Solutions for

Carrier/ASOs

TALON offers health insurance issuers a fully compliant turn-key solution to the Transparency in Coverage Rule and No Surprises Act at far lower development, maintenance, and support cost versus a comparable in-house solution. The TALON platform also efficiently delivers patented tools for carriers and Administrative Services Organizations (ASOs) to leverage the new market-driven healthcare system to drive down insured out-of-pocket costs and overall plan expenditures, much to the delight of your clients and shareholders alike. 

At the heart of TALON’s scalable architecture is a machine learning system that aggregates data feeds from multiple sources. Our system continuously updates the claims data warehouse and leverages this massive database alongside contracted rate files and feeds to produce  detailed, accurate machine-readable files with predictive and actual negotiated rates. 

In addition to the machine-readable files requirements covering in-network and out-of-network and prescription drug rates beginning on January 1, 2022, the Transparency in Coverage Rule requires employer-sponsored group health plans and health insurance issuers to make available personalized out-of-pocket-cost information and the underlying negotiated rates for all covered health care items and services through an internet-based self-service tool. Advanced EOBs must also be made available at least one business day before services are to be furnished (but no later than three days after being scheduled) to ensure “No Surprise” billing. TALON’s mobile-first MyMedicalShopper™, which served as the prototype for these federal mandates, fully meets these and all other transparency requirements today.

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

While enforcement of the internet-based self-service tool requirement may commence in mid-2022 or sometime thereafter, the No Surprises Act requires employer compliance beginning on January 1, 2022. Your commercial health insurance customers risk fines up to $100 per member per day upon enforcement. Understandably risk-averse client CEOs, CFOs, CHROs and benefits managers expect their healthcare benefits administrators and/or carriers to provide the solutions they must have to mitigate their risk. 

While the financial risks related to non-compliance are great, employers and carriers should embrace the benefits of the Transparency in Coverage Rule and No Surprises Act as the impressively bipartisan legislation transforms the health care marketplace from a fractured one to truly consumer-first. Carriers will benefit from this market transformation by leveraging the TALON platform, which served as the prototype for the legislation, to drive down healthcare costs by encouraging and rewarding smart consumerism. 

If “surprise billing”and ever-rising insured out-of-pocket costs and employer plan spending are never-ending thorns in your side, it does not have to be that way. TALON will help you deliver transformative change to the fractured healthcare marketplace- efficiently, effectively, and with No Surprises.

For a quick overview of MyMedicalShopper, click here .  With links below, our Executive Summary introduces the new laws, rules, and the TALON platform, while our Planning Guide presents both in greater detail. 

We are here to help. Our experts are ready to work with you to ensure your compliance and employer client safe harbor.

Learn more:

Executive Summary
10 Key Considerations
Planning Guide
Transparency in Coverage Final Rule
No Surprises Act

TALON Knowledge Center

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.

Smart Consumerism

The best benefits for consumers.