Ensure Compliance with the No Surprises Act & Transparency in Coverage
As a long-time champion for transparency and an advocate for protection from surprise medical bills, Vālenz® provides an integrated array of solutions – all within one data-driven ecosystem – that empower self-insured employers and payers to comply with legislative requirements of the No Surprises Act (NSA) and Transparency in Coverage (TiC) regulations, both effective Jan. 1, 2022.
While those mandates are new, our solutions are not. For years, we’ve been using our proven, data-driven systems to deliver true transparency and decision enablement for self-funded health plans. With deep roots in clinical and member advocacy alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy, we improve cost, quality and outcomes for plans and members.
And, we’ve been doing that successfully for years, so you can rest assured everything we do ensures your full compliance with all laws and regulations.
Map Your Path to Compliance with Valenz
From member engagement and transparency to out-of-network claims processing and payment, we enable full compliance every step of the way.
Balance billing protections & continuity of care
We extend our longstanding commitment and proven methodology for fair, defensible, market-sensitive pricing on every claim to assure a uniform level of protection for out-of-network emergency facilities and services, air ambulance transports, and services delivered or ordered from an in-network facility.
Reveal costs & scope prior to service
We support development of advanced explanation of benefits (AEOB) by delivering machine readable files (MRFs) to your health plan or data aggregator partner. We also partner with Integrated Payor Solutions (IPS) and Healthcare Bluebook to provide data aggregation options.
Deploy provider & facility cost comparisons
We deliver MRFs* to health plans or their data aggregator partners to support development of price comparison tools.
Deliver easy-to-access provider information
Valenz MRFs*, augmented with GIS information if available, will be delivered to health plans or their data aggregator partners. Additionally, our enhanced member portal accelerates provider look-ups of Valenz Access network and Valenz-friendly providers.
Share coverage details online & on paper
We deliver MRFs* to the health plan or their data aggregator partners to support compliance with the July 2022 requirement for public disclosure of coverage details and online cost sharing and rate information tools.
* Transparency in Coverage Rule Finalized (June 22, 2022)
- The Departments of Health and Human Services, Labor, and the Treasury finalized the Transparency in Coverage rule requiring health insurers and employer self-insured health plans to create a member-facing price comparison tool and, effective July 1, 2022, post publicly-available machine readable files.
- If a plan utilizes a network, they must conform to CMS file specifications and supply an IN rate file and an OON allowed amount files containing the historical out of network net plan allowable amount for all covered items and services including prescription drugs.
- If a plan does not utilize a network, such as the majority of non-contracted MEC or Referenced Based Pricing (RBP) plans, the plan must conform to CMS file specifications and supply OON allowed amount files containing the historical out of network plan allowable amount for all covered items and services including prescription drugs.
Your Comprehensive Guide to Compliance
Read our eBook – a
complete guide for
employers and health plan
partners on assuring compliance
with NSA and TiC regulations.
Mitigating the Risk of Independent Dispute Resolutions
In addition to supporting your compliance with regulatory requirements, everything we do at Valenz fundamentally reduces or eliminates the risk of the Independent Dispute Resolutions (IDRs). Other firms with solutions to sell say IDRs will happen frequently under NSA and TiC – we say the opposite: IDRs are avoidable when you partner with Valenz.
Our tried-and-true VMS® repricing methodology circumvents payment disputes by ensuring fair, defensible, market-sensitive QPAs that both parties agree to. QPAs are based on years of real-world data from Valenz Access contracted networks, as well as additional layers of data from the broader Valenz ecosystem. It has always been our practice to negotiate with providers on your behalf in the rare instances where they appeal a QPA. The IDR process only comes into play when an agreement isn’t reached through the normal appeal process – and for our clients, that’s a very seldom occurrence.
Achieve Compliance with Confidence Today
We are committed to continuous innovation across the Valenz ecosystem as you chart a path to compliance. Call us today to learn more: (866) 762-4455
