--- title: Industry-Leading NSA and TiC Compliance Tools | Valenz Health description: Learn how Valenz Health helps TPAs and the self-funded employers they serve ensure No Surprises Act and Transparency in Coverage compliance. image: https://blog.valenzhealth.com/hubfs/Untitled%20design%20-%202025-08-07T171254.754.png --- [Skip to content](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-2#page-content) [![Valenz Health](https://blog.valenzhealth.com/hubfs/web/logo.svg)](https://www.valenzhealth.com/) - [Who We Serve](https://www.valenzhealth.com/who-we-serve/) - [Solutions](https://www.valenzhealth.com/solutions/member-experience/) - [About Us](https://www.valenzhealth.com/about-us/) - [Resources](https://www.valenzhealth.com/resources/) - [Contact](https://www.valenzhealth.com/contact/) ### [Patients](https://www.valenzhealth.com/who-we-serve/members/) ### Payers - [Employers](https://www.valenzhealth.com/who-we-serve/employers/) - [Taft-Hartley Funds](https://www.valenzhealth.com/who-we-serve/taft-hartley-funds/) ### Providers - [Healthcare Facilities and Providers](https://www.valenzhealth.com/who-we-serve/healthcare-facilities-and-providers/) ### Plans - [Health Plans](https://www.valenzhealth.com/who-we-serve/health-plans/) - [Third-Party Administrators](https://www.valenzhealth.com/who-we-serve/third-party-administrators-tpas/) - [Brokers and Consultants](https://www.valenzhealth.com/who-we-serve/brokers/) - [Stop Loss Producers](https://www.valenzhealth.com/who-we-serve/stop-loss-producers/) #### Partner with Us Discover how Vālenz Health® can simplify the healthcare experience with our innovative solutions. [Explore All](https://www.valenzhealth.com/who-we-serve/) ### Member Experience - [Overview](https://www.valenzhealth.com/solutions/member-experience/) - [Clinical Engagement](https://www.valenzhealth.com/solutions/member-experience/clinical-engagement/) - [Valenz Bluebook](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) - - [Bluebook Rx](https://www.valenzhealth.com/solutions/member-experience/bluebook-rx/) - [Surgical and Imaging](https://www.valenzhealth.com/solutions/member-experience/surgical-imaging/) - [Infusion Therapy](https://www.valenzhealth.com/solutions/member-experience/infusion-therapy/) ### Payment Integrity - [Overview](https://www.valenzhealth.com/solutions/payment-integrity/) - [ABN Medical Necessity](https://www.valenzhealth.com/solutions/payment-integrity/abn-medical-necessity-validation/) - [Clean Claim Verification](https://www.valenzhealth.com/solutions/payment-integrity/clean-claim-verification/) - [Bill Review](https://www.valenzhealth.com/solutions/payment-integrity/clinical-bill-review/) - [Curated Data Sources](https://www.valenzhealth.com/solutions/payment-integrity/curated-data-sources/) - [In-Network Repricing](https://www.valenzhealth.com/solutions/payment-integrity/in-network-repricing/) - [Out-of-Network Repricing](https://www.valenzhealth.com/solutions/payment-integrity/out-of-network-repricing/) ### Provider Quality - [Overview](https://www.valenzhealth.com/solutions/provider-quality/) - [Credentialing](https://www.valenzhealth.com/solutions/provider-quality/credentialing/) - [Provider Staff Sanction Monitoring](https://www.valenzhealth.com/solutions/provider-quality/provider-staff-sanction-monitoring/) - [CareChex® Awards](https://www.valenzhealth.com/solutions/provider-quality/carechex-awards-by-quantros/) - [Outcomes Analytics by Quantros](https://www.valenzhealth.com/solutions/provider-quality/outcomes-analytics/) ### Plan Performance - [Overview](https://www.valenzhealth.com/solutions/plan-performance/) - [Stop Loss](https://www.valenzhealth.com/solutions/plan-performance/stop-loss/) - [Variable Copay](https://www.valenzhealth.com/solutions/plan-performance/variable-copay/) ### Platform - [Integrated Platform](https://www.valenzhealth.com/solutions/integrated-platform/) #### Solution Finder Find the right solution for your needs. [Get Started](https://www.valenzhealth.com/solutions/) ### Company - [About Valenz Health](https://www.valenzhealth.com/about-us/) - [Careers](https://www.valenzhealth.com/about-us/careers/) ### Why Valenz - [Leadership Team](https://www.valenzhealth.com/about-us/#Executive-Leadership) - [Our Mission](https://www.valenzhealth.com/about-us/#About-Valenz-Health) - [Our Values](https://www.valenzhealth.com/about-us/#Core-Values) #### Join Our Team Be part of the healthcare revolution. We're hiring talented individuals who share our vision. [View Open Positions](https://www.valenzhealth.com/about-us/careers/) ### Regulatory & Compliance - [The No Surprises Act (NSA)](https://www.valenzhealth.com/resources/no-surprises-act/) - [Transparency in Coverage (TiC)](https://www.valenzhealth.com/resources/transparency-in-coverage/) - [OIG