Transparency in Coverage – Machine-Readable Files

Effective July 1, 2022, the Transparency in Coverage (TIC) regulations require health insurers and group health plans to disclose cost-sharing information to participants and make pricing information for medical items and services publicly available through machine readable files (MRFs), which contain the negotiated rates for in-network providers and allowed amounts derived from historical claims for out-of-network providers. These files follow the Centers for Medicare & Medicaid Services-approved JSON format and are not meant for a consumer-friendly search of rates, benefits or cost sharing. Please refer to the member resources available through https://www.anthem.com/ca for this information.

Looking for estimate rates? Access estimated rates for services based on your area by logging into the Anthem website or the Sydney Health Mobile App and looking for the Find Care & Cost link.

A machine readable file is a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention. 

Anthem publishes and maintains the MRFs with data for the Directors Guild of America-Producer Health Plan. These files will be updated on the first day of each month. Please use the link below to access MRFs for the Health Plan provided by Anthem, which contain information regarding the: (1) negotiated rates for in-network providers for medical items and services; and (2) out-of-network allowed amounts and billed charges.

It is important to note that all treatments, services or supplies must be considered medically necessary pursuant to the Health Plan Summary Plan Description to be eligible for coverage. The Health Plan SPD is available at www.dgaplans.org/Health-Plan-Booklet.pdf. You may also contact the Health Plan if you would like a hard copy mailed to you at no cost.

How to View MRFs through Anthem 
Access Anthem’s general website at https://www.anthem.com/ca. 

1. Visit Anthem’s MRF website by clicking here or access it via the link: https://www.anthem.com/ca/machine-readable-file/search/.
2. Scroll to the bottom of the page and locate the search bar.

3. Type in the Health Plans’ Employer Identification Number (EIN): 23-7067289.
4. When using the search option, the page will display links to several files, including:

• • Applicable In-Network Negotiated Rate Files
  • Out-of-Network Allowed Amount Files
  • Out-of-Area Rates (applicable when members use providers in non-Anthem states)

5. If you have any questions about the MRFs or any specific services or claims, please contact the Health Plan at (323) 866-2200, Ext. 401 for more information.