Technology-related obstacles could prevent organizations from delivering “plain English” summaries that are mandated by new rules
BURLINGTON, Mass.--(BUSINESS WIRE)--HealthEdge®, provider of the only modern, enterprise-class software platform for healthcare payors, today highlighted that the regulations released by the U.S. Department of Health & Human Services (HHS) requiring payors to provide a “plain English” Summary of Benefits and Coverage (SBC) to members is likely to create significant difficulty for payors that are using outdated technology platforms.
“This is yet another example of the ever-changing regulatory environment in healthcare creating difficulty for payors with outdated technology”
The new rules require health insurers and group health plans to provide clear, consistent and comparable information about health plan benefits and coverage. The rules also specify that consumers should receive a short, easy-to-understand Summary of Benefits and Coverage (SBC) that will enable them to quickly answer questions about their available options.
Unfortunately, many payors using legacy technology solutions will be unable to comply, since there is no single place where a comprehensive description of benefits is stored. The information needed to create the required “plain English” and understandable documents is currently available in difficult to understand configuration settings that reside in a number of disparate systems.
“This is yet another example of the ever-changing regulatory environment in healthcare creating difficulty for payors with outdated technology,” said HealthEdge CEO Rob Gillette. “Regulatory changes, including HIPAA 5010 and ICD-10, along with the healthcare market’s evolution, require the ability to quickly adapt to evolving market conditions. Payors who leverage advanced systems that enable them to quickly address and support industry changes are the ones that will be successful, both now and in the future.”
HealthEdge® provides the only modern, enterprise-class software platform for healthcare payors. Using the patented HealthRules® software suite, health plans, health insurance companies, and other payors can finally respond to new business opportunities and market changes in hours, not months or years, while drastically reducing both IT and operational costs. Leveraging an investment of over $125 million, HealthRules is the most modern, scalable, and cost-effective technology in the industry. HealthEdge is the only choice for payors to survive and thrive in the emerging healthcare economy. For more information, visit www.healthedge.com.
Noah Brown, 617-502-4300