1) Provider network termination notices to members for Continuity of Care on 1/1/2022
- PHP is generating termination files 3 x weekly for our payers to notify members who are in continuous care
- Payers can obtain the Network allowed amounts for a terminated provider’s claim from our portal
2) Provider data accuracy on 1/1/2022
- PHP is updating our provider data 3 x weekly and performing an audit every 90 days
3) Payer Contracting
- References to “GAG clauses” have been removed from all agreements on 1/1/2022
4) Qualified Payment Amounts (QPA) on 1/1/2022
- PHP can provide a Qualified Allowed Amount (QAA) for services in support of the QPA requirement, however, our QAA is based on data from our 48 counties only
5) Machine-readable files (MRF) must be generated and made available on a public website no later than 7/1/2022 for:
- In-network rates for covered items and services
- Out-of-network allowed amounts and billed charges for covered items and services
- This would fall under the responsibility of the Payer due to the additional benefit calculation requirements
- Currently the requirement for MRF Pharmacy data has been deferred
6) Price-comparison tool and cost-estimating tool (first 500 services) effective 1/1/2023
- PHP does not have the health plan benefit information. We are working on an ‘Allowed amount” price-comparison tool
