Background

Boulder Administration Services, a third-party administrator (TPA), provides tailored healthcare administration services to self-funded employers, and is known for its highly personalized service and innovative solutions. Boulder Administration Services, similar to all Payors, faced a significant challenge with the introduction of the ‘No Surprises Act’ by CMS in January 2022. The act mandates that health plans provide clear, accessible pricing information to consumers, which requires comprehensive data management and transparent reporting processes.

Challenge

To comply with the ‘Transparency in Coverage Rule’, Boulder Administration Services needed to:

1. Collect and manage vast amounts of data on healthcare pricing and services.
2. Ensure the accuracy and transparency of this data for consumers.
3. Protect sensitive information.
4. Streamline processes to meet tight regulatory deadlines without compromising service quality.

Solution

Boulder Administration Services turned to tara by Deerhold, a powerful data management and compliance tool designed to help healthcare administrators meet regulatory requirements efficiently. tara offers advanced data analytics, member level/family level cost accumulation, and security features making it an ideal solution for compliance with the 'Transparency in Coverage Rule'.

Results

The implementation process involved several key steps:

1. Initial Assessment and Planning:
   • Boulder Administration Services collaborated with Deerhold’s implementation team to assess their current data management processes.
   • A customized implementation plan was developed to ensure seamless integration with Boulder Administration Services’ existing systems.
2. Data Migration and Integration:
   • The machine readable files were collected through the vendors supporting Boulder Administration Services that required multiple rounds of verifications.
   • Integration with Boulder Administration Services’ current systems was carried out to ensure continuous data flow and updates on the data.
   • The continuous data flow required the data vendors to produce MRFs consistently to match the member’s eligibility and the total dollars that were accumulated over a given time period.
3. Training and Support:
   • Boulder Administration Services staff received comprehensive training on using tara’s features and tools.
   • Deerhold provided ongoing support to address any issues and ensure smooth operation.
4. Compliance Monitoring and Reporting:
   • tara’s compliance tool was configured to track Boulder Administration Services’ adherence to the 'Transparency in Coverage Rule' requirements.
   • The users were able to access all the information that was enforced by CMS and all users have given positive feedback due to the simplicity of use from tara

Implementation

The implementation of tara resulted in several significant benefits for Boulder Administration Services:

1. Enhanced Compliance:
   • Boulder Administration Services achieved full compliance with the ‘Transparency in Coverage Rule’, avoiding potential fines and penalties.
2. Improved Data Accuracy and Transparency:
   • Tara’s advanced data management tools improved the accuracy and reliability of pricing information.
   • Consumers received clear, transparent information, enhancing trust and satisfaction.
3. Operational Efficiency:
   • Automation of data collection, analysis, and reporting streamlined Boulder Administration Services’ operations.
   • Staff could focus more on providing high-quality service to clients.
4. Cost Savings:
   • The cost-effective solution reduced the need for additional compliance staff and resources.
   • Boulder Administration Services managed to stay within budget while meeting all regulatory requirements.

Dror Baruch Gravett, the President and Chief Executive Officer of Boulder Administration Services was very satisfied with the process and solution, stating

“Between regulation and innovation, there is always something new to explore, improve, and build in this industry. Having trusted partners, like Deerhold, which carry the same passion for quality and excellence is a benefit for us, our clients, members and community as a whole.”

Conclusion

By implementing tara, Boulder Administration Services successfully navigated the challenges of the ‘Transparency in Coverage Rule’, ensuring compliance, improving operational efficiency, and maintaining their commitment to providing exceptional service to their clients. This case study demonstrates the importance of leveraging advanced technology solutions to meet regulatory requirements in the ever-evolving healthcare industry.