Easy End-to-End MRF Management

Our self-service web administration tool simplifies the management of complex plan mappings and automates the publishing and hosting of the MRFs required by our Plan and TPA partners. The S365 MRF Hub allows users to easily map the required information, including reporting entities, reporting plans, and provider references, to generate the MRFs and TOCs required for the individual payers/issuers.

01

MRF Management

The ingestion, aggregation, and management of Home in-network MRFs and Host in-network MFTs

  • Support for local and/or externally hosted MRFs
  • Support for internal and/or external Provider reference objects
  • Aggregation of local and partner MRFs for network and/or ASO specific requirements
  • Support for archiving of previously published MRFs

02

Configuration Management

Administration of the configuration rules used to generate the Home plan or ASO specific MRFs. Rules can be automated and submitted via files and/or a web form.

  • Administration of business rules for MRF aggregation and TOC generation
  • Mapping of reporting entities, reporting plans and payer
  • Configuration management for product, network, and link files
  • Generation of TOCs for based on payer, issuer and ASO/ASC requirements

03

Hosting for the Public Presentation of Files

Enabling Plans and issuers required to make TOCs and MRFs files public for plan policy years beginning with 2022 through a hosted, compliant site.

  • White labeled website
  • Search capabilities based on payer, EIN, HIOS, etc.
  • ASO TOC Integration options

04

Utilization Reporting

Provides plans with details about the consumption of hosted files within a defined time frame.

  • Management of the TOCs and MRFs
  • Storage and Egress reporting on consumption

Introducing MRF Rates Manager

Plans do not need to develop their own rates based service offering for delivering cost estimates for their local products.

As an additional service to the MRF Hub, our MRF Rates Manager is a service to help Health Plans produce the necessary cost inputs to drive Rates-based Cost Estimation and Self-Service UI. Also available now, Rates Manager enables Plans to utilize their MRF files needed to publish rates to the mandated self-service user interface by way of our upgraded cost estimator.

To meet the requirements of the 7 data elements, Sapphire’s new S365 MRF Rates Manager will ingest and manage the Plan’s MRFs to power the S365 Cost Estimator. This includes:

  • Inventory of local product MRFs and TOCs used by the Plan
  • Data transfer of local product MRFs and TOCs to Sapphire
  • Ingestion/processing of Plan’s MRFs and TOCs
  • Transformation and aggregation of the MRFs with the plan’s provider and ancillary data
  • Configuring member benefits and network mappings to enable personalized rates estimation

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Transparency in Coverage

Preparing for Transparency in Coverage & No Surprises

We’re partnering with current and new clients to ensure compliance with the regulations—and to plan for life beyond Jan. 1, 2022.

Significant federal transparency regulations, the No Surprises Act, and local variations on Right to Shop policies (among others) are creating a torrent of changes for health plans to address concurrently as they seek to improve customer satisfaction. Our solution works to accommodate both goals. By integrating the requirements for these regulations to our client-validated roadmap, we help our clients reach mandate milestones while building an increasingly personalized member experience.