Listen as Zelis claims pricing experts Mary Piecuch, Maisie Weir and Matt Mikulski join Xtelligent Healthcare’s Kyle Murphy to talk about the impact of recent regulations like the No Surprises Act (NSA) on claims pricing.
The NSA, aimed at protecting consumers from unexpected medical bills, has reshaped how payers handle claim pricing and negotiations. While the intent is to shield patients from the financial shock of out-of-network charges, the implementation has been anything but straightforward. Payers now face the daunting task of ensuring compliance while also managing their financial exposure.
One of the critical strategies in adapting to this regulation and others like it is leveraging data transparency wherever possible. Consistent and clear data around in-network claims, for example, can arm payers with more information as they go into contract negotiations. Complex calculations and reimbursement methodologies can be used to provide more insight on every claim. All of that data helps ensure consistency as regulations continue to shift.
Furthermore, the role of a knowledgeable partner cannot be overstated. In this complex regulatory environment, having expert guidance is invaluable. A partner who understands the intricacies of the regulations and can provide strategic insights and recommendations is a significant asset. This collaboration can lead to more informed decision-making and improved outcomes in claim management.
The benefits of a consultative approach extend beyond compliance. It also plays a crucial role in cost management, helping payers to identify potential saving opportunities and optimize their claim processing strategies. This proactive approach ensures that payers are not only compliant but also competitive in a market that is continuously being reshaped by new rules.
As costs continue to rise and regulations continue to change, health plans also need to prioritize member solutions that can help members understand confusing out-of-network bills. Working with a partner to ensure effective member support is invaluable.
The rapidly shifting regulations create a need for adaptability, expert partnerships and a focus on data transparency. By embracing these elements, payers can navigate the complexities of claim pricing effectively, ensuring compliance, financial health and improved provider and member relationships.
Zelis has a wide range of solutions available to help health plans accomplish this. Learn more about them here.
