Healthcare payers must prepare for new requirements stemming from the No Surprises Act and the Transparency in Coverage Rule (TiC). In this article, originally published on Future Healthcare Today, there are four stages outlined to best meet the upcoming TiC regulations.
The No Surprises Act and the Transparency in Coverage Rule (TiC) will begin to go into effect in the coming year, and healthcare payers must prepare to meet regulatory deadlines. The transparency regulations from NSA and TiC are designed to support consumers, share insight into the costs of services, and enable cost comparison between providers.
With deadlines approaching, healthcare IT partners are devising solutions to help meet the needs of payers. Dennis J. Charland, Senior Vice President of Sales at Sapphire Digital, commented that “we are in an unprecedented time as it relates to mandates. We are seeing both the No Surprises Act and the Transparency in Coverage Rule hitting us. We’ve had some delays in the enforcement date, but those deadlines are coming up quickly.”
July 1, 2022, is the deadline for meeting the Machine-Readable Files (MRFs) regulation. This requires that payers produce monthly MRFs to report negotiated rates or maximum allowable for a given provider and covered service. The specific file requirements include: in-network negotiated rate files, out-of-network allowed amount files, and in-network negotiated prescription drug files. To help with execution, “it’s important to think about the MRF regulation as stepping stones,” said Charland. The process can be broken down into four stages:
Stage 1: Generation/Origination
Payers will need to implement a compliant MRF plan by July 1, 2022, and should start preparing now. Solutions are able to support IT services and verify data when filing generation occurs. Additionally, standard file formats and publishing rules will keep files regulated within the system.
Stage 2: Data Ingestion/Aggregation
In order to have useful cost information for members in the proposed cost estimation circumstance, the MRFs not only need to be in order, but the data needs to be portable and shareable. Therefore, the plans need to incorporate a central location to aggregate the information.
Stage 3: Manipulation/Application
MRFs are not suitable for sharing directly with members and will not take the place of a cost transparency tool to provide accurate costs. However, a cost engine or platform is improved when augmented by MRF data to present the right information. Solutions that support a cost engine can guide members along their care journey.
Stage 4: Presentation/Contextualization
Members can choose more affordable care with provider discovery and cost transparency tools. Starting with data from MRFs and adding intuitive features, such as searchable provider directories and cost engines, aid the member experience.
Even though there are many responsibilities and burdens on payers, healthcare IT solutions increase the focus on cost visibility and cost accuracy. New solutions continue to be created to help payers meet these beneficial regulations. Because of the shifting healthcare landscape, the new regulations will change the member experience for the better.
To learn more about meeting transparency requirements and Machine-Readable Files, click here.
