Machine Readable Data & Support
Machine Readable Data for Provider Network and Prescription Formulary Content for Federally-Facilitated Marketplace (FFM) Qualified Health Plans (QHP).
As required by the Patient Protection and Affordable Care Act, for plan years beginning on or after January 1, 2016, qualified health plan (QHP) issuers in the Federally-Facilitated Marketplace (FFM) are required to publish information regarding their provider directories and formulary drug lists on their website in a machine-readable format.
This requirement increases and enhances consumer transparency by allowing software developers to access up-to-date, accurate and complete formulary and provider data needed to create innovative and informative tools.
Select options below for individual files or view all in the Index.
Interoperability and Patient Access for AvMed Entrust and Medicare Members.
Third Party App Developers
We support third party app developers who create and connect to our API for use by our members. App developers can register to our Developer portal to test and manage their apps. We offer both sandbox and production environments to test APIs in both environments.
Machine Readable Data for Healthcare Price Information for Individual and Group Plans.
The Departments of the Treasury, Labor, and Health and Human Services issued the Transparency in Coverage final rules (85 FR 72158) on November 12, 2020. The final rules require non-grandfathered group health plans and health insurance issuers in the individual and group markets to disclose healthcare price information for plan years beginning on or after January 1, 2023.
This requirement enhances consumer transparency by allowing software developers to access up-to-date pricing information needed to create innovative and informative tools that will help consumers make informed healthcare decisions.
Select 'View Index' below to access the index file and locations of the rate files.
CMS Transparency in Coverage Final Rule Fact Sheet