-
-
The Road to MRFs’ Final Data Schema Has Several Speedbumps
In October 2020, CMS issued the Transparency in Coverage final rule. As part of this rule, health plans are required to publish machine-readable files (MRFs) for their negotiated rates, out-of-network allowed amounts, and prescription (Rx) coverage rates and allowed amounts. On March 1, 2022 approximately 18 months after the rule was issued, CMS locked v1.0.1 of the schema for MRFs. Getting to this “enforcement data schema” wasn’t easy. There were 20 other versions of the schema before it — and CMS may not be finished fine tuning it either.
-
Five Tips to Help Payors Navigate the No Surprises Act
Some healthcare payors continue to struggle to create an effective strategy to deal with No Surprises Act (NSA). In this post, Claritev offers five suggestions to help payors effectively navigate the new law.
-
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.
-
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.
-
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.
-
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.
-
Understanding Provider Directory Requirements Under the No Surprises Act
Claritev examines providers' and health plans' requirements for provider directories under the No Surprises Act.
-
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.
-
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.
Category: No Surprises Act
