- Prohibitions on benchmarking and comingling claims data from multiple companies
- Prohibitions on using data to develop or use any type of price transparency tool
- Prohibitions on using claims data to create any type of health care comparison data base
- Prohibitions on using claims data to do any cross-carrier comparisons
- Prohibitions on using claims data to run any type of RFP or RFI process to shop carrier
- Prohibitions on using claims data to contract with business coalitions, accountable care
organizations, or centers of excellence
- Prohibitions on using data to “steer” members between providers of the same service
type or category
- Prohibitions on performing certain analytical procedures on claims data, includes
reverse engineering of pricing, margins, etc.
- Prohibitions on disclosure of claims data to any employees who are involved in provider
network development or negotiating pricing and terms on behalf of any coalition or
- Upon terminating a carrier, prohibitions on maintaining the Company’s own historical
claims data or sharing historical claims data with the Company’s new carrier.
- Limitations on carrier’s sharing of mental health or substance abuse data
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