasonably accurate idea of the cost associated with their treatment plan.
Using the tool, members are also able compare procedures and services among providers and facilities to make the most of their healthcare dollars. In 2023, this tool will be updated with even more codes to ease the way of Providence Health Plan members.