Insurers are already learning that implementing the Transparency in Coverage Final Rule will be no small task.   

In 2020, PANACEA was one of a select group of vendors to have successfully implemented compliant machine-readable files and self-service tools for providers nationwide in the required timeframe. With a dedicated and seasoned clinical coding team and financial experts to help navigate the many nuances typical throughout this process, insurers can now work with a proven process and company to do the same to meet the Transparency in Coverage requirements.

PANACEA will import all claims, payment, negotiated rate and fee schedules into its robust CLAIMSauditor system to feed the machine-readable files and self-service tool to produce the following:

Machine-Readable File Validation Reports and Production:

• In-network negotiated rates
• Out-of-network allowable amounts as historical payments and charges
• In-network negotiated rates for covered drugs and net prices for prescription drugs at the pharmacy location level

Consumer Self-Service/Patient Estimation Tool:

Panacea’s self-service tool allows consumers to obtain out-of-pocket estimates within seconds for the healthcare procedure or service they will be having.   They can search by procedure or service name, code, provider, insurer product and more.  Estimates are provided on-screen, and consumers can print or email the estimate.   The estimation tool includes the organization’s branding and is customizable.  Co-pay, coinsurance, and deductible data are imported into our system on a real-time basis. Consumers also can enter this information should they not readily have their insurance card information available. Panacea utilizes responsive technology so that consumers can view and use it on their desktop, tablet or smartphone.

To learn more about PANACEA’s Transparency in Coverage Solution, schedule a one-hour discovery session.