Texas Court Rules Arbitrators Can’t Place Higher Importance on QPA in Surprise Bill Arbitration
Claritev discusses how the Texas Federal Court struck down the HHS’s interpretation of how the QPA should be used in the IDR process outlined in the NSA.
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The Basics of Machine-Readable Files
Transparency in Coverage Final Rule requires health insurers and group health plans to post three machine-readable files on a website. In this blog post, Claritev explores this requirement.
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What Is Payment Integrity?
An estimated $1.2 trillion in healthcare spending is attributed to some form of waste or abuse that leads to overcharges. Payment integrity solutions are tools healthcare payors use to help bring down this staggering number. Claritev discusses what these solutions do.
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The Basics of the Federal IDR Portal
The No Surprises Act requires a Federal Independent Dispute Resolution (IDR) portal to be used to initiate the Federal IDR process, select an IDR entity, and submit arbitration offers. Claritev discusses the basics of this portal.
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With Notice and Consent, Surprise Bill Protection Can Be Waived
The No Surprises Act allows providers to bill enrollees for the balance due after the health plan pays its portion in some circumstances if the enrollee signs a consent form. Claritev explores this exception to member balance billing.
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Understanding Provider Directory Requirements Under the No Surprises Act
Claritev examines providers' and health plans' requirements for provider directories under the No Surprises Act.
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The No Surprises Act: Continuity of Care Requirements
The No Surprises Act requires health plans or issuers to notify certain enrollees in a timely manner when a provider or facility is terminated from the network due to contract expiration or non-renewal. Claritev examines what this means.
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Five Healthcare Trends to Watch in 2022 that Can Rein In Skyrocketing Costs
While healthcare spending continues to soar, impacting all players in the healthcare ecosystem, Claritev understands it will take a combination of forces chipping away at the margins to make healthcare more affordable. Here are five trends we’re watching in 2022 with the potential to lower costs, improve outcomes, and make our health system more sustainable over time.
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State Law vs. The No Surprises Act
In addition to the federal No Surprises Act, many states have their own laws that protect consumers from surprise medical bills. In the states with their own laws, Claritev examines which law takes precedence.
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How the No Surprises Act Changes Reimbursement
The No Surprises Act (NSA), effective January 1, 2022, changes the reimbursement process for claims identified as surprise bills. Claritev explains how.