Unlocking the Complexity of CMS Transparency in Coverage (TIC) MRF Data

As the healthcare landscape continues to evolve, the introduction of the Centers for Medicare & Medicaid Services CMS Transparency in Coverage (TIC) rule has created a monumental shift in how health plans, payers, and hospitals handle data. While the goal of TIC is clear—to increase transparency and lower healthcare costs by making pricing data publicly available—the practical challenges involved in meeting this mandate are less straightforward.

Health insurers, hospitals, and third-party administrators are now faced with the enormous task of creating and processing Machine-Readable Files (MRFs). These files are essential for compliance, but they’re also complex, vast, and—frankly—hard to manage.

At siftia , we’ve seen first-hand how overwhelming this process can be. Our experience in helping clients navigate the technical hurdles of MRF data engineering has given us key insights into what payers and hospitals need to succeed in this new era of healthcare transparency.

The Challenge: Managing Massive MRF Data Sets

MRFs are not your average data files. They contain billions of data points, covering everything from service prices to healthcare costs, and they are structured in JSON format—which, while machine-readable, is far from easy for human analysis. This creates several significant challenges for payers and hospitals:

• Massive Data Volumes: The amount of data that needs to be processed is staggering. We’re talking about terabytes of information, sometimes as much as 15 TB per organization, which can overwhelm traditional systems.
• Complexity of JSON: JSON is great for machines, but it’s not designed for easy human interpretation. This makes the files difficult for stakeholders to analyze without proper tools.
• Frequent Updates: CMS requires regular updates to these files, meaning this isn’t a “one-and-done” effort. The process is continuous, requiring a scalable approach to handle the ongoing data processing.

The Solution: Automating MRF Creation and Processing

Siftia specializes in processing complex, hard-to-read JSON MRFs, turning them into accessible, actionable data.

At Siftia, we’ve developed a set of data engineering solutions tailored specifically to meet these challenges. Our approach focuses on two key areas:

1. MRF Creation: We work with payers and hospitals to automate the creation of machine-readable files in compliance with CMS TIC guidelines. This process involves extracting data from various sources, cleaning and structuring it into the required format, and ensuring that all files meet regulatory standards.
2. MRF Processing: We specialize in processing the complex, hard-to-read JSON MRFs, making the data accessible and usable for stakeholders. Our solutions convert raw data into formats that allow for easy analysis, ensuring that health plans and third parties can derive meaningful insights from the information.

What This Means for Payers and Hospitals

Automating the creation and processing of MRFs reduces manual effort, speeds up compliance, and frees up resources for strategic initiatives.

For health plans and providers, the benefits of automating MRF creation and processing are substantial:

• Increased Efficiency: Automating the data engineering process reduces the manual effort required to create and maintain these files. It also speeds up compliance reporting, freeing up resources to focus on other strategic initiatives.
• Improved Data Usability: By transforming JSON files into more accessible formats, we make it easier for healthcare providers and consultants to analyze and act on the data. This creates a better understanding of pricing trends and enables more informed decision-making.
• Scalability: Our solutions are built to handle the massive data volumes required by the TIC rule, ensuring that organizations can scale their MRF processing as their data needs grow.

Success in Action: The Power of Data Engineering

We’ve seen the tangible benefits of our approach with clients like Third Horizon . Working with them, we processed 37 billion data points—the equivalent of analyzing 10 million e-books—making complex data more understandable and actionable for their teams. Our system now supports 157 insurance issuers across the U.S., ensuring seamless compliance with federal and state-level operations.

With the right data engineering solutions, organizations can not only meet the technical demands of TIC compliance but also leverage the data to drive meaningful change.

This experience has shown us that with the right data engineering solutions, organizations can not only meet the technical demands of TIC compliance but also leverage the data to drive meaningful change in their operations.

Looking Ahead: Why Data Engineering is the Future

As the healthcare industry becomes more data-driven, the ability to manage and process large data sets like MRFs will become a competitive advantage. Organizations that embrace automation and scalable data solutions will not only stay compliant but will also unlock new opportunities for cost savings and efficiency improvements.

At Siftia, we’re committed to helping payers, hospitals, and healthcare consultants navigate these complexities. Our data engineering solutions are designed to simplify the process and provide long-term, sustainable results.

If you’re struggling with the creation or processing of MRFs, let’s talk. We’d love to show you how Siftia can help your organization simplify compliance and make better use of your data.

Ready to Simplify Your MRF Compliance? Contact me to talk about how we can help streamline your MRF data management.