Transparency in Coverage and No Surprises Act

How We’re Helping Your Plan Comply

Crescent Health Solutions is currently preparing the services and capabilities needed to support and assist Plan Sponsors in complying with these requirements.
Click links below to learn more information from the Centers for Medicare and Medicaid Services.

Overview of Transparency in Coverage and No Surprises Act
Surprise Billing and Protecting Consumers


Provider Directories
Access to up-to-date provider databases on a public-facing website beginning with plan years on or after January 1, 2022 is a requirement of the Act. Each network/vendor is responsible for managing provider network requirements for their contracted providers. Crescent will include links to applicable network databases from our benefit portal. Crescent client service representatives can assist member questions related to a provider’s network status.

ID cards
The No Surprises Act requires that, for plan years beginning on or after 1/1/22, online and printed ID cards include in-network and out-of-network deductibles, out-of-pocket maximums, and a telephone number and website address where members may obtain support, including network information. New cards will be provided by Crescent through client human resource departments.
Machine-readable files
Group health plans are now required to create and publish machine-readable files on a public site and update them monthly for in-network rates and out-of-network allowed amounts and billed amounts. (Implementation of the prescription drug machine-readable files has been delayed indefinitely pending additional guidance.) Crescent will provide a link to a table of contents containing the applicable MRFs for their plans through the benefits portal. Plan Sponsors should then post the link on their public website.
LINKS TO MRFS
Additional Requirements Postponed/Under Research

The Transparency in Coverage Rule requires that members be provided with benefit cost estimator tools (by Internet website or paper) that help members estimate their out-of-pocket costs and compare costs for covered network and out-of-network services. A similar cost comparison tool (including by telephone) for services from a network provider is required under the No Surprises Act. The Departments have deferred enforcement of the price comparison tool under the No Surprises Act until plan years beginning on or after January 1, 2023, to align with the Transparency in Coverage rule.

Please note: Federal guidance regarding the Transparency in Coverage Rule and the Consolidated Appropriations Act, 2021, which includes the No Surprises Act, continues to be revised and updated; click here for our latest legislative and regulatory updates. The below summary reflects Crescent’s current plans. Please reach out to Client Services (x226) with questions. Crescent does not provide legal advice. We recommend our clients and Plan Sponsors consult their legal counsel to ensure their plans are compliant with the applicable laws.