Category: Blog

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

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

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