Partner pricing - $4,999 per year
*Comparative analysis is required to maintain ongoing compliance. This involves ongoing analysis of networks, vendors, expected claim amounts, formularies and provider reimbursements. To that end, MHPAEA compliance requires ongoing work.
**We do however expect renewal rates to be less expensive than first year rates. Once we have finalized these rates we will post them here.
- Access to our proprietary discovery session designed to collect all necessary information required to create your comparative analysis
- Dedicated account manager
- Entering into a Business Associate Agreement (BAA) thus allowing our team to collect and review medical and pharmacy claims as needed
- Review of plan information, plan financials, administrative service agreements and plan documents
- Standard pricing assumes analysis of one third party administrator (TPA) arrangement, one pharmacy benefit manager (PBM) arrangement, one medical plan network, one medical management and utilization review vendor and up to three different medical plans. If the Client organization has more vendors than this, they can be added to your standard package for an additional fee.
- Delivery of .pdf version of your plan comparative analysis to meet the “show your work” requirements
- Comparative analysis will include full analysis of broad plan limits.
- Comparative analysis will include analysis of quantified treatment limitations (QTLs), including applying the substantially all and predominant tests to the necessary classifications and sub classifications of expected, future plan claims.
- Comparative analysis will include analysis of non-quantified treatment limitations (NQTLs), including but not limited to a review of medical management standards, exclusions for medical necessity, standards for categorizing care as experimental, prior authorization, concurrent review, network tier decision criteria, standards for network participation, formulary design, comparative provider reimbursement rates, comparative provider reimbursement rates as a percentage of Medicare, plan exclusions, plan restrictions and plan limits on duration of services.