Reference-Based Pricing Is Here to Stay
Claritev explores why the No Surprises Act will have minimal impact on reference-based pricing.
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September 30th Interim Final Rule Brings Clarity to the Arbitration Process
The 2nd Interim Final Rule for the No Surprises Act clarifies the arbitration process and the importance of the QPA.
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Post Pay Negotiation and Baseball-Style Arbitration Replace Balance Billing for Surprise Bills
“Baseball-style” arbitration under the No Surprises Act is designed to encourage payors and providers to reach agreement before formal dispute resolution. By requiring arbitrators to choose between final payment offers rather than splitting the difference, the process incentivizes both sides to submit reasonable proposals and settle disputes more efficiently without prolonged arbitration.
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Value-Driven Health Plans Take Reference-Based Pricing to the Next Level: A Q&A with Ryan Day, President of HST
In November of 2020, Claritev acquired HST. We sat down with HST’s president, Ryan Day, to learn about HST’s past and plans for the future.
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What Is QPA?
The Qualifying Payment Amount (QPA) is a central component of the No Surprises Act, representing the median in-network rate used by health plans to determine out-of-network reimbursement. Understanding how QPA is calculated and applied is critical for payors and providers navigating payment decisions and the IDR arbitration process.
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Surprise Billing and the Impact for Payors
Surprise billing has created significant challenges for healthcare payors, increasing costs and administrative complexity. The No Surprises Act aims to protect patients while shifting payment disputes to payors and providers, making it essential for organizations to understand its impact on reimbursement, negotiations, and the overall claims process.
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WANTED: new answer to growing COB problem
The old tried and true approach to coordination of benefits isn’t enough anymore. Claritev’s Coordination of Benefits (COB) solution blends the right people, processes, and tech, allowing our team and clients to work smarter rather than harder.
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COVID-19 Billing: 4 ways the pandemic is reshaping healthcare payments
Everyone wants a return to normal. But given all we’ve experienced during this pandemic, going back to “business as usual” seems unlikely. Here are four ways COVID-19 has changed the billing landscape and what we can expect for the future.
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Three ways to modernize your COB approach
Traditional Coordination of Benefits (COB) processes are manual and error-prone. Learn how new technologies can help your plan transition from cost recovery to cost avoidance.
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Case Study: Retaining important business
Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by: significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.