Our Blog: The New Healthcare Marketplace

America’s new market-driven healthcare system offers huge opportunities for all players in the commercial health insurance ecosystem – employers, advisors, professional benefits administrators, and carriers alike. Our blog presents vital information and knowledge you need to not only comply with, but also to benefit from, and win.

TPAs: A Piecemeal Solution To Transparency In Coverage Could Be Your Last Meal

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

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Complying with the Transparency in Coverage Final Rule and No Surprises Act: Taking Baby Steps is the Expensive Way to Go

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,

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Compliance with Transparency Mandates Is NOT Optional for Employers

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

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Download the full Planning Guide
Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule


July 1 is “Healthcare Independence Day”

  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

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Not Acting:  $35 Million in Annual Fines Await a Typical 500 Employee Non-Compliant Employer

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 significant

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Insurers’ ‘Gaming’ of Obamacare Provision Seen Boosting Premiums

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,

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Executive Summary

Download the Executive Summary of Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule

10 Key Considerations

What you need to consider with Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule

Planning Guide

Download the Planning Guide Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule

Transparency in Coverage Final Rule

Learn about how the final rule applies to your group.

No Surprises Act

Learn about how the act applies to your group.

True Price Transparency

True price transparency means no surprises.

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