What do Transparency in Healthcare and the No Surprises Act mean to your health plan?
Transparency in Healthcare (TinC) and the No Surprises Act (NSA) of the 2021 Consolidated Appropriations Act (CAA), and local variations on Right-to-Shop policies (among others) are rapidly changing healthcare while your plan seeks to improve customer satisfaction.
S365™ and SmartShopper® solutions work to accommodate both goals for your plan. The requirements for these regulations are already integrated. This helps your plan reach mandated milestones while building an increasingly personalized member experience.
As an employer, what are the benefits and impacts of TinC and NSA?
The SmartShopper solution supports both financial and non-financial incentives to give your health plan the broadest flexibility to drive the engagement and utilization you want to see from your members, patients, and employees. We work with our client partners, to deliver multi-channel engagement campaigns and continuous innovation to increase program utilization—while maintaining compliance with cost transparency regulations.
What impact will your employees feel from the regulations?
It’s all positive! Better access to cost data and network provider education will be critical. That’s where SmartShopper provides employees a digital shopping platform that has helped millions of consumers nationwide understand the cost of healthcare.
According to a recent survey of SmartShopper users, 98% of SmartShoppers would recommend the program to friends or coworkers. And with an average savings of $641 and $75 average reward check per eligible shop, members are saving real money for them and their plans as they get high quality, low cost care and live healthy lives.
Why is SmartShopper® so critical to your strategy?
With the heightened focus on customer and member experience and the new cost transparency regulations, SmartShopper is a strategic healthcare selection experience for plans. It leads to better healthcare choices that save money for members’ employers and themselves, as well as earning them rewards for selecting the most cost-effective providers and site of service for care.
- It fulfills the requirement of a price-comparison tool required under the CAA.
- It allows covered individuals and in-network providers to compare cost-sharing amounts for covered services based on geographical regions, participating provider, and specific service.
- In-network provider negotiated rates and historical out-of-network allowed amounts are expected to be made available on your member website by July 2022. The data is expected to be updated monthly.
- Provider directories and their accuracy is supposed to be updated no less than every 90 days.
To learn more about our approach to navigating these significant mandates, please reach out to request a meeting through your sales person, account manager.
Learn more about how Sapphire works with health plans.
The SmartShopper® program is offered by Sapphire Digital™, part of Zelis®. Incentives available for select procedures only. Payments are a taxable form of income. Rewards may be delivered by check or an alternative form of payment. Members with primary coverage under Medicaid or Medicare are not eligible to receive incentive rewards under the SmartShopper program.