Navigating the No Surprises Act with careviso’s Total Access Tool, seeQer
A careviso client needed a fully customized platform to handle the nuances and complexities of patient access to diagnostic testing. seeQer was able to handle all aspects of the healthcare transparency legislation including benefits, patient cost responsibility and health plan network status. Download the full case study to learn more about how seeQer can help your organization.
Introduction
The No Surprises Act, effective January 1st, 2022, protects patients from receiving surprise medical bills from out-of network services. The act requires providers and labs/facilities to provide health plans, or patients directly, with a good faith estimate (GFE) including the verification of patient coverage, contract rates for care, and expected billing and diagnostic codes within 1 to 3 days of scheduling the care.
An advanced explanation of benefits is a requirement for health plans. Fines per case can be imposed; however, penalties are not yet enforced.
1 in 5 emergency room visits include out-of-network care
For uninsured patients, providers must provide a GFE within of 1 to 3 days of scheduling the appointment
$10,000 of fines can be administered to non-compliant providers and facilities once enforced
7.1 million (18%) emergency visits annually include at least one out-of network claim
Activating Precision Medicine
careviso is a healthcare technology company committed to helping navigate the No Surprises Act, by automating a solution through our total access tool, seeQer. seeQer automates the process of price transparency to answer patients’ important questions.
A Price Transparency Pilot with a careviso laboratory customer ran in January 2022. The goal of the pilot was to evaluate seeQer against a current competitor’s tool used by the customer, combined with manual calls to the payer.
careviso’s seeQer was able to pull enough data to get a result on 85% of the cases, while the industry standard is a 75% yield. The competitor’s tool was able to pull data on 45% cases, and the remainder had to be manual phone calls. Of the resulting seeQer cases, 98% were correct. When a case was incorrect it defaulted to a higher final cost estimate, ultimately allowing for a positive patient experience.
85% of seeQer cases pulled enough data to get a result
The industry standard of cases with enough data to retrieve a result is 75%
In 45% of cases the competitor’s tool pulled enough data to get a result
Of the seeQer cases pulled, 98% were correct
Our product can pull accurate price estimates to provide patients and health plans with full price transparency.
seeQer facts
100k real-time pricing estimates performed
90% covered lives integrated
Real-time pricing estimates
>90% accuracy rate
Thousands of CPT codes configured
careviso is committed to answering the important questions for patients and ordering physicians. Our total patient access tool, seeQer, can identify a patient’s out of pocket expense, health plan policy, and insurance benefits to provide answers to patients, providers, and payers.
