
Machine Readable Network and Out of Network Rate Files Enforcement Begins July 1, 2022
Posted on July 1, 2022 at 2:36 pm
The Transparency in Coverage Final Rules (“the TiC Final Rules”) apply to non-grandfathered group health plans and health insurance issuers offering non-grandfathered coverage in the group and individual markets. The rules require the disclosure of information (in machine readable file format) regarding in-network provider rates, out-of-network allowed amounts, and negotiated rates for covered prescription drugs […]
Transparency Reporting Requirements under the CAA
Posted on February 22, 2021 at 1:36 pm
The Consolidated Appropriations Act outlines new transparency requirements for covered service providers as it relates to ERISA group health plans. The Act requires covered service providers, i.e., brokers and consultants to include certain disclosures regarding the receipt of direct and indirect compensation in contracts for services entered, extended, or renewed on or after December 27, […]
The Consolidated Appropriations Act of 2021 Mental Health Parity Expansion – Reporting Requirements
Posted on February 17, 2021 at 5:10 pm
Health plans and insurers that impose a nonquantitative treatment limitation (NQTL) on mental health or substance use disorder benefits (such as a restriction based on facility type) must perform and document a comparative analysis of the NQTL’s design and application. Other NQTL limit examples include quantitative (i.e., visit limits) and nonquantitative treatment limitations (i.e., preauthorization […]