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Submitted URL: https://t.nylas.com/t1/215/8z6joblh45pbc7pyhky6ibm5m/0/d1a3a7dd6fe325bd4a515ce962d007183242676fb3614b5a51fa4b520fc5511a
Effective URL: https://www.beckerspayer.com/payer/faq-on-federal-price-transparency-regulations-released.html
Submission: On June 07 via api from US — Scanned from DE
Effective URL: https://www.beckerspayer.com/payer/faq-on-federal-price-transparency-regulations-released.html
Submission: On June 07 via api from US — Scanned from DE
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FAQ ON FEDERAL INSURANCE PRICE TRANSPARENCY REGULATIONS RELEASED
Andrew Cass - Wednesday, April 20th, 2022
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A federal compilation of frequently asked questions about transparency in
coverage regulations set to go into effect later this year was released April
19.
Last year, CMS said it was delaying enforcement of the insurance price
transparency rule until July 1, 2022. The rule requires insurers and health
plans to disclose in-network provider rates for covered items and services,
out-of-network allowed amounts and billed charges for all covered items and
services, and negotiated rates and historical net prices for covered
prescription drugs. The rates are supposed to be presented in separate
machine-readable files.
The FAQ was prepared jointly by HHS and the Labor and Treasury departments.
In the FAQ, the departments said an enforcement safe harbor will be provided
when plans using alternative reimbursement arrangements cannot accurately derive
a specific dollar amount until after services are rendered. In these instances,
plans can instead list the formula, variables, methodology or other information
about how the rate would be derived.
For contractual arrangements where a plan agrees to pay an in-network provider a
percentage of the billed charges and is not able to assign a dollar amount until
a bill is generated, the plans may instead report the percentage number,
according to the FAQ.
Read the full FAQ here.
Latest articles on payer :
Blue Cross of California accused of improperly denying COVID-19 reimbursements
Cigna begins covering special baby formula after Arizona family complains
New Jersey looks to expand Medicaid to minors regardless of immigration status
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through automation which will take place on Monday, June 20th, 2022 at 12:00 PM
CST - Register Now!
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TOP 40 ARTICLES FROM THE PAST 6 MONTHS
* Anthem plans to change name, rebrand
* 2 minutes — and traffic — may have cost Tufts Health $400M
* Payer mix in the nation's top 20 hospitals
* UnitedHealth to buy home-health firm LHC Group
* California universal healthcare bill dies before key vote
* Longtime Centene CEO Michael Neidorff dies
* Texas orders payer to cease all operations
* Kaiser Permanente's special California Medicaid contract raises concerns
* Centene names new CEO
* Cancer patients win lawsuit against Aetna over denied treatment
* Centene CEO to take medical leave of absence
* Steve Hamman out as president of BCBS Illinois; replacement named
* Bright Health lays off 150 workers, 5% of workforce
* UnitedHealth blasts Justice Department challenge to Change deal
* The largest health insurance provider in each state
* UnitedHealth Group quietly buys Oregon medical groups
* California governor proposes office to curb hospital, physician, payer costs
* Single-payer healthcare bill faces key decision in California
* Medical Mutual taps Cleveland Clinic CFO as new CEO
* Aetna, Optum must face 'dummy code' lawsuit, Supreme Court rules
* MaineHealth says $70M in unpaid claims reason to drop Anthem
* Mayo Clinic blocks out-of-network appointments for MA beneficiaries amid
UnitedHealthcare negotiations
* BCBS of Texas, Memorial Hermann sever contract, affecting 100,000
* UnitedHealth sees 14% revenue growth in Q1: 14 things to know
* $5M fine against BCBS largest in Georgia regulator's history
* Oscar Health's COO to resign
* 'Big 6' payers ranked by 2021 revenue
* UnitedHealthcare axes paper prior authorization, decision letters
* Physicians call ACO redesign 'direct contracting in disguise'
* Medicare Advantage Organization denials of prior authorization requests raise
concerns
* Allina Health | Aetna names new CEO
* Cigna discussed potential acquisition with Centene in late 2021
* UnitedHealthcare, Broward Health terminate contract, affecting thousands
* CommonSpirit launching outcome-based healthcare model in 6 underserved
communities
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reimbursement issue
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things to know
* Payers speak out on proposed Mass General Brigham expansion
* Optum, Change Healthcare set $650M merger reversal fee, extend agreement
through 2022
* Biden proposes ACA coverage expansion to include more families
* 'Big 6' payers ranked by 2021 profits
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