Compliance](https://www.valenzhealth.com/resources/oig-compliance/) ### Industry Insights - [Fighting Fraud, Waste, and Abuse](https://www.valenzhealth.com/resources/fraud-waste-abuse/) - [Self-Funded Insurance](https://www.valenzhealth.com/resources/self-funded-health-insurance/) #### Resource Center Stay informed with our latest whitepapers, guides, and industry insights. [Browse All Resources](https://www.valenzhealth.com/resources/) [![Valenz Health](https://blog.valenzhealth.com/hubfs/web/logo.svg)](https://www.valenzhealth.com/) - Who We Serve - Solutions - About Us - Resources - Contact Us - Login - Search Back ### Who We Serve - [Overview](https://www.valenzhealth.com/who-we-serve/) #### Patients - [Members](https://www.valenzhealth.com/who-we-serve/members/) #### Payers - [Employers](https://www.valenzhealth.com/who-we-serve/employers/) - [Taft-Hartley Funds](https://www.valenzhealth.com/who-we-serve/taft-hartley-funds/) #### Providers - [Healthcare Facilities and Providers](https://www.valenzhealth.com/who-we-serve/healthcare-facilities-and-providers/) #### Plans - [Health Plans](https://www.valenzhealth.com/who-we-serve/health-plans/) - [Third-Party Administrators](https://www.valenzhealth.com/who-we-serve/third-party-administrators-tpas/) - [Brokers and Consultants](https://www.valenzhealth.com/who-we-serve/brokers/) - [Stop Loss Producers](https://www.valenzhealth.com/who-we-serve/stop-loss-producers/) Back ### Solutions - [Overview](https://www.valenzhealth.com/solutions/) - [Member Experience](https://www.valenzhealth.com/solutions/member-experience/) - [Payment Integrity](https://www.valenzhealth.com/solutions/payment-integrity/) - [Provider Quality](https://www.valenzhealth.com/solutions/provider-quality/) - [Plan Performance](https://www.valenzhealth.com/solutions/plan-performance/) - [Platform](https://www.valenzhealth.com/solutions/integrated-platform/) Back ### About Us - [Overview](https://www.valenzhealth.com/about-us/) - [Careers](https://www.valenzhealth.com/about-us/careers/) Back ### Resources - [Overview](https://www.valenzhealth.com/resources/) - [The No Surprises Act (NSA)](https://www.valenzhealth.com/resources/no-surprises-act/) - [Transparency in Coverage (TiC)](https://www.valenzhealth.com/resources/transparency-in-coverage/) - [Office of Inspector General Compliance](https://www.valenzhealth.com/resources/oig-compliance/) - [Fighting Fraud, Waste, and Abuse (FWA)](https://www.valenzhealth.com/resources/fraud-waste-abuse/) - [Self-Funded Insurance](https://www.valenzhealth.com/resources/self-funded-health-insurance/) Back ### Payment Integrity - [Overview](https://www.valenzhealth.com/solutions/payment-integrity/) - [ABN Medical Necessity Validation](https://www.valenzhealth.com/solutions/payment-integrity/abn-medical-necessity-validation/) - [Clean Claim Verification](https://www.valenzhealth.com/solutions/payment-integrity/clean-claim-verification/) - [Bill Review](https://www.valenzhealth.com/solutions/payment-integrity/clinical-bill-review/) - [Curated Data Sources](https://www.valenzhealth.com/solutions/payment-integrity/curated-data-sources/) - [In-Network Repricing](https://www.valenzhealth.com/solutions/payment-integrity/in-network-repricing/) - [Out-of-Network Repricing](https://www.valenzhealth.com/solutions/payment-integrity/out-of-network-repricing/) Back ### Provider Quality - [Overview](https://www.valenzhealth.com/solutions/provider-quality/) - [Credentialing](https://www.valenzhealth.com/solutions/provider-quality/credentialing/) - [Provider Staff Sanction Monitoring](https://www.valenzhealth.com/solutions/provider-quality/provider-staff-sanction-monitoring/) - [CareChex® Awards by Quantros](https://www.valenzhealth.com/solutions/provider-quality/carechex-awards-by-quantros/) - [Outcomes Analytics by Quantros](https://www.valenzhealth.com/solutions/provider-quality/outcomes-analytics/) Back ### Member Experience - [Overview](https://www.valenzhealth.com/solutions/member-experience/) - [Clinical Engagement](https://www.valenzhealth.com/solutions/member-experience/clinical-engagement/) - [Valenz Bluebook](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) - [• Bluebook Rx](https://www.valenzhealth.com/solutions/member-experience/bluebook-rx/) - [Precision Care](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/#precision-care/) Back ### Plan Performance - [Overview](https://www.valenzhealth.com/solutions/plan-performance/) - [Stop Loss](https://www.valenzhealth.com/solutions/plan-performance/stop-loss/) - [Variable Copay](https://www.valenzhealth.com/solutions/plan-performance/variable-copay/) Back ### Search # Test Post 3 By [Vālenz Health®](https://blog.valenzhealth.com/valenzhealth2025test/author/valenz-health) - June 