In compliance with the Transparency in Coverage (TiC) Final Rule, which was finalized on November 12, 2020, Maestro Health is offering up in-network and out-of-network (also called "allowed amount") files on behalf of its clients. The list of machine-readable files (MRFs) below will be updated as we receive new files from our network partners.
Due to limitations in presenting complicated and differing contracted rate methodologies in a standardized way, the contracted rate in the machine-readable files will not always reflect the contracted rate that applies in an individual member’s case due to differences in negotiated rate methodologies that depend on the mix of services on a claim. These files are not intended for patient use and likely will not be a patient’s best resource to obtain a cost estimate for any given claim. Differences in the service type and location could affect the rates that apply in an individual case. As described below, there are variables that exist by member that must be considered to arrive at contracted rates applicable for specific terms and services. Due to these variables, there may be a discrepancy between a negotiated rate listed in the machine-readable files and the contract rate applicable to a specific member claim. In each case, the actual contracted rate will determine the cost for a given claim.
Available In-Network Files:
Available Out-of-Network Files: