Machine Readable Files

Transparency in Coverage rules require that health plans share negotiated prices for services in publicly available machine-readable files.

In compliance with the Consolidated Appropriations Act (CAA) and the Transparency in Coverage rules, the below machine readable files (MRF) are available to our members and will be updated on a monthly basis. 

NOTE: Per the CAA guidelines, the machine readable files are only available in a .json file format, and the files can be extremely large in size. In order to access the files, please ensure that you have the appropriate network capacity to download the files, as well as a .json file reader, before attempting to download any files. If you do not have the proper software to read a .json file, you will be unable to open or view the files.

Negotiated Rates for In-Network Providers

To access the machine readable files for Blue Cross and Blue Shield of Vermont providers for our products, please go to our Machine Readable Files website and click on the "In Network" option in the left hand menu. Due to the potential size of these files, the files have been compressed. Please note that the files in this area of the website are separated by the following products — we have provided the associated prefixes below.

Note: The information displayed in the files represents the rates Blue Cross and Blue Shield of Vermont and/or Other Blue Cross Licensees have negotiated with their in-network providers for covered items and services. This is not, however, an estimate of the cost patients will be responsible for paying for such item or service. Individual cost will vary depending upon the terms of the individual's specific health insurance coverage and the structure of the reimbursement arrangement, if applicable. Blue Cross and Blue Shield of Vermont and Other Blue Cross Licensees have made reasonable efforts to ensure the data displayed in the files is complete and accurate at the time it was published. The data is refreshed each month.

  • 0002 PPO VFP (ZID)
  • 0003 PAR INDEMNITY (ZIA)
  • 0005 PPO EPO—NO PCP (ZIL)
  • 0006 PPO BLUECARE ACCESS (ZID)
  • 0011 PAR HMO (ZIE)
  • 0020 PPO QHP EPO (ZIG, ZII)
  • 0021 PPO NON QHP EPO (VEI, ZIK)
  • 0022 PAR BCBSVTSELECT (ZIJ)
  • 0023 PAR VHP (ZIH)
  • OO24 PPO VHP OAP (EVT, ZIU)

To access the machine readable files for out-of-state Blue Cross providers, view the Host Plan MRF for In Network Rates spreadsheet. The spreadsheet provides access to the provider reimbursement rates that would be applied when Blue Cross and Blue Shield of Vermont members see Blue Cross network providers in other states. There are separate tabs for each prefix/product combination. Due to the potential size of the files, they have been compressed.

Historical Allowed Amounts and Billed Charges for Out-of-Network Providers

To access the machine readable files for out-of-network providers, which are based on historical claims data, visit our Machine Readable Files website and click on "Out of Network" in the left hand menu. If the file contains no data, it means that the threshold of having twenty out-of-network provider claims for the same procedure and product within the defined historical look back period was not met. Please note that the files in this area of the website are separated by the following products — we have provided the prefixes below:

  • 0002 PPO VFP (ZID)
  • 0003 PAR INDEMNITY (ZIA)
  • 0005 PPO EPO—NO PCP (ZIL)
  • 0006 PPO BLUECARE ACCESS (ZID)
  • 0011 PAR HMO (ZIE)
  • 0020 PPO QHP EPO (ZIG, ZII)
  • 0021 PPO NON QHP EPO (VEI, ZIK)
  • 0022 PAR BCBSVTSELECT (ZIJ)
  • 0023 PAR VHP (ZIH)
  • OO24 PPO VHP OAP (EVT, ZIU)

Other Resources