Dynamic Negotiation Offer: Leveraging Machine Learning in the Toughest and Easiest Negotiations
Claritev is using machine learning in its toughest and easiest negotiations
-
-
Initial IDR Report Released Per No Surprises Act Requirement
The first federal report on the No Surprises Act’s Independent Dispute Resolution (IDR) process reveals significantly higher dispute volumes than anticipated, along with operational challenges in eligibility determinations and resolution timelines. These early insights highlight the complexity of the IDR process and the need for more efficient strategies as payers and providers adapt to evolving requirements.
-
LifeNet Files Its Third Lawsuit Challenging Parts of the No Surprises Act
Directly on the heels of the Texas Medical Association’s (TMA’s) third lawsuit (TMA 3) challenging portions of the No Surprises Act (NSA), LifeNet, a company that provides ground and air ambulance services, has also filed their own third lawsuit (LifeNet 3).
-
Texas Medical Association Files Third Lawsuit Challenging Parts of the No Surprises Act
On Wednesday, November 30, 2022, the Texas Medical Association (TMA) filed its third lawsuit challenging portions of the No Surprises Act (NSA). The latest lawsuit targets provisions of the July 2021 Interim Final Rule (“July IFR”).
-
Should reference-based pricing be part of your healthcare benefits this year?
Americans are concerned about rising healthcare costs, and among the insured, almost half worry about covering their deductible. With the cost of employee benefits projected to rise, employers and employees are looking for ways to lower costs. Ryan Day, President of HST, a Claritev Company, outlines ways reference-based pricing provides value, transparency, and quality in employee benefits.
-
Navigating the No Surprises Act – MultiPlan’s Susan Mohler to Speak at the Texas Covered Health Care Conference Nov. 8
MultiPlan’s Susan Mohler will present at the Texas Covered Health Care Conference, offering expert insights on navigating the No Surprises Act and helping payors adapt to evolving regulatory requirements.
-
Pre-Payment Negotiation Is Beneficial to Payors and Providers in Settling Surprise Bills
The August Final Rule clarified that arbitrators need to consider QPA along with other factors such as provider experience and severity of the patient’s illness. Claritev explores whether this clarification means payors should consider adjusting the strategy they use to process surprise bills.
-
Texas Medical Association Challenges Provisions to IDR Process
On Thursday, September 22, the Texas Medical Association (TMA) filed a lawsuit challenging the August 19th Final Rule of the “Requirements Related to Surprise Billing.” The suit challenges provisions concerning the way Independent Dispute Resolution (IDR) entities must treat the Qualifying Payment Amount (QPA) compared to the additional factors described in the law: training/experience/outcomes; provider and plan market share; patient acuity; teaching status/case mix/scope of services of the facility; and prior good faith efforts to contract.
-
Midyear Check-In with Healthcare Payors on the No Surprises Act
Healthcare payors who believed they were prepared to comply with the No Surprises Act (NSA) without assistance have realized the new law is more complex than they initially thought. That’s the message Claritev has repeatedly received from clients who elected to try to manage the NSA or parts of it on their own.
-
Stabilizing the Unsustainable: A Look at the Healthcare Market in 2022 and the Stabilizing Power of Reference-Based Pricing
When employees and employers think of healthcare, adjectives like, “expensive” and “costly” may come to mind. Health systems, policy analysts, and other healthcare experts agree. They’ve labeled the rising costs in U.S. healthcare as unsustainable.