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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,…

An extraordinary transformation in commercial health insurance will begin on January 1 when the federal regulations known as the No Surprises Act and the Transparency in Coverage Rule usher in a new market-driven healthcare system. Many in the health insurance ecosystem view the requirements as hopelessly complex and onerous. Not us. TALON views these mandates…

Join us on Thursday, January 20th for TALON’s first webinar in our series highlighting how to understand, assess, and prepare for this transformative legislation. TALON will highlight the critical steps to ensure compliance for key commercial health insurance stakeholders; employers and employees; plan advisors and brokers; and third-party administrators, ASOs, and insurance carriers. The webinar…

The No Surprises Act prohibits balance billing in the case of surprise medical bills — those for non-emergency services furnished by out-of-network providers during a visit by the patient at an in-network facility — unless the law’s notice and consent requirements are met, according to the Interim Final Rule published earlier this summer. Out-of-network providers…