From 45 days to less than one
How Providence Health Plan transformed MRF compliance into a same-day, fully automated process—and a member-facing advantage.
Rebuilt from a fragmented, manual workflow into a unified system powered by real-time claims data.
INDUSTRY
Health Plan
CLAIMS PLATFORM
Facets
PRODUCTS
MRF Generation, MyMedicalShopper
45 to 1
CYCLE TIME
From 45 days to less than one day
100%
AUTOMATION
No manual steps required for execution
2.4x
TECH ROI
Automation & reduced overhead
4+ to 0
STAFFING
FTEs & contractors redeployed to higher-value work
CHALLENGE
The Transparency in Coverage Rule asks two things of regulated health plans and TPAs: publish accurate Machine-Readable Files (MRF) every month and give members a real cost-comparison tool that actually works.
Most organizations have one of those covered. Almost none have both done well.
Providence Health Plan, a provider-owned nonprofit serving members across Oregon and Washington, was carrying both obligations through a process that was slow, fragile, and expensive. Each monthly MRF cycle ran 40 to 45 days. Thirteen processing bundles. Four-plus dedicated staff plus outside contractors. AWS infrastructure heavy enough to crash under its own load.
They turned to TALON to rebuild the entire pipeline — back-end compliance and member-facing experience — on one platform.
A monthly compliance cycle that cost more than it should.
Like many regulated payers, PHP’s monthly MRF cycle depended on fragmented workflows, manual intervention, and heavy infrastructure. What worked at smaller volumes became increasingly fragile, expensive, and difficult to maintain.
SOLUTION
One Platform. Both Sides of the TiC Mandate
PHP replaced its vendor-dependent workflow with TALON—unifying compliance and member transparency on a single system powered directly by core claims data.
01
Native integration with the claims platform
TALON connects directly to Facets — no extraction-and-transformation layer, no third-party data shuffling, no AWS infrastructure to provision. The data is read where it lives.
02
Automated MRF generation & publication
What used to require 13 bundles and a small operations team now runs in a single same-day cycle. CMS Schema 2.0 compliance is maintained automatically; no manual reconfiguration required.
03
MyMedicalShopper™ on the same data
The pricing PHP members see in their cost-shopping tool matches the rates in their compliance MRF — because both come from the same source. One platform, both regulatory obligations, zero data drift.
RESULT
From Effort to Automation
The transformation reduced cycle time, eliminated manual work, and removed infrastructure risk—while maintaining full compliance with evolving CMS requirements.
"
All that complexity is just gone — we don't have to manage this process anymore.
WOODY ARTHUR • PROVIDENCE HEALTH PLAN
IN PRACTICE
Compliance & Member Value, Generated Together
Most organizations treat MRF publication and member shopping tools as separate workstreams, with separate vendors, separate data sources, and separate teams. PHP unified them.
MRF Generation & Publication
PHP’s monthly compliance cycle now runs end-to-end in less than a single day. The data is generated from the system of record, validated against current CMS schema requirements, and published on time — every month, without exception.
The team that previously oversaw that process has been redeployed. The AWS infrastructure that previously crashed under load has been retired. The complexity is gone.
MyMedicalShopper™
PHP members access a real-time cost-comparison tool with personalized out-of-pocket estimates, provider quality ratings via ProScore™, and encounter-level pricing through Encounter Estimate™ — all surfaced from the same pricing data that drives compliance publication.
This isn’t a member portal that approximates published rates. It is the published rates, made useful.
This Architecture Works for TPAs and Health Plans Alike
PHP is a health plan, but the underlying problem — data extracted from a claims platform, transformed by a generic vendor, and bolted to a separate member shopping tool — is the default state for most organizations carrying TiC obligations today.
___
For Health Plans
If your MRF cycle takes weeks, requires a dedicated operations team, or depends on infrastructure that has to be reserved in advance, you’re paying for overhead that doesn’t need to exist.
The PHP architecture is replicable: native integration with your claims platform, automated monthly publication, and a member-facing tool fed by the same pricing data that drives your compliance file.
___
For TPAs
Self-funded employer clients are increasingly ingesting MRF data and benchmarking against it at renewal. The file your team publishes is the file sitting across the table at every renewal conversation.
TALON’s native integration with 16+ claims administration platforms — including Facets, Mphasis Javelina, VBA, WLT, Plexis, and others — means the same outcome is available regardless of where your data lives.
Want the complete case study?
The full PDF goes deeper into the implementation, the architectural decisions, and what the rollout looked like for PHP’s team. Free to download — delivered straight to your inbox.