Our Blog: The New Healthcare Marketplace
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
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,
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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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
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
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,
Resources
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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