In-Network File Requirements for Local/Regional Plans

[Stephanie-Raymond]

Many local/regional plans contract with national plans to offer secured rates for covered services nationwide.

Is a local/regional plan required to merge the national plan’s MRF into their In-Network MRF, which would create size, merging and updating challenges?

Or instead, could a local plan meet the In-network MRF requirements by linking to the applicable national plan’s MRF URL in the location where the local/regional plan’s In-Network MRF is published?

@Stephanie-Raymond Would under the local plan a member be able to use the national plan's provider as a in-network provider for a negotiated rate as if they were a provider directly under the local plan (which I would think is yes)? If the answer is yes, then you would need to include the national in-network rates array data with the MRF generated by the local plan since they are considered under the one plan as in-network providers and not out of network providers.

This is why there has been a ongoing conversation for a while on the need to have a mechanism to reference in-network rates data because of the merging, storage and egress charges of a single monolithic file.