Ensure Compliance with Transparency in Coverage and CCA

Plans, TPAs and other organizations must act quickly to comply with competing guidance and timelines associated with these federal mandates. Partner with Sapphire to navigate the complexity.

With over 15 years in cost transparency, we are experts in this space. Our data and product teams have built a number of solutions and services to help manage through the complexity.

We’re ready to help.

Our Suite of Transparency Solutions

MRF Creation

For those who need help with the generation of the Base In-Network MRFs and Base Allowed-Amounts MRFs, Sapphire can provide project management and project delivery capabilities to produce those files. For each, the scopes are outlined below:

  • In-Network MRFs: Includes operational readiness, data and contract analysis, transformation logic design and MRF development and configuration
  • Out-of-Network/Allowed Amount MRFs: Includes operational readiness, data review and analysis, and MRF development and configuration

The ability to aggregate and host the Sapphire generated Base MRFs with additional Host or network partner MRFs is offered through the Sapphire MRF Hub and Hosting offering described below.

MRF Hub

Our MRF Hub 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 infrastructure to store, aggregate, and generate the home and host MRFs come as a part of the SaaS offering to help organizations streamline the complexity of generating plan-specific MRFs.

  • End-to-end management of the MRFs
  • Self-service Web Configuration Manager
  • Hosting for the public presentation of the TOCs and MRFs.
  • Utilization Reporting

MRF Rates Manager

Plans do not need to develop their own rates based service offering for delivering cost estimates for their local products. Ingest and manage your in-network and out-of-network rates files to power the S365 Cost Calculator to meet the Transparency in Coverage Regulations. Our Rates Manager meets the data requirements for providing rates based cost estimations for all networks/products.

The MRF Rates manager can be used to:

  • Manage the storage and processing of the local product MRFs
  • Perform the combination of the MRF data with ancillary data sources
  • Integrate rates data is with S365 Cost Calculator and benefits systems

The MRM solution requires that the client is using S365 and the S365 Cost Calculator.

MRF Data Service

Our MRF Rates Data Service can acquire and process the In-Network MRF files to a standardized format on a regular cadence (Monthly, Quarterly, etc.). By removing the complexity of handling and processing these large MRFs, the MRF Rates Data Service allows you to focus on the analysis of the data using a simplified format.

The MRF Rates Data Service can be used to:

  • Acquire one or more specific In-Network MRFs from the Payer
  • Acquire all In-Network MRFs within the Payer’s TOCs

In-Network MRF files that are made available by the Payer Rates Data Service are provided in an open-source column-oriented data file format designed for efficient data storage and retrieval.

S365® Healthcare Shopping and Transparency Platform

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 have been updated to provide members with this information along with all other supporting attributes to help members understand the cost of care.

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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