09, 2026 [Cost and Quality Transparency](https://blog.valenzhealth.com/valenzhealth2025test/tag/cost-and-quality-transparency) [Compliance](https://blog.valenzhealth.com/valenzhealth2025test/tag/compliance) [Payment Integrity](https://blog.valenzhealth.com/valenzhealth2025test/tag/payment-integrity) Share ![](https://blog.valenzhealth.com/hs-fs/hubfs/Untitled%20design%20-%202025-08-07T171254.754.png?width=485&height=485&name=Untitled%20design%20-%202025-08-07T171254.754.png) As the individuals often tasked with the responsibility of meeting [No Surprises Act (NSA)](https://www.valenzhealth.com/resources/no-surprises-act/) requirements and [Transparency in Coverage (TiC)](https://www.valenzhealth.com/resources/transparency-in-coverage/) rules, third-party administrators (TPAs) play a key role in helping self-funded plans stay compliant. But they don’t have to do it alone. By teaming up with Vālenz Health®, TPAs not only receive direct, personalized support from an organization well-versed with compliance matters. They also get access to the most comprehensive cost and quality data available, as well as the ability to expertly navigate and execute all aspects of claims services affected by NSA and TiC regulations. The result: Higher satisfaction from self-funded employers, better client retention, and smarter, better, faster healthcare for all involved. ## How Innovative Solutions from Vālenz Health® Help Ensure NSA and TiC Compliance As an industry leader in innovative healthcare solutions, Valenz is uniquely positioned to meet the legislative requirements of protecting patients from surprise medical bills and providing easily accessible information on the true costs of care — [all offered as part of a single integrated platform](https://www.valenzhealth.com/solutions/integrated-platform/). Add your callout content here. Learn More What that means for your self-funded clients: - Better [price and data transparency](https://blog.valenzhealth.com/price-transparency-in-healthcare) - Higher member engagement and smarter care choices - Improved efficiency in managing [out-of-network claim processes and payments](https://www.valenzhealth.com/solutions/payment-integrity/out-of-network-repricing/) - Minimized likelihood of [costly independent dispute resolutions (IDRs)](https://blog.valenzhealth.com/nsa-idr-compliance) ### Member-Facing Tools for Better Transparency The TiC rulings from 2020 make it clear: All healthcare plans and issuers must disclose price and cost-sharing information to plan participants, beneficiaries, and enrollees. Valenz Bluebook does that heavy lifting — so TPAs and members don’t have to. With an extensive claims dataset at its fingertips, [Valenz Bluebook](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) integrates both cost and outcomes data, distills it down, and makes it instantly understandable using a simple green-yellow-red color-coded system for both quality of care and cost. The goal: Engage members early and often, giving them access to necessary, helpful information as they search for procedures and providers, **before** they have received care.  ![Valenz Bluebook Cropped](https://blog.valenzhealth.com/hs-fs/hubfs/Blog/Blog%20Graphics/Valenz%20Bluebook%20Cropped.png?width=688&height=283&name=Valenz%20Bluebook%20Cropped.png) Valenz Bluebook leans heavily on historical claims data (from qualified databases only) to guide members to the right provider/facility for the right care at the right price, a designation we call “Fair Price.” In doing so, the platform fulfills the legal requirement to share specific pricing, while also protecting the member experience by paving a clear path to the lowest-cost, highest-quality care option. And while TiC regulations don’t require the inclusion of quality data, Valenz Bluebook goes the extra mile to include it — [because it plays a significant factor in cost determination, too](https://www.healthcaredive.com/spons/from-hidden-costs-to-smarter-choices-why-transparency-is-key-to-lowering-h/819407/). By strategically layering the quality component into the pricing equation, Valenz Bluebook decreases the likelihood of unplanned readmissions or complications, which not only drive negative member experiences but also increase total costs for the plan. | **Icon** | **Quality** | **Cost** | | --- | --- | --- | | **Green** | Top third of quality ratings | Fair Price | | **Yellow** | Middle third of quality ratings | Slightly above the Fair Price | | **Red** | Bottom third of quality ratings | Highest cost | With this approach, Valenz Bluebook long ago established itself as a national leader in improving cost and quality transparency — years before NSA and TiC regulations went into effect. As a result, today’s