The Consolidated Appropriations Act and the No Surprises Act established consumer-focused protections that every group health plan and plan sponsor must satisfy. MedExpert delivers a full suite of services to comply with each — and integrates side-by-side with the vendors you already use.
Congress enacted consumer protections against surprise medical bills and for price transparency. Required for all group health plans and plan sponsors. Balance billing is prohibited; plan sponsors are liable for excess charges.
MedExpert's compliance suite covers each requirement of the CAA, integrated with your existing TPA, PBM, and network arrangements. No rip-and-replace — and no compliance gaps.
Member-facing tools and the analytical infrastructure to make price-transparency data actually useful. Surfaces in-network rates, out-of-network allowed amounts, and member-specific cost share — searchable by procedure, provider, and facility.
MedExpert's patented Advanced EOB delivers member-friendly pre-service cost estimates designed to support compliance with CAA Advanced EOB requirements and informed health care decision-making.
Demonstrate compliance with the Mental Health Parity and Addiction Equity Act through systematic comparative analyses, documented non-quantitative treatment limit (NQTL) testing, and audit-ready reporting.
Identify and protect members in active treatment when network or carrier transitions occur. Workflow and member outreach to satisfy CAA continuity-of-care obligations.
In-network rate files and out-of-network allowed-amount files generated, validated, and hosted to current Transparency in Coverage specifications.
Annual prescription drug data collection (RxDC) reporting prepared and submitted on schedule, integrated with your PBM's data feeds.
Qualifying Payment Amount calculation and IDR portal support — including documentation, defensible methodology, and active dispute representation.
MedExpert has a well-deserved reputation in applying advanced technology to medical solutions; administering integrity programs; providing a patent-pending EOB solution; and delivering sophisticated logistics. Over the last decade we've introduced integrity and transparency solutions that put MedExpert at the national forefront of compliance capabilities to the No Surprises Act and the intertwined Transparency Rules.
We'll review your current compliance posture, identify gaps, and propose a tailored MedExpert package — typically within five business days. No obligation.
Or reach us directly: info@medexpert.com · 650.326.6000
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