Transparency in Coverage
Beginning July 1st, 2022, the Transparency in Coverage Rules (TIC Rules) requires MediExcel Health Plan to disclose on its public website, information regarding in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for covered items and services, as well as negotiated rates and historical net prices for covered prescription drugs, in separate machine-readable files (MRF.)
These MRFs are formatted to allow easy access and data analysis by researchers, regulators, and application developers. While these files are accessible to all, the files are large and written in JSON, which is a machine-readable language that is not easily interpreted or searchable. For questions about this requirement, email firstname.lastname@example.org.
Prescription Drug Reporting
The following information is provided regarding the compliance of prescription drug data collection (RxDC) reporting by MediExcel Health Plan.
CMS (U.S. Federal Centers for Medicare & Medicaid Services) requires RxDC reporting of certain employer group coverage finances and prescription drug utilization experienced during the 2022 reference year Prescription Drug Data Collection (RxDC) | CMS). Such RxDC reporting is required to be submitted to CMS for all MediExcel Health Plan fully insured health coverage plans by June 1, 2023.
MediExcel Health Plan has been engaged with CMS to ensure that given its status as a Mexican health service plan, MediExcel Health Plan properly complies with CMS requirements.
As of May 30, 2023, MediExcel Health Plan affirms that it has submitted the required RxDC reporting to CMS and CMS has acknowledged receipt of said reporting. Thus, making MediExcel Health Plan compliant with the reporting requirements (P2 and D1-D8) for the 2022 reference year for all its employer groups associated with enrollee membership in its plans.
Price Comparison Tool
Please note that this Price Comparison Tool (PCT) is required under Federal laws and rules (Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR)). The Federal Centers for Medicare & Medicaid Services (CMS) has established a listing of 500 shoppable items and services (https://www.cms.gov/healthplan-price-transparency/resources/500-items-services) in which health plans are required to provide the member’s cost-sharing responsibility. There are two unique aspects regarding MediExcel Health Plan (MEHP). 1) The vast majority of the covered healthcare items and services are only rendered in Mexico. The only category of health care services that may be covered by MEHP in the U.S. pertains to emergency and urgent care services. 2) The vast majority of MEHP-covered healthcare services are copay-related and not coinsurance.
For purposes of complying with federal PCT requirements, MEHP is providing the 500 shoppable items and services as if rendered in the U.S. Only those shoppable items and services that can be provided on an urgent and emergency care basis shall have a cost component. Those shoppable items and services that do not have an urgent or emergency care basis in the U.S. will reflect the status of not being covered in the PCT. In addition to utilizing the PCT to obtain price comparison information, a member can also contact our Member Services team at (619) 365-4346, or via e-mail at email@example.com, for the requested information.