TPAs can trust Valenz to be the data expert on their behalf, allowing them to focus solely on what they do best: adjudicating claims and supporting employers. The goal of such a partnership is to simplify healthcare — for everyone. ### Expertise in Claims and Negotiation With the IDR management process estimated to have cost [$5 billion over the last few years alone](https://www.healthaffairs.org/content/forefront/substantial-costs-no-surprises-act-arbitration-process), TPAs need an expert by their side to manage any IDR processes and, more importantly, avoid future IDR risks with proper payment integrity solutions from the start. In addition to their full understanding of NSA requirements, the [Valenz Payment Integrity](https://www.valenzhealth.com/solutions/payment-integrity/) team uses their deep experience with negotiations and the complexities of out-of-network provider billing and payment expectations to take the burden off TPAs’ shoulders, managing: - The claims payment process, including CMS portal navigation - The open negotiations process, including initiation, calculation of qualified payment amounts (QPAs) and rate acceptance within a timely manner - IDR initiation, including payment, selection, and delivery of the final offer QPAs regularly pose challenges for TPAs due to the extensive amount of data required — data pulled from multiple markets with multiple emergency providers, air ambulance providers, and other specialty services. The wealth of qualified data in the Valenz Bluebook solution removes those challenges, ensuring unparalleled data accuracy for efficient negotiations that minimize any additional payments needed to settle claims. This means more reasonable reimbursement rates, backed by a deeper level of data that supports and defends the negotiation. From aggregating all data and showing that good-faith negotiations were conducted, to touching on the seven data points on which an IDR entity will make its decision, Valenz understands the importance of meeting the NSA's rigid rules and timelines every step of the way — and provides all the support TPAs need during the compliance process to ensure favorable outcomes for your self-funded clients. The solution can be found in our **Valenz Bluebook Comply** and **Out-of-Network (OON) Repricing** bundle, which offers [NSA compliance protection and cost containment](https://www.valenzhealth.com/resources/no-surprises-act/) in a single, proactive strategy. By combining our full compliance suite with data-driven, defensible reimbursements, Valenz delivers an average 70.6% savings, less than 1% provider appeal rates, and rapid turnaround to take the administrative and financial burden off your shoulders. And, with an upfront IDR fee payment structure, we reduce financial exposure for your team, eliminating payment timing risk, as well. ![11.26 comply oon repricing promo](https://blog.valenzhealth.com/hs-fs/hubfs/Social/2025/November/11.26%20comply%20oon%20repricing%20promo.png?width=500&height=500&name=11.26%20comply%20oon%20repricing%20promo.png)[Learn more by contacting our team members today](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-2#contact-us).   ### One Partner to Meet Every Need It’s extremely difficult for self-funded employers to achieve full compliance with the NSA and TiC on their own, even when working with knowledgeable and helpful TPAs. To effectively manage claims, drive savings, and support a positive member experience, TPAs need to use every tool at their disposal — and that includes a third-party, data-centric partner like Valenz. The Valenz integrated platform combines both member experience and post-claim compliance to leverage a greater intersection of data, delivering actionable insights, identifying savings opportunities, and guiding better decisions by: - Aggregating years of robust claims data from thousands of provider network cases using industry-leading sources of payment-, cost-, and charge-based datasets, as well as biometrics and clinical data - Analyzing care quality, utilization, and cost - Leveraging data-mining capabilities that identify patterns and pinpoint high-performing providers with optimal cost structures - Ensuring defensible, market-supported reimbursements As part of our mission to simplify healthcare for all, Valenz doesn’t just provide support to TPAs, either. Our team also educates [self-funded employers](https://www.valenzhealth.com/resources/self-funded-health-insurance/) about the compliance process, ensuring they are knowledgeable enough to ask appropriate questions, confirm that their TPAs are advocating for them appropriately, and otherwise play a proactive role in their compliance efforts. ## Deliver Better Compliance Solutions with Vālenz Health® Today