TALON case study: Nonprofit plan cuts TiC MRF cycle time to under 24 hours

TALON released a case study describing how a regional nonprofit health plan reduced its Transparency in Coverage machine-readable file cycle time. The report says direct integration with the plan’s claims administration platform shortened the timeline from 45 days to less than 24 hours, while enabling real-time member cost transparency.

The case study says the plan previously used a non-specialized vendor solution that relied on manual data extraction and transformation from its claims administration platform. It also states the process required coordination across four or more internal FTEs and two to three external contractors, involved continuous infrastructure management, and increased effort for auditability and CMS schema requirement handling.

TALON’s processing layer integrates directly with the plan’s claims administration platform as a system of record for pricing data. The layer applies compliance logic, validation, and CMS schema formatting, then produces two aligned outputs from a single source: regulatory-compliant MRFs and a member-facing treatment cost calculator. The design says it removes a reconciliation layer that typically creates divergence between compliance files and member shopping tools.

The case study links the changes to outcomes including consolidating 13 manual processing bundles into a single automated pipeline, redeploying four-plus internal FTEs from MRF operations, and retiring a reserved cloud compute environment. It also reports a 2.4x return on the technology investment through automation and infrastructure elimination, and launching a real-time member cost transparency experience using the same pricing dataset that powers MRF generation.

“The complexity is just gone. We don't have to manage this process anymore, and we have much greater confidence that our pricing data is accurate and compliant,” said the health plan's Software Development Lead. “Machine-readable files shouldn't be treated as just another compliance checkbox,” said Mark Galvin, CEO of TALON. “When health plans build a trusted pricing data foundation, they can power compliance, member shopping, claims repricing, and network analytics from the same infrastructure.”

TALON said it supports more than 80 health plans and TPAs, integrates with more than 16 claims administration platforms, maintains 99.9% U.S. commercial MRF coverage, and provides pricing data for more than 2.8 billion procedures.

Provided by Globe Newswire on behalf of Talon Cyber Security. Click to read original content.