Instead of our traditional fun-and-games holiday party, we launched the Expion Elves Holiday Challenge. And it became one of the most meaningful moments of our year. At Expion, our culture is built on ideas, and this one came directly from one of our own. We broke into teams, and each team chose an organization close to their … Turning the Holiday Celebration Into Meaningful Impact
Cigna’s announcement to shift away from prescription drug rebates for its fully insured plans in 2027 and for Express Scripts’ customers in 2028 is another signal of ongoing change in how pharmacy economics may be structured in the future. The transition from post-sale rebates to up-front discounts has the potential to redefine how value is measured … Cigna’s Plan to Shift from Drug Rebates: What it Could Mean for Pharmacy Strategy — and a Call to Action for Smarter Pharmacy Strategy
Gaithersburg, MD, August 13, 2025 – Inc., the leading media brand and playbook for the entrepreneurs and business leaders shaping our future, today announced that Expion Health has earned a spot on the annual Inc. 5000 list, the most prestigious ranking of the fastest-growing private companies in America. The list provides a data-driven snapshot of … Expion Health Earns Spot on 2025 Inc. 5000 List of America’s Fastest-Growing Private Companies
When it comes to your professional journey, staying vigilant is crucial. At Expion Health, we prioritize your safety and want to ensure you are equipped to identify and report potential job scams. Here are 4 valuable tips to keep in mind: ⓵ Verify the source: Be cautious of unsolicited emails or text messages claiming to represent a … Tips to Protect Yourself from Job Scams
BRENTWOOD, Tenn., and GAITHERSBURG, Md., October 3, 2024 – Today ClarisHealth, provider of the leading integrated payment integrity technology platform for health plans, announced a strategic partnership with Expion Health. ClarisHealth is pre-integrating Expion Health into the Pareo® platform to offer enhanced out of network (OON) claims management capabilities designed to detect and avoid more claims overpayments without … ClarisHealth Partners with Expion Health to Offer Enhanced Out of Network Claims Management Services on the Pareo® Platform
It’s not uncommon for facilities or PPO networks to assert that a claim is DRG-based to deter payors from pursuing further review. On the surface, this might seem like a dead end for an Itemized Bill Review, but that’s not always the case. When informed that a claim was repriced at a DRG, it’s crucial … The Power of Probing: Why You Should Question DRG-Based Claims
The concept of ethical administration has rapidly become a hot topic – so much so that it is the theme of this year’s Health Care Administrators Association (HCAA) TPA Summit. This post, inspired by insights from Nicholas Stone, SVP, Medical Cost Containment Sales at Expion Health, examines what constitutes “Ethical Administration,” aiming to highlight the … Choosing the Right Partners: Administrators’ Quest for Vendors Committed to Ethical Administration in Non-Network Claims
Expion Health is pleased to announce our strategic partnership with HUB International, which was launched at HUB’s Clinical and Pharmacy Conference. As a preferred partner, Expion Health will provide expertise in medical bill review, independent reviews, and actionable insights for strategic pharmaceutical initiatives, complemented our powerful, award-winning ExpionIQ analytics. Nick Stone, SVP, Medical Cost Containment … Expion Health Announces Strategic Partnership with HUB International
In the changing landscape out-of-network (OON) medical claims, health plans & TPAs face the dual challenge of managing costs while ensuring fairness and transparency. A recent New York Times article spotlighting practices by certain industry players has intensified concerns regarding the management of OON claims. Such revelations underscore the importance of adopting business practices that … Navigating Shifting Market Expectations: Enhancing OON Claim Repricing Fairness and Transparency
Expion Health’s analysis of the latest CMS report from February 2024, which sheds light on the Independent Dispute Resolution (IDR) process for No Surprises Act (NSA) cases. for the first half of 2023, uncovered a particularly interesting finding: plan dollars are being wasted on what we have termed “no-response” claims. These occur when health insurance … NSA No-Response IDR Determinations a Surprising Waste of Plan Dollars
Expion Health, a pioneer in leveraging powerful technology and dynamic pricing strategies for healthcare cost containment, has been named to the esteemed CIO 100 Award list for 2024, honoring its groundbreaking ExpionIQ Advisor. For more than 25 years, the CIO 100 Awards have recognized innovative organizations around the world that exemplify the highest level of strategic … Expion Health Wins Prestigious CIO 100 Award
A central theme emerged, at the HCAA Executive Forum: the imperative for TPAs to evolve as a fiduciary-like partner for their groups and their employees. In this dynamic landscape, the call for transparency and control in medical claims and administrative costs has never been louder or clearer. A New Paradigm for TPAs In the face … Harnessing Transparency and Control: Key Takeaways from the HCAA Executive Forum from Expion Health
The Federal government recently proposed changes to the NSA IDR process in hopes of holding all involved organizations more accountable and forcing initiating and non-initiating parties to be more diligent in documentation and timely admin fee payments. While the end goal may be to increase speed, efficiency, tracking and transparency, the immediate result is health … Get Ready: CMS Proposes Numerous Changes to IDR Process
Today, Expion Health, a pioneer in leveraging powerful technology and dynamic pricing strategies, unveiled its new collaboration with Mark Cuban Cost Plus Drug Company, PBC (Cost Plus Drugs). This strategic alliance will integrate Cost Plus Drugs’ revolutionary pricing into Expion Health’s product suite, offering an innovative way to tackle the escalating costs of specialty drugs.Karin … Expion Health and Mark Cuban Cost Plus Drug Company, PBC Forge Innovative Collaboration to Enhance Pharmacy Cost Management
