Price transparency checklist: How to ensure you're compliant with the upcoming price transparency deadlinesPrice transparency checklist: How to ensure you're compliant with the upcoming price transparency deadlines
Articles

Price transparency checklist: How to comply with upcoming price transparency requirements

May 24, 2022
Lena Kelly

Answer these questions to determine how to prepare for both short-term and long-term compliance with the price transparency mandates that go into effect on July 1, 2022.

The path to price transparency compliance is complex. With regularly changing timelines and requirements, and significant penalties for non-compliance beginning July 1, 2022, plan sponsors must quickly determine how they will meet, and continue to meet, the ever-changing transparency mandates.

Needless to say, the countdown to price transparency enforcement has begun. Are you ready?

Answer the questions below to determine what you should be thinking about for both short-term and long-term compliance.
  • Are you aware of the new price transparency requirements for employer-sponsored health plans and that penalties for those who do not comply are set to take effect starting July 1, 2022?
  • Is your network vendor or carrier creating a machine-readable file (MRF) that has the details of the in-network negotiated rates for your plan(s)?
  • Is your plan administrator or carrier creating an MRF that has the details of the historical allowed amounts for any out-of-network care received by members of your plan?
  • Will your plan administrator or carrier provide extra data around price, cost-sharing details, and pre-authorization requirements in your member portal?
  • Do you have a way to monitor ongoing compliance to avoid any penalty fees?
Results: 

ALL YES answers: Great news! You’re likely achieving compliance through your carrier.

  • While your carrier might assist you with the short-term requirements of meeting compliance, self-insured employers are ultimately the ones on the hook for ensuring ongoing compliance, and are the ones liable for enforcement fines. This can be tricky, especially given the frequency with which these requirements, and the timelines for meeting these requirements, change. 
  • Amino works with employers to run a monthly compliance audit to ensure that the solution your carrier provides continues to satisfy the requirements. If we find that part of the requirements are no longer met, we’ll notify you immediately so that you can address the situation before getting penalized.

Any NO answers? Amino can work with you to achieve compliance for your plans. Here’s some of the extra things you get with Amino too:

• MRF aggregation and hosting services: 

  • Amino offers MRF aggregation and hosting services, which may be of particular interest to plan sponsors offering plans administered by multiple contracting entities, have direct contracts with providers, and carve-outs, as they will not be able to rely on a carrier to help with compliance requirements specifically related to MRFs.
  • Amino will host MRFs on a publicly accessible website showing in-network rates, out-of-network allowed costs and prescription drug prices under the plan formulary, as required by the TIC guidelines.

• A consumer-grade, TIC-compliant shoppable tool

  • Price transparency alone can be dangerous. Plan members often falsely equate high cost with high quality and can easily end up choosing the most expensive option when they need care. Amino combines price transparency with rich quality data so that when your members need care, we confidently recommend the high-quality, cost-efficient providers.

Caught your attention? Beyond meeting price transparency compliance, Amino will also provide your members:

  • Appointment booking
  • Integrated benefits
  • Client specific theme
  • Personalized engagement support

Ready to assess your compliance status? Schedule a free consultation with Amino today.

Subscribe to Building Blocks

People-centered perspectives, delivered to your inbox every other week.
We use your email address to send you relevant content. You can unsubscribe from our mailing list any time. For more details, check out our Privacy Policy.

Related content

What healthcare benefits do plan members really want?
Articles

The journey to better health: What plan members really want

What healthcare solutions do plan members really want in their benefits package? Here are four solutions plan members are looking for to support their care journey.

Read Article
Amino Healthcare Digital Guidance Case Study: A leading healthcare company
Case studies

Case Study: A leading healthcare company

How Amino is helping a leading healthcare company maximize their existing benefits—and save the business over $500k.

Read Article
What should we expect from price transparency in healthcare?
Articles

Four thoughts on healthcare price transparency from industry leaders

What can you do to prepare for price transparency requirements? Find out from the folks who wrote the rule.

Read Article