Client Insights
________ are trained non-clinicians who assist a pregnant person during, and/or after childbirth.
What is a doula.
The solution that addresses mental health, behavioral health and substance use disorders.
This requirement went into effect for all ERISA-mandated health plans February 10, 2021.
What is NQTL Requirements?
AKA Core Product Evolution Team
What is CPET?
$7500
What is the Self-Only Coverage Out of Coverage Maximum?
Cosmetic services would continue to be excluded.
What is Gender Affirmation?
This product just earned URAC Accreditation.
What is Omada Health?
Prohibits group health plans or health plan issuers from entering into a provider agreement with a health care provider, network or associations of providers, TPA, or other service provider offering access to a network of providers that would directly or indirectly prohibit the group health plan or insurer from releasing cost or care information to plan participants or accessing de-identified claims data, or sharing such information in compliance with privacy regulations.
What is the Gag Clause Prohibition Compliance Attestation (GCPCA)?
AKA Claims Experience Transmissions File
What is a CET file?
This is the most common letter in the English language.
Consists of benefit changes and recommendations to enhance client's plan design and stay current with coverage trends, standards of care, and regulations.
What are Client Insights?
Cost of Care Navigator Plus
What is $4.00 PEPM?
Today this tool includes the 500 'shoppable' items an services defined by the Centers for Medicare and Medicaid Services (CMS) and required under the CAA.
AKA Employer Portal
What is HealthX?
What does the "M" in the candy M&M stand for?
Who are Mars and Murrie? (the two men that developed the candy)
This recommendation is to help ensure compliance with the MHPEAEA and to avoid unintentionally creating NQTL.
What is Wilderness Therapy and Boarding Schools, or Gender Affirmation?
Members are required to fill 90-day supplies at CVS mail or CVS Pharmacy.
The telemedicine cost-share safe harbor for these types of health plans remains in place until December 21, 2024.
What is HDHP?
AKA NDA
What is a Non-Disclosure Agreement?
CMS informally announced that no reporting for this service will be required in 2023, and to date no further guidance has been provided.
What is air ambulance?
What are orthotics?
An innovative way to pay healthcare providers based on the quality of the care they provide instead of the quantity.
What is Value Based Care?
Name one service protected from balance-billing under the No Surprises Ace.
What is...
1) OON emergency services?
2) OON air ambulance services?
3) OON provider services at an INN facility, where the member has no control over the OON provider?
AKA DME
What is Durable Medical Equipment?
We have 1000s of these SWAG items, but they are being discontinued.
What are light-up wristbands?