The Expion Health team left the Self-Insurance Institute of America, Inc. 2023 Conference energized and inspired. We had insightful conversations with over 40 different organizations and immersed ourselves in thought-provoking speaker sessions. 🔑 The key takeaway: Self-insured groups and administrators are assessing their current approach to managing medical claims costs, leading them to reevaluate their … Expion Insights from SIIA 2023
Expion Health proudly announced it has been named an inaugural UiPath AI10 Award Winner. The UiPath AI10 Awards recognize the 10 best and most innovative uses of AI-powered automation across UiPath’s global customer base. Expion Health was recognized for its AI at Work leadership at UiPath FORWARD VI, UiPath’s annual gathering of global AI and … Expion Health Named Inaugural UiPath AI10 Award Winner
NSA currently excludes Urgent Care and Ground Ambulance services despite pressure to do so. However, some states have begun to provide protection. This means self-funded employers must determine which coverage to use. What may seem like the right path may not always make the most economic sense. To ensure the best savings, self-funded plans should … NSA Minute: Ground Ambulance & Urgent Care Services
Blue Shield’s shift from a single PBM to multiple specialized partners for pharmacy benefits management has health plans wondering if disaggregation is right for them. At Expion Health, we’re here to highlight why this shift matters and how we can support health plans like yours with this strategy. 1. Strategic Alignment: Partnering Without Conflict Moving … Blue Shield of California Pharmacy Shake-Up: 3 Disaggregation Considerations for Health Plans
There are 5 costly challenges payers still face when it comes to NSA claims. These challenges are exposing payers to compliance risks and upsetting members. Expion Health’s NSA Navigator is designed to solve those challenges. Don’t expose yourself to NSA compliance and member satisfaction risks. Understand the top challenges payers face and how to solve … Top 5 NSA Challenges & Solutions for Payers
Payers grapple with the complexities of the No Surprises Act (NSA), but self-insured plans face an added challenge in states that allow plans opt-in to state laws instead of the federal law. Selecting between state or federal laws demands careful analysis of factors such as: breadth of protections, data inputs allowed for payment determinations, claims … Navigating the No Surprises Act: The State vs. Federal Balance Billing Dilemma
GAITHERSBURG, Md. — Expion Health, a leading provider of innovative healthcare technology solutions, is proud to announce its dual triumph at the prestigious TITAN Health Awards. The company’s AI-driven repricing and analytics platform, ExpionIQ™, and its member experience app, ExpionME, both clinched the Silver Award in the Insurance Technology Solution and Innovation of the Year … Expion Health’s Groundbreaking Solutions Win Silver at the 2023 TITAN Health Awards
Independent dispute resolution (IDR) has gained remarkable popularity among healthcare providers since the implementation of the No Surprises Act (NSA). The statistics from the first year of the NSA reveal an unexpectedly high volume of IDR cases—14 times more than initially projected. As of March 31, 2023, IDR entities have issued a substantial 42,158 payment … Inside the Numbers: The Surging Popularity and Impact of IDR under the No Surprises Act
Expion Health, previously known as Exponent Health, has taken a bold step in the advancement of healthcare technology with the launch of its mobile app, ExpionME, and a strategic company-wide rebranding. The introduction of ExpionME, designed to ease the burden of rising healthcare costs for payers and their members starting with balance billing, signifies the … Expion Health Launches Innovative Mobile App, ExpionME, and Rebrands from Exponent Health
The Independent Dispute Resolution (IDR) process for NSA continues to deliver surprises and complexities for payers. For example, in a February IDR ruling, a provider was required to refund money to a payer! A successful IDR outcome requires a strong strategy. It’s essential to have a skilled team that is current on IDR guidance and … NSA Minute: IDR Surprises
Legal challenges to the No Surprises Act (NSA) continue to arise with six lawsuits brought forth so far. One lawsuit challenging the constitutionality has failed, but challenges to the regulations used to enforce the statute have continued to erode timely decisions in the independent dispute resolution (IDR) process. Another is challenging the QPA methodology around … NSA Minute: Impact of Legal Challenges
At the end of 2022, half of hospitals are in the red — putting pressure on hospitals to look for new opportunities to increase revenue. This year, OIG added to the pressure with transparency in coverage enforcement and by looking at hospitals seeking to obtain bad debt recoveries from CMS. All of this is compounded … NSA Minute: Hospitals’ Financial Strategy
As we follow the impact of NSA, we continue to see unexpected scenarios occur. For example, with out-of-network at an in-network facility or even emergency care, we assume this excludes office visits. However, recently it has been shown that there are unique instances where office visits could fall under NSA around radiology and clinical lab. … NSA Minute: Unexpected Scenarios
The recent No Surprises Act’s (NSA) report from HHS, Department of Labor, and Department of the Treasury presented eye-opening statistics about the impact and challenges of independent dispute resolution (IDR). Harnessing the power of our NSA claims processing technology, we are helping clients navigate these challenges by calculating defensible QPAs, identifying claims that are ineligible for IDR, … NSA Minute: Eye Opening IDR Statistics
As our hearts and prayers go out to Damar Hamlin and his family for a speedy recovery after his on-field medical emergency, we are reminded of the complexities of emergency care, especially if ongoing care is needed. Even after the immediate crisis has passed, post-stabilization care may still be needed. The No Surprises Act has been instrumental … NSA Minute: Separating NSA and Post-Stabilization Codes
Calculating accurate QPAs is difficult and mistakes can be costly and create compliance risks. Here’s what to do.
