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Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

June 17, 2021

Health Care Price Transparency and the No Surprises Act Summit: Critical Information for Today AND Tomorrow

Schedule with Presentations - All times listed are Eastern Time (ET)

10:00 - Welcome

10:15 - 11:30  Hospital Price Transparency: Requirements to Make standard charges public (shoppable services, machine-readable format). Impact on patients and lessons learned.

  • Terry Cunningham, Director, Administrative Simplification Policy, American Hospital Association
  • Cynthia Fisher, Founder and Chairman, PatientRightsAdvocate.org
  • Stanley Nachimson, Principal, Nachimson Advisors

11:30 - 12:30  Health Plan Transparency in Coverage: Requirements to disclose price/cost sharing information to participants, beneficiaries, and enrollees (shoppable services, formats). Impact on patients

  • Anne Phelps, Principal, US Health Care Regulatory Leader, Deloitte & Touche, LLP
  • Steven Schultz, Director, State Legislative Affairs, Arthritis Foundation
  • Eileen Lee, Vice President, Product Management, Zelis Payments

1:00 - 2:30  No Surprises Act Requirement: Advanced Explanation of Benefits (statutory provisions, impacted stakeholders, data transmission and workflow issues). Impact on stakeholders.

  • Terry Cunningham, Director, Administrative Simplification Policy, American Hospital Association
  • Andrew Scholnick, Senior Legislative Representative, AARP
  • Beth Davis, Senior Manager, AllScripts
  • Heather McComas, Director, Administrative Simplification Initiatives, American Medical Association
  • Erin Weber, CORE Director, CAQH
  • Kelley Schultz, Executive Director, Commercial Policy, AHIP
  • Vanessa Candelora, HL7 FHIR Da Vinci Project PMO

2:30 - 3:30  No Surprises Act RequirementsID cards, price transparency web tool, contracts between plans and providers, provider directories, and impact on stakeholders.

  • Stanley Nachimson, Principal, Nachimson Advisors
  • Anna Hyde, Vice President of Advocacy and Access, Arthritis Foundation
  • Mark Pratt, Senior Vice President, Public Affairs, CAQH
  • Alison Armstrong, Director, Public Policy, Anthem

3:30 - 4:25  Summary: Industry Perspectives, Top Challenges, Timelines, Recommendations for Next Steps

  • Matthew Albright, Chief Legislative Affairs Officer, Zelis Payments
  • Stanley Nachimson, Principal, Nachimson Advisors
  • Viet Nguyen, Technical Director, HL7 Da Vinci Project
  • Robert Tennant, Vice President, Federal Affairs, WEDI

4:25 - 4:30  Closing Remarks

Access Passcode: lQNcw!*4

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