HealthSmart Client Transparency Webinar

HealthSmart is committed to ensuring that our clients can be compliant with new regulations taking effect soon

Effective January 1, 2022, health plans will be required to post extensive plan pricing data, including cost-sharing details, in and out of network rates, as well as an online consumer pricing tool. Compliance is mandated at the plan level, so self-funded plans will be primarily responsible for compliance. Most plans, however, will rightly expect their TPA partners to support them with compliance.

The Healthcare Price Transparency Rule is rooted in an executive order on healthcare price and quality transparency that was issued in June 2019. The move was part of a larger push to use price transparency to curtail price increases and enable patients to compare the cost of services when making healthcare decisions.

On January 1, 2021, the Healthcare Price Transparency Rule became law under the statutory authority of the Patient Protection and Affordable Care Act (ACA). On that date, hospitals and health systems were required to post pricing for hundreds of procedures, with more to come in subsequent years. Hospitals and health systems have been finding compliance with the law to be a challenge, and so far, enforcement has been lax. With a little more time to prepare, health plans and plan sponsors might hope to be better prepared.

On July 1 of this year, the Department of Health and Human Services published final rules for another recently enacted piece of legislation dubbed the No Surprises Act. While the primary intent of this act is to protect patients from excessive balance bills for emergency and ancillary services provided in in-network facilities, it has implications for payers, plans and brokers. This act is also expected to go into effect on January 1.

Please join us for this timely webinar.

By viewing this webinar, attendees will learn: 

• Key provisions of the Price Transparency Act (PTA) and No Surprises Act (NSA)
• Timelines for compliance
• What can plan sponsors learn from the experience of hospitals, which have already been required to implement price transparency rules?
• Likely effects price transparency will have on the cost of health benefits
• HealthSmart's approach to developing a service offering to address PTA and NSA
• Timeline for development and release of compliance support tools
• A call to action for clients and brokers

Speaker:	Craig Julien Executive Vice President, HealthSmart
	Craig Julien joined HealthSmart in 2016 as Senior Vice President of Operations for the Company’s eastern region. In 2018, he was promoted to Executive Vice President, TPA Operations, overseeing HealthSmart's core operational and service functions for medical, dental, vision, COBRA, FSA and STD claims administration. Prior to joining HealthSmart, Craig served as Vice President of Global Operations for TriZetto, a Cognizant Company, where he was responsible for all aspects of claims operations, including receipt and entry of membership data, plan building, account management, inventory management, claims processing and customer service. He has 20 years’ experience in BPO operations, 10 years’ experience in the healthcare payer vertical and eight years' experience with the QNXT and QicLink platforms. Prior to his experience at TriZetto, Craig held senior level roles with Kenexa Technologies (an IBM Company), Ceridian, and CNA Insurance Companies. Craig holds an MBA from University of California – Irvine, a BS in Business Administration from University of Phoenix, and a number of certifications, including a Six Sigma Green Belt.

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