If you’re a TPA who’s tired of juggling multiple vendors to meet legislative requirements, it’s time for a simpler approach. In addition to providing all the services you need for full NSA and TiC compliance, Valenz offers an end-to-end solution suite that optimizes the cost, quality, and utilization of high-value healthcare across the entire member journey. By integrating cost containment and member engagement in [ValenzONE](https://www.valenzhealth.com/solutions/plan-performance/valenz-one/), we connect patients with high-quality, lower-cost providers and health systems to deliver measurable savings to plan members, self-insured employers, and the TPAs and brokers who serve them. This represents our latest innovation in creating smarter, better, faster healthcare for all. As compliance legislation evolves, Valenz will remain the partner that skates to where the puck is going to solve for the unseen challenges ahead — supporting TPAs, brokers, and, most importantly, the members at the heart of the plan from start to finish. Find out more about how Valenz ensures compliance with NSA and TiC regulations by connecting with our team below. ### Connect With Us to Learn More ![Vālenz Health®](https://blog.valenzhealth.com/hs-fs/hubfs/Valenz%20Logo%20Signature.png?width=48&height=48&name=Valenz%20Logo%20Signature.png) [Vālenz Health®](https://blog.valenzhealth.com/valenzhealth2025test/author/valenz-health) Vālenz Health® empowers employers, brokers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience. Our solutions combine advanced technology, clinical expertise, and extensive cost, quality, and utilization datasets to execute across the entire healthcare journey — connecting insights and action for greater transparency, flexibility, and cost containment within a complex system. By helping our customers and members navigate healthcare with confidence, we support smarter care decisions, strengthen plan performance, and deliver better value for everyone we serve. ## Related Articles [![](https://blog.valenzhealth.com/hubfs/Untitled%20design%20-%202025-08-07T171254.754.png)](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-1) ### [Test Post 2](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-1) As the individuals often tasked with the responsibility of meeting No Surprises Act (NSA) requirements and Transparency in Coverage (TiC) rules, third-party administrators (TPAs) play a key role in helping self-funded plans stay compliant. [Vālenz Health®](https://blog.valenzhealth.com/valenzhealth2025test/author/valenz-health) June 09, 2026 [![](https://blog.valenzhealth.com/hubfs/Untitled%20design%20-%202025-08-07T171254.754.png)](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health) ### [The Financial Era of Health Plan Strategy: How Employers are Rethinking their Approach to Benefit Design](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health) TLDR Summary Block Faucibus sapien eu et risus vestibulum enim pulvinar mauris. Accumsan et mi magna... Introduction elementum a eleifend duis maecenas tincidunt at integer integer fringilla accumsan tincidunt nibh adipiscing duis suspendisse in elementum sapien egestas eu donec sed et interdum nam diam a donec ultricies fermentum pulvinar purus sed aliquet tempor augue ut bibendum magna. Key takeaways Gravida netus a scelerisque id. Diam arcu sit porttitor tristique. Dictumst ultricies nisl tempus nunc tristique placerat. Vitae eu odio turpis consequat suspendisse diam elit velit. Imperdiet. Tortor mattis nunc pulvinar sapien quam. As the individuals often tasked with the responsibility of meeting No Surprises Act (NSA) requirements and Transparency in Coverage (TiC) rules, third-party administrators (TPAs) play a key role in helping self-funded plans stay compliant. [Vālenz Health®](https://blog.valenzhealth.com/valenzhealth2025test/author/valenz-health) June 09, 2026 Share ## In this article - [Section Title](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-2#test-anchor-1) - [Section Title](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-2#section) - [Section Title](https://blog.valenzhealth.com/valenzhealth2025test/industry-leading-nsa-and-tic-compliance-tools-valenz-health-2#section) In this article Section Title Section Title Section Title Ready to Simplify Self-Insurance? ## Your Journey Starts Here Connect with a Valenz team member to explore the difference our solutions can make for you. ![Vālenz Health](https://www.valenzhealth.com/wp-content/uploads/2025/05/logo.svg) [![Youtube](https://www.valenzhealth.com/wp-content/uploads/2025/06/Icon-Youtube.svg)](https://www.youtube.com/@valenzhealth) [![Linkedin](https://www.valenzhealth.com/wp-content/uploads/2025/06/Icon-Linkedin.svg)](https://www.linkedin.com/company/valenz/) [Login](https://www.valenzhealth.com/user-login/) [Help