Hi, I work at a health insurance company in the IT department, helping build software for our employees and members. With the new Consolidated Appropriations Act coming through, it’s making me think about efforts toward price transparency, and that got me thinking about what sort of information would be needed in order to allow members to look up accurate quotes for healthcare services or drugs, with a very low chance of surprise bills.
Off the top of my head, what might be required from the member…
1) some kind of identifying procedure code such as CPT or HCPCS, or an identifying drug code, like NDC
2) Subscriber ID/member ID/policy number. This could be used to get most of the required information, like plan benefits, active status, medicaid/Medicare details, network area, deductible, cost sharing, and current out of pocket cost totals
3) Location of the healthcare service; or, if it’s a drug, location of the pharmacy
4) the date of the healthcare service (if there’s a known price change in the near future, we could take that into account)
5) ask the user whether they’re going to use some service that changes the claim after the fact. At our company this occurs with certain groups who use third parties to help pay claims
Anything else I’m missing here that would be needed? This seems like a short list.
submitted by /u/Doctor_119
[link] [comments]
Hi, I work at a health insurance company in the IT department, helping build software for our employees and members. With the new Consolidated Appropriations Act coming through, it’s making me think about efforts toward price transparency, and that got me thinking about what sort of information would be needed in order to allow members to look up accurate quotes for healthcare services or drugs, with a very low chance of surprise bills. Off the top of my head, what might be required from the member… 1) some kind of identifying procedure code such as CPT or HCPCS, or an identifying drug code, like NDC 2) Subscriber ID/member ID/policy number. This could be used to get most of the required information, like plan benefits, active status, medicaid/Medicare details, network area, deductible, cost sharing, and current out of pocket cost totals 3) Location of the healthcare service; or, if it’s a drug, location of the pharmacy 4) the date of the healthcare service (if there’s a known price change in the near future, we could take that into account) 5) ask the user whether they’re going to use some service that changes the claim after the fact. At our company this occurs with certain groups who use third parties to help pay claims Anything else I’m missing here that would be needed? This seems like a short list.
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