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Definition

In-network rate file

The MRF listing every rate a plan has negotiated with its in-network providers, by billing code and provider.

The in-network file is the largest and most useful MRF. For each covered item or service, identified by a billing code, it lists the negotiated rates and which providers each rate applies to.

Rates carry details that matter for comparison: whether the rate is professional or institutional, the place of service it applies to, any billing code modifiers, and the type of rate, such as a fixed negotiated dollar amount, a percentage, or a per diem.

Providers are referenced by NPI and TIN, often through shared provider reference lists so the same group of providers isn't repeated for every rate.

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