Center](https://support.valenzhealth.com/hc/en-us) [Trust Center](https://trust.valenzhealth.com/) [Privacy Policy](https://www.valenzhealth.com/privacy-policy/) Cookie Settings [Cookie Policy](https://www.valenzhealth.com/cookie-policy/) [California Privacy Rights Notice](https://www.valenzhealth.com/california-privacy-rights-notice/) [Terms and Conditions](https://www.valenzhealth.com/terms-and-conditions/) 1717 McKinney Ave, Suite 1000, Dallas, TX 75202, USA | [(866) 762-4455](tel:+18667624455) © 2026 Vālenz Health® ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ { "@type" : "Thing", "name" : "Cost and Quality Transparency" }, { "@type" : "Thing", "name" : "Compliance" }, { "@type" : "Thing", "name" : "Payment Integrity" } ], "articleBody" : "As the individuals often tasked with the responsibility of meeting No Surprises Act (NSA) requirements and Transparency in Coverage (TiC) rules, third-party administrators (TPAs) play a key role in helping self-funded plans stay compliant. But they don’t have to do it alone. By teaming up with Vālenz Health®, TPAs not only receive direct, personalized support from an organization well-versed with compliance matters. They also get access to the most comprehensive cost and quality data available, as well as the ability to expertly navigate and execute all aspects of claims services affected by NSA and TiC regulations. The result: Higher satisfaction from self-funded employers, better client retention, and smarter, better, faster healthcare for all involved. How Innovative Solutions from Vālenz Health® Help Ensure NSA and TiC Compliance As an industry leader in innovative healthcare solutions, Valenz is uniquely positioned to meet the legislative requirements of protecting patients from surprise medical bills and providing easily accessible information on the true costs of care — all offered as part of a single integrated platform. Add your callout content here. Learn More What that means for your self-funded clients: Better price and data transparency Higher member engagement and smarter care choices Improved efficiency in managing out-of-network claim processes and payments Minimized likelihood of costly independent dispute resolutions (IDRs) Member-Facing Tools for Better Transparency The TiC rulings from 2020 make it clear: All healthcare plans and issuers must disclose price and cost-sharing information to plan participants, beneficiaries, and enrollees. Valenz Bluebook does that heavy lifting — so TPAs and members don’t have to. With an extensive claims dataset at its fingertips, Valenz Bluebook integrates both cost and outcomes data, distills it down, and makes it instantly understandable using a simple green-yellow-red color-coded system for both quality of care and cost. The goal: Engage members early and often, giving them access to necessary, helpful information as they search for procedures and providers, before they have received care. Valenz Bluebook leans heavily on historical claims data (from qualified databases only) to guide members to the right provider/facility for the right care at the right price, a designation we call “Fair Price.” In doing so, the platform fulfills the legal requirement to share specific pricing, while also protecting the member experience by paving a clear path to the lowest-cost, highest-quality care option. And while TiC regulations don’t require the inclusion of quality data, Valenz Bluebook goes the extra mile to include it — because it plays a significant factor in cost determination, too. By strategically layering the quality component into the pricing equation, Valenz Bluebook decreases the likelihood of unplanned readmissions or complications, which not only drive negative member experiences but also increase total costs for the plan. Icon Quality Cost Green Top third of quality ratings Fair Price Yellow Middle third of quality ratings Slightly above the Fair Price Red Bottom third of quality ratings Highest cost With this approach, Valenz Bluebook long ago established itself as a national leader in improving cost and quality transparency — years before NSA and TiC regulations went into effect. As a result, today’s TPAs can trust Valenz to be the data expert on their behalf, allowing them to focus solely on what they do best: adjudicating claims and supporting employers. The goal of such a partnership is to simplify healthcare — for everyone. Expertise in Claims and Negotiation With the IDR management process estimated to have cost $5 billion over the last few years alone, TPAs need an expert by their side to manage any IDR processes and, more importantly, avoid future IDR risks with proper payment integrity solutions from