Referenced-based Pricing is a great tool to contain costs while fairly reimbursing claims, but without the proper payment integrity programs how do we know the claim is correct before repricing? Payment Integrity expert Katy Brant explores the ways high dollar bill reviews can enhance the overall savings in reference-based pricing. Katy will provide case study examples of complex claims and how a deep dive clinical review can uncover significant errors which can be leveraged in balance bill settlements with challenging providers.

For more information on payment integrity solutions, please contact us at info@6degreeshealth.com

How has the 2024 sales game changed for the industry? With renewals winding down in 2023, it is time to start planning for 2024 with an actionable mindset shift for selling. 10 things/ways to maximize your sales goals in 2024.

How do benefits pros use the first objective mark of value of health plans to deliver world-class health outcomes?

The Plan Grader has been 5+ years in the making. Healthcare’s modus operandi has been to drive down the healthcare road looking in the rearview mirror. If one knows anything about the distribution of healthcare spending and individual claimants, that’s not terribly useful. We tested/refined the Plan Grader for 3+ years to prove it was predictive of a high-performance health plan. In other words, the first leading indicator of high-performance health plans when the industry norm has been to look at lagging indicators.

This webinar will take a deep dive into the world of Mental Health Parity compliance and explain what a NQTL analysis is, what a QTL calculation is, who is subject to these provisions, how reporting works, and many more nuanced pieces of this Mental Health Parity puzzle. 

The Mental Health Parity Act of 1996 was passed nearly three decades ago, but that statute did not become permanent until the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in 2008. This passage of the MHPAEA began a decades-long struggle to enforce the statute that is now colloquially referred to as the Mental Health Parity Law. Over ten years later, the mental health parity testing requirement for group health plans within the Consolidated Appropriations Act of 2021 has bolstered these MHPAEA enforcement efforts. Under the MHPAEA, parity analyses are performed separately on quantitative treatment limitations (QTLs) and non-quantitative treatment limitations (NQTLs).

What are QTLs and NQTLs? Both analyses seek to ensure that more restrictive limitations are not being placed on mental health/substance use disorder (MH/SUD) benefits than they are on medical/surgical (M/S) benefits. Quantitative treatment limitation (QTLs) calculations include items like copayments and annual visit limits and are based on real claims experience. Non-quantitative treatment limitation (NQTLs) analyses are performed on more abstract limitations, such as prior authorization requirements or formulary design.  

Our September Fireside Chat will feature Scott Washburn, VP of Human Resources at Tree Top, with 25+ years of executive leadership and HR experience.

A glimpse into the story and data around Tree Top’s decision to implement Referenced Based Pricing (RBP) and the specific results they achieved.