Ensure compliance for Transparency in Coverage and CCA

Partner with Sapphire to navigate the near-term requirements and the long-term goals of the transparency regulations.

Federal mandates have opened up new opportunities to engage consumers through transparency, and plans will have to act quickly to comply with competing guidance and timelines. As organizations navigate the arc of transparency, plans and partners will continue to weigh near and long-term opportunities and risks of upcoming mandates to set mitigation strategies appropriately. We’re ready to help. 

Compliant Self-Service Cost Visibility

Health plans and TPAs are required to make personalized out-of-pocket cost information and the underlying negotiated rates for all covered healthcare items and services available to members (and their authorized representatives) through an internet-based self-service tool. An initial list of 500 shoppable services will be required to be available via an internet-based self-service tool for plan years that begin on or after January 1, 2023. The remainder of all items and services are due on or after January 1, 2024. Our world-class cost engine and cost transparency tools will continue to provide members with this information along with all other supporting attributes to help members understand the cost of care.


Easy MRF Aggregation and Hosting with Our S365 MRF Hub

Sapphire has solution to the complex and evolving MRF requirements for Health Plans. BCBSA and CMS actions have changed the MRF obligation for Plans. Our S365 MRF Hub meets the Transparency in Coverage compliance requirements for aggregating and publishing home and partner rates based on in-network MRFs monthly for July 1, 2022. The solution is purpose-built to manage the complexity of network mappings, aggregation, file size, hosting and archiving requirements, and the infrastructure requirements to allow for downloading of these extremely large files. A web interface and all infrastructure to store, aggregate, and generate the home and host MRFs come as a part of the SaaS offering to help Plans and TPAs streamline the complexity of generating plan-specific MRFs. 

Delivering Transparency Holistically

The delivery of the transparency mandates will happen over three or more years and will require a dual focus on the underlying data and the member experience resulting from the cost calculations. Beginning with the requirement to make rates publicly available through machine readable files for in-network, out-of-network, bundled payments and pharmacy, the requirements shift toward making those costs visible to members in an internet-based cost tool. We call this the “Arc of Transparency” and it involves these stages:

  1. Generation / Origination
  2. Ingestion / Aggregation
  3. Manipulation / Application
  4. Presentation / Contextualization
  5. and Beyond

Learn Sapphire’s Comprehensive Approach to Transparency in Coverage and the No Surprises Act

Receive a copy of our plan including our entire S365 Transparency & Care Navigation Roadmap. You’ll see how we can pave the road of transparency for you.

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