the start. In addition to their full understanding of NSA requirements, the Valenz Payment Integrity team uses their deep experience with negotiations and the complexities of out-of-network provider billing and payment expectations to take the burden off TPAs’ shoulders, managing: The claims payment process, including CMS portal navigation The open negotiations process, including initiation, calculation of qualified payment amounts (QPAs) and rate acceptance within a timely manner IDR initiation, including payment, selection, and delivery of the final offer QPAs regularly pose challenges for TPAs due to the extensive amount of data required — data pulled from multiple markets with multiple emergency providers, air ambulance providers, and other specialty services. The wealth of qualified data in the Valenz Bluebook solution removes those challenges, ensuring unparalleled data accuracy for efficient negotiations that minimize any additional payments needed to settle claims. This means more reasonable reimbursement rates, backed by a deeper level of data that supports and defends the negotiation. From aggregating all data and showing that good-faith negotiations were conducted, to touching on the seven data points on which an IDR entity will make its decision, Valenz understands the importance of meeting the NSA's rigid rules and timelines every step of the way — and provides all the support TPAs need during the compliance process to ensure favorable outcomes for your self-funded clients. The solution can be found in our Valenz Bluebook Comply and Out-of-Network (OON) Repricing bundle, which offers NSA compliance protection and cost containment in a single, proactive strategy. By combining our full compliance suite with data-driven, defensible reimbursements, Valenz delivers an average 70.6% savings, less than 1% provider appeal rates, and rapid turnaround to take the administrative and financial burden off your shoulders. And, with an upfront IDR fee payment structure, we reduce financial exposure for your team, eliminating payment timing risk, as well. Learn more by contacting our team members today. One Partner to Meet Every Need It’s extremely difficult for self-funded employers to achieve full compliance with the NSA and TiC on their own, even when working with knowledgeable and helpful TPAs. To effectively manage claims, drive savings, and support a positive member experience, TPAs need to use every tool at their disposal — and that includes a third-party, data-centric partner like Valenz. The Valenz integrated platform combines both member experience and post-claim compliance to leverage a greater intersection of data, delivering actionable insights, identifying savings opportunities, and guiding better decisions by: Aggregating years of robust claims data from thousands of provider network cases using industry-leading sources of payment-, cost-, and charge-based datasets, as well as biometrics and clinical data Analyzing care quality, utilization, and cost Leveraging data-mining capabilities that identify patterns and pinpoint high-performing providers with optimal cost structures Ensuring defensible, market-supported reimbursements As part of our mission to simplify healthcare for all, Valenz doesn’t just provide support to TPAs, either. Our team also educates self-funded employers about the compliance process, ensuring they are knowledgeable enough to ask appropriate questions, confirm that their TPAs are advocating for them appropriately, and otherwise play a proactive role in their compliance efforts. Deliver Better Compliance Solutions with Vālenz Health® Today If you’re a TPA who’s tired of juggling multiple vendors to meet legislative requirements, it’s time for a simpler approach. In addition to providing all the services you need for full NSA and TiC compliance, Valenz offers an end-to-end solution suite that optimizes the cost, quality, and utilization of high-value healthcare across the entire member journey. By integrating cost containment and member engagement in ValenzONE, we connect patients with high-quality, lower-cost providers and health systems to deliver measurable savings to plan members, self-insured employers, and the TPAs and brokers who serve them. This represents our latest innovation in creating smarter, better, faster healthcare for all. As compliance legislation evolves, Valenz will remain the partner that skates to where the puck is going to solve for the unseen challenges ahead — supporting TPAs, brokers, and, most importantly, the members at the heart of the plan from start to finish. Find out more about how Valenz ensures compliance with NSA and TiC regulations by connecting with our team below. 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