Category: News

NSA No-Response IDR Determinations a Surprising Waste of Plan Dollars

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 Wins Prestigious CIO 100 Award

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

Harnessing Transparency and Control: Key Takeaways from the HCAA Executive Forum from Expion Health

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

Get Ready: CMS Proposes Numerous Changes to IDR Process

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

Expion Health and Mark Cuban Cost Plus Drug Company, PBC Forge Innovative Collaboration to Enhance Pharmacy Cost Management

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

Expion Insights from SIIA 2023

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 Named Inaugural UiPath AI10 Award Winner

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 Minute: Ground Ambulance & Urgent Care Services

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 of California Pharmacy Shake-Up: 3 Disaggregation Considerations for Health Plans

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

Top 5 NSA Challenges & Solutions for Payers

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

Navigating the No Surprises Act: The State vs. Federal Balance Billing Dilemma

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

Expion Health’s Groundbreaking Solutions Win Silver at the 2023 TITAN Health Awards

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

Inside the Numbers: The Surging Popularity and Impact of IDR under the No Surprises Act

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 Launches Innovative Mobile App, ExpionME, and Rebrands from Exponent Health

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

NSA Minute: IDR Surprises

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

NSA Minute: Impact of Legal Challenges

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

NSA Minute: Hospitals’ Financial Strategy

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

NSA Minute: Unexpected Scenarios

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

NSA Minute: Eye Opening IDR Statistics

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

NSA Minute: Separating NSA and Post-Stabilization Codes

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

Don’t Risk It: QPA Calculation

Calculating accurate QPAs is difficult and mistakes can be costly and create compliance risks. Here’s what to do.

The Impact of Humira Biosimilars: 5 Factors That Will Reduce Payer Costs

The use of biosimilar products in lieu of originator biologic products has been a hot topic of discussion since the first FDA approval of Zarxio (a biosimilar for Neupogen) in 2015. Since then over 30 new biosimilars have been FDA approved but the biosimilar market hasn’t taken off as expected. The slower than expected uptake The Impact of Humira Biosimilars: 5 Factors That Will Reduce Payer Costs

Biosimilars 101

The biologics market could see some significant changes with the current and upcoming interchangeability approvals of several biosimilar products. Let’s dive into what biosimilars are and the importance of interchangeability. What is a biosimilar?A biosimilar is a potential alternative for an existing FDA-approved biologic. They are highly similar (can have minor differences in inactive components) Biosimilars 101

Expion Health Wins Best Tech For Good

Tech in Motion has named Expion Health as Chicago’s Best Tech for Good in this year’s Timmy Awards, recognizing the top workplaces for tech professionals across North America. Expion Health was chosen by other members of the tech industry in Chicago for utilizing tech to help tackle today’s most pressing social, global and ecological challenges, Expion Health Wins Best Tech For Good

Expion Health Named Top 100 Healthcare Technology Companies

Expion Health has been named one of the Top 100 Healthcare Technology Companies for 2022 by The Healthcare Technology Report. The honorees represent some of the best companies in the healthcare technology space across a range of specialties including genomics, pharmaceuticals, analytics, and consumer healthtech. These companies are changing the face of the industry and impacting Expion Health Named Top 100 Healthcare Technology Companies

Expion Health Achieves HITRUST CSF® Certification to Manage Risk, Improve Security Posture, and Meet Compliance Requirements

HITRUST CSF Certification validates Expion Health is committed to meeting key regulations and protecting sensitive information. GAITHERSBURG, MD — Expion Health, a leading provider of medical and pharmacy cost containment and transparency solutions for health plan sponsors and pharmacy benefits managers across the healthcare spectrum, today announced its technology platforms ClaimSave and Claims Automation have Expion Health Achieves HITRUST CSF® Certification to Manage Risk, Improve Security Posture, and Meet Compliance Requirements

Expion Health continues to expand offering with acquisition of National Bill Audit Services

GAITHERSBURG, MD — Expion Health is excited to announce the acquisition of National Bill Audit Services (NBAS) as part of its commitment to continually evolve its offering to meet clients’ cost containment challenges. The companies share a reputation for high-touch, high-value service models, and the addition of NBAS expands Expion Health’s product portfolio by adding Expion Health continues to expand offering with acquisition of National Bill Audit Services

Fee Negotiation: Controlling Out-of-Network Claims Costs Following the No Surprises Act

On December 27, 2020, H.R.133 — the FY2021 Omnibus Appropriations Bill — was signed into law. Embedded within the nearly 2,200-page bill was the No Surprises Act, a significant piece of bipartisan legislation designed to protect consumers against the bitter pills that come with surprise medical billing.