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Healthcare CAA transparency outline

The purpose of this outline is to provide you with a snapshot of how different carriers are complying with the CCA regulations that were just passed. This does not address the broker pricing transparency portion of the law, just the carrier/member requirements.

Timeline of regulation requirements

  • No Surprises Rule – The No Surprises Rules prohibit the provider from balance billing an individual, even if the provider views the amount paid by the health plan as inadequate for the service rendered. This provision of the CAA was in effect on Jan 1, 2022. [1]
  • Under Phase One of the new rules, health plans must publicly post machine-readable files for in-network rates, out-of-network allowed amounts and billed charges, and prescription drug negotiated rates (prescription delayed indefinitely) and historical prices. These Phase One transparency regulations apply to plan years beginning on or after January 1, 2022. – Delayed until Jul 1, 2022
  • In Phase Two, health plans must provide an internet service tool that supplies information relevant to their costs for 500 specified items and services. The tool must allow for searching by billing codes, descriptive terms, and in-network providers. Enrollees must be able to refine and reorder their search by geography and the amount of cost-sharing responsibility. Phase Two applies to plan years beginning on or after January 1, 2023.
  • Phase Three extends Phase Two to all items and services, and applies to plan years beginning on or after January 1, 2024.[2]

[1]CLICK HERE

[2]CLICK HERE

Carrier Specific Compliance

Carrier: Capital Blue Cross

Online Pricing Tool available? – Yes- provider look up

Advanced EOB’s available? Yes – upon request for specified services

Website: https://www.capbluecross.com/wps/portal/cap/campaign/caa

Machine Readable Files: https://www.capbluecross.com/wps/portal/cap/about/machine-readable-file-transparency-in-coverage – goes live July 1st, 2022.

Carrier: Geisinger

Online Pricing Tool available? – Currently under development. Requirement deadline ofJanuary 1st, 2023

Advanced EOB’s available? Yes – upon request for specified services

Website: https://www.geisinger.org/health-plan/nosurprisesact

Machine Readable Files: https://www.geisinger.org/health-plan/nosurprisesact – Files will be available on July 1, 2022

Carrier: Amerihealth TPA

Online Pricing Tool available? – Currently under development. Requirement deadline ofJanuary 1st, 2023

Advanced EOB’s available? TBD

Website:

Website: https://www.ahatpa.com/transparency-in-coverage/67890?key=xxxxxxx – Available Jul 1, 2022.

Machine Readable Files: https://www.ahatpa.com/transparency-in-coverage/67890?key=xxxxxxx

Carrier: Meritain

Online Pricing Tool available? – Yes under Healthcare Bluebook

Advanced EOB’s available? Yes – upon request for specified services

Website: Not posted yet.

Machine Readable Files: Available Jul 1, 2022.

Carrier: Highmark

Online Pricing Tool available? – Yes – provider look up

Advanced EOB’s available? Yes – upon request for specified services

Website: https://hbcbs.highmarkprc.com/No-Surprises-Act/No-Surprises-Act?preview=true&ptemplateId=5&ppageId=14598&pversionId=16243

Machine Readable Files: https://mrfdata.hmhs.com/

Carrier: Aetna (AFA)

Online Pricing Tool available? – Yes under Healthcare Bluebook

Advanced EOB’s available? Yes – upon request for specified services

Website: TBD

Machine Readable Files: https://health1.aetna.com/app/public/#/one/insurerCode=AETNACVS_I&brandCode=ALICSI/machine-readable-transparency-in-coverage?reportingEntityType=Third%20Party%20Administrator_6644&lock=true

Carrier: UnitedHealth Care

Online Pricing Tool available? – Currently under development. Requirement deadline ofJanuary 1st, 2023

Advanced EOB’s available? Yes/no

Website: https://www.uhc.com/content/dam/uhcdotcom/en/HealthReform/PDF/Provisions/reform-CAA-external-faq.pdf

Machine Readable Files: https://transparency-in-coverage.uhc.com/?_gl=1*1iz4w5n*_ga*NTMxMzU0OTExLjE2NjE1MTg1ODI.*_ga_HZQWR2GYM4*MTY2MTUxODU4Mi4xLjAuMTY2MTUxODU4Mi4wLjAuMA