Countdown to Price Transparency Compliance: What You Need to Know

The road to price transparency compliance is complex and ever-changing. The HealthSparq team recently held a discussion to help translate the latest requirements and support health plans in developing an action plan to keep moving forward toward the deadlines. There is also plenty to watch out for tied to state developments and enforcement, and we want to help everyone be as prepared as possible.

In case you missed it, below are three takeaways from our recent webinar as we march toward the initial July 1, 2022 compliance enforcement date.

MRF file generation needs to be adaptive

As of March 1, we have a v1 data schema for machine-readable files (MRFs) from CMS under the Transparency in Coverage mandate. CMS indicated they will continue to iterate the data schema in the future to accurately represent the actual contracts that plans have in this space.

The latest CMS updates include changes to support additional rate types, ability to add custom billing codes, and address the challenges of very large file volume and file sizes. Those are major changes only four months before the enforcement deadline. A flexible solution will ensure plans can rapidly adapt as mandated data evolves.

Solving consumer challenges is at the forefront

When talking about requirements for self-service tools that plans must provide starting January 1, 2023, under the No Surprises Act and Transparency in Coverage, it’s important to consider the CMS changes on MRFs since many plans will use that dataset to deliver the member-facing experience. Mandated data isn’t really the same as how people experience care, or what they understand about healthcare. Health plans have a business opportunity with self-service support..

While there is a lot of focus on the compliance and regulatory side to meet mandates, it is critical to address the challenges people face in healthcare. Plans must transform raw rate data and deductibles into something that contextualized–from ensuring only the right providers are showing for the right services to helping people understand what is the most likely service they might receive.

Compliance extends to the state level

For health plans and issuers subject to CMS enforcement authority, non compliance can result in corrective action, monetary penalties up to $100 per day for each violation and for each member affected by the violation.

States are also swiftly moving towards their own price transparency regulations. Our VP of Regulatory detailed a two-prong approach that plans should be focusing on in 2022 and offered a few suggestions to ensure health plan readiness. You can read more in the recent blog.

Don’t get caught off guard when it comes to price transparency rules. Get to know the challenges ahead and look to create a differentiated approach for your compliance strategy. Watch the on-demand webinar now to gain even deeper insights on the topics shared above.