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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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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Our Take on the No Surprises Act, Transparency in Coverage Rule

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 …

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TALON To Present Expert Insights On No Surprises Act, Transparency in Coverage Rule Compliance and Safe Harbor. LinkedIn Live Webinar, Thursday, Jan. 20th 2:00 PM EST

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 …

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TALON Publishes Planning Guide For No Surprises Act, Transparency in Coverage Compliance

Addressing the need for employers, commercial health insurance advisors and brokers, third-party administrators, ASOs and carriers to find clarity and a path forward regarding numerous mandates contained within the No Surprises Act and Transparency in Coverage Rule, TALON has published its Planning Guide, Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule. …

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Top TPAs Select TALON For Compliance, Safe Harbor and Competitive Advantage In the New Market-Driven Healthcare System

TALON has recently licensed its turn-key solution for federal No Surprises Act and Transparency in Coverage Rule compliance and safe harbor to leading third-party administrators (TPAs).  “These TPAs are poised to not only protect clients against the financial risks of non-compliance, but also to take full advantage of America’s new market-driven healthcare system that begins …

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