The US Federal government departments released mandates for Health Plans or Issuers to provide better transparency in coverage for consumers. Plans must disclose cost-sharing information to enrollees, beneficiaries, or participants related to the covered services. Issuers also need to publish in-network negotiated rates, historical out-of-network allowed amounts, and prescription drug pricing based on each provider's contracts and plans offered. The disclosed information will guide the consumers to make better decisions regarding services, providers, and their health. Health Plans need to integrate their internal systems to achieve compliance.
Milestones on the Timeline
MLR Calculation Update
Effective with the 2020 MLR reporting year
Disclosure to Public
Applicable for Plan years beginning on or after
Jan 1, 2022
Disclosure to Enrollees
Jan 1, 2023 – Applicable to 500 Pre-defined items or services
Disclosure to Enrollees
Jan 1, 2024 – Applicable to
all items or services
Requirements
How Can You Achieve It?
To ensure that your solution fulfills future requirements, below are the vital elements you need to account for in your technology roadmap.
Enterprise Applications Integration
Authentication and Authorization
Content & Vocabulary Mappings
Data
Management
Error Handling
Audit
FHIR
We Can Help You With
Assessment
Compliance gap identification, and process blueprinting
Roadmap Planning
Chart out an execution plan with milestones
Implementation
Leverage technology to realize the roadmap
Go-Live and Support
Performance consistency and continuous improvement
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