Machine Readable Files

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

IMPORTANT NOTE: The Machine Readable Files are not currently available for viewing.

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.

Machine Readable Files for Negotiated Rates for In-Network Providers and Historical Allowed Amounts for Out-of-Network Providers

The below Table of Contents file provides information to access the machine readable files for Blue Cross and Blue Shield of Vermont in-network providers, including out-of-state Blue Cross providers, for our products. For out-of-state providers, the file 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. Due to the potential size of these files, the files have been compressed.

The Table of Contents file also provides access to the machine readable files for out-of-network providers, which are based on historical claims data. 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 provided are separated by the following products — we have provided the associated prefixes below.

  • 0002 PPO VFP (ZID)
  • 0005 PPO EPO—NO PCP (ZIL)
  • 0020 PPO QHP EPO (ZIG, ZII)
  • 0023 PAR VHP (ZIH)
  • 0024 PPO VHP OAP (EVT, ZIU)

Note: The information displayed in the In-Network 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.

Table of Contents by Product and HIOS and EIN numbers