Data Sheet: Achieving Transparency Compliance Through HealthRules Payer
Achieving regulatory compliance in the healthcare industry is a complex and evolving challenge, particularly with mandates such as the Transparency in Coverage (TIC) Final Rule and the No Surprises Ac
Achieving regulatory compliance in the healthcare industry is a complex and evolving challenge, particularly with mandates such as the Transparency in Coverage (TIC) Final Rule and the No Surprises Act. HealthEdge® offers a comprehensive solution through its HealthRules® Payer platform, designed to help health plans meet these requirements seamlessly and efficiently.
HealthRules Payer incorporates advanced tools, including the Trial Claims functionality, to enable health plans to provide accurate, personalized cost-sharing information across multiple channels—online, over the phone, and in paper form. This capability ensures compliance with the Price Comparison Tool provisions of the No Surprises Act, allowing members to access essential pricing information effortlessly.
HealthEdge adopts a three-phase approach to enhance pricing transparency for members:
- Machine-Readable Files containing rates and allowed amount data, effective from July 1, 2022.
- Internet-based Price Comparison Tool for 500 items and services, accessible online, by phone, or in paper form starting January 1, 2023.
- Comprehensive Price Comparison Tool for all items and services, available from January 1, 2024.
The Member Portal and Call Center functionalities of HealthRules Payer further streamline the process, providing accurate cost-sharing details tailored to individual benefit plans. This not only meets regulatory requirements but also significantly improves member satisfaction by delivering information through preferred channels.
Key Benefits:
- Regulatory Compliance: Meet mandates from the TIC Final Rule and No Surprises Act by the stipulated deadlines.
- Process Efficiency: Streamline regulatory compliance using HealthEdge's existing tools.
- Enhanced Member Experience: Provide easy access to pricing and cost-sharing information.
- Multi-Channel Support: Cater to member preferences with diverse information delivery methods.
HealthEdge's HealthRules Payer stands as a vital tool for health plans aiming to achieve regulatory compliance while enhancing member satisfaction and operational efficiency.
Learn more about how HealthEdge can help your organization stay compliant and thrive in an evolving regulatory landscape.
