When thinking about the future and the present, it comes as no surprise that data is the lifeblood of modern enterprise. From the largest corporations to the smallest local businesses, data and the files that contain them, loom large over almost everything in this digital world, healthcare included. In this ecosystem, legislation like the Transparency in Coverage rule has the potential to upend many of the common best practices, but what does that mean for payers and providers? And how does it fit into the broader No Surprises Act?
Future Healthcare Today has extensively covered the No Surprises Act, the Independent Dispute Resolutions process, and even the nature of telehealth and how it impacts members. However, at the heart of this legislation is the seemingly simple purpose of making the healthcare process more transparent.
A provision of the Transparency in Coverage rule, signed into law in late 2020, has entered into force, requiring that health insurers and employer self-insured health plans must create and post publicly available Machine-Readable Files (MRFs) for in-network, out-of-network, and prescription data. These files are meant to help enable transparency but on their own are not meant to serve as member-facing price comparison tools.
The Transparency in Coverage rule leaves a certain level of ambiguity as far as the implementation is concerned, however, there are many stipulations regarding the formatting of the data. To better explain what is expected and to dive deeper into what this rule means, Future Healthcare Today spoke with Lisa LaMaster, VP of Business Solutions for Out-of-Network, and Stacey Karp, Sr. Solutions Advisor, both at Zelis.
Listen to the full conversation below or click here to listen to the podcast in your browser:
To learn more about how Zelis is working with providers, payers, and members, click here.