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Even before the Transparency in Coverage Rule (TiC) was finalized in October 2020, requiring health insurance plans and issuers to disclose healthcare pricing information to plan participants, we were asking ourselves how to build a platform that would usher in this new era in healthcare. Compliance is an essential and foundational element, but at our…

As we have seen in recent months, CMS has started to pick up the pace of hospital audits to ensure Transparency in Coverage (TiC) compliance. Where there was more leniency for noncompliance before as entities worked through the heavy lifting of system implementations to satisfy new requirements, the looming threat of penalty fees in the…

If there’s one thing that’s not a secret, it’s that changes to the healthcare system tend to move at a snail’s pace. The Affordable Care Act, for example, took nearly 5 years from the time of its introduction to the first open enrollment period1. Looking on a smaller scale at group health plans, even implementing…

Since its founding in 2014, TALON has been ahead of the regulatory curve, setting the standard in a breakthrough market and even influencing the Transparency in Coverage Rule. Our platform was used as an industry standard upon which the new federal mandates were based. TALON provides employers with the tools they need to stay compliant,…

Various elements of the Transparency in Coverage Final Rule and the No Surprises Act have already taken effect, and others will take effect over the next two years.  This staged rollout of requirements (with very significant fines for non-compliance) could encourage employers to opt for piecemeal software solutions that end up being far more costly,…

The Transparency in Coverage Rule (TiC) already requires that companies post machine readable files (MRF) which disclose negotiated rates for every in-network provider and the historical payments to, and billed charges from, out-of-network providers.  The MRF must also include in-network negotiated rates and historical net prices for covered prescription medications, broken down by health plan…

The Implications of Non-Compliance Can Be Dire The phrase “transparency fines are coming” is now a moot point, because—like it or not—transparency fines are here, and enforcement has begun. With the pivotal July 1 deadline to meet the Machine-Readable Files (MRFs) provision of the Transparency in Coverage Rule now behind us, a shocking number of…

  Americans should now consider July 1 as “Healthcare Independence Day.” Why? Because on July 1, 2022 the nation can celebrate an incredible victory for the hundreds of millions of people who have been deprived, for far too long, of the real freedom to choose amongst healthcare providers who truly compete for their business—by offering…

  The Biden Administration Will Fine Companies of All Sizes for Not Complying with the Transparency in Coverage Rules of the Affordable Care Act Health Plans, management consultants, TPA’s, and advisory brokers are being held accountable by employer groups to ensure compliance. Meanwhile, opportunistic vendors providing fractional solutions are underserving in this critical venture, leaving…

Larger companies typically sponsor self-funded health plans in which the employer pays most medical bills directly and hires third-party administrators to handle claims and help design plans. Those plans aren’t subject to the ACA’s medical loss ratio rules, but they can be affected. “When you look at the administrative services-only parts of those same entities,…