Fintech Today
  • About
  • Banking
  • Insurance
  • Resources
    • COVID-19
Subscribe
No Result
View All Result
  • Digital Transformation
  • Customer Experience
  • Cybersecurity & Risk
  • Regulation & Compliance
  • Claims Management
Fintech Today
  • Digital Transformation
  • Customer Experience
  • Cybersecurity & Risk
  • Regulation & Compliance
  • Claims Management
No Result
View All Result
Fintech Today
No Result
View All Result
Home Customer Experience

How Will the No Surprises Act Impact Healthcare Payers?

by Kelsey Winick
August 16, 2021
in Customer Experience, Featured, Insurance, Regulation & Compliance
Reading Time: 4 mins read
A A
No Surprises Act
Share on FacebookShare on Twitter

The No Surprises Act was passed by Congress in December 2020. The purpose of the Act is to protect patients from surprise medical bills and prohibits balance billing of patients for certain out-of-network care. Healthcare payers and providers will have until January 1, 2022, to update their processes to comply with the new rules and regulations.

The Act will “require extensive planning to ensure the infrastructure is in place to support both the payer and provider requirements for 2022,” said Matthew Albright, Chief Legislative Affairs Officer at Zelis. “For payers, top of mind is regulatory compliance with a real focus on solutions that will drive down that administrative burden of the legislation, while also supporting dispute resolution and claim cost management.”

Over the following months, healthcare payers will need to analyze the Act’s requirements to develop their pricing strategy. “Pricing, identifying qualified claims, managing the provider dispute process, and effective clean settlement are all going to require significant resources, coordination nation, and planning in advance of 2022,” said Albright.

According to the legislation, payers must:

  • Establish a verification process in which the payer verifies and updates provider directory information “not less frequently than once every 90 days.”
    • The verification process must have a process for removal of a provider if the payer is unable to verify info “during a period specified by” the payer.
    • Information to be verified includes: name, address, specialty, telephone number, and digital contact information.
  • Establish response protocol for members who request information on whether a provider is in-network.
    • Via telephone call and electronic, web-based, or internet-based means
  • Maintain directory database on a public website + dated print directory.

Payers are also responsible for updating patient insurance ID cards, both physical and electronic, to include the deductible, Out of Pocket maximum limit, telephone number and website address for consumer assistance, and information on in-network providers. Some payers are devising ways, such as QR codes, to fit more information on one card while remaining compliant with the requirements. Additionally, a price comparison tool on the payer’s plan website is also required. This tool will help patients compare the cost-sharing for specific items or services by specific providers concerning the plan year, geographic region, and participating providers.

Healthcare payers need to consider these new Act requirements when planning over the next year. Albright suggests that the organization asks itself, “how are you going to achieve market alignment with your pricing strategy? How will members be supported? What will they do if they get a balanced bill? How will your existing partners add value and support your compliance?” to prepare for the transition into 2022.

To learn more about how to get in compliance with the No Surprises Act, click here.

Tags: Insurance IDNo Surprises ActNSAPayerspolicyZelis

RELATED POSTS

Health Insurers
Customer Experience

Helping Health Insurers Understand NSA Claims Identification

May 13, 2022
Third Party Administrators
Digital Transformation

Third Party Administrators Need a Comprehensive Suite of Solutions to Meet Today’s Transparency Requirements

January 18, 2022
Four Stages
Digital Transformation

Four Stages to Meet Regulations: How Healthcare Payers Can Prepare for the Upcoming Machine-Readable File Requirements

January 11, 2022

TRENDING NOW

  • Arizona’s Motor Vehicles Department (MVD) Makes Payment Offerings More Accessible

    782 shares
    Share 313 Tweet 196
  • Monetizing Data: Follow the Yellow Brick Road

    627 shares
    Share 251 Tweet 157
  • Taking Financial Consolidation to the Next Level

    494 shares
    Share 198 Tweet 124
  • Selling Life Insurance Policies Via Vending Machines is the Ultimate Form of Customer Convenience

    596 shares
    Share 238 Tweet 149
  • The State of Digital Transformation in the Fintech Industry

    544 shares
    Share 218 Tweet 136

CONNECT WITH US

BECOME AN INSIDER

Get Financial Technology Today news and updates in your inbox.

Strategic Communications Group is a digital media company that helps business-to-business marketers drive customer demand through content marketing, content syndication, and lead identification.

Related Communities

Future Healthcare Today
Government Technology Insider
Modern Marketing Today
Retail Technology Insider
Today’s Modern Educator

Quick Links

  • Home
  • About
  • Contact Us

Become a Sponsor

Financial Technology Today offers content and advertising sponsorships to leading technology solution and service providers. Interested in becoming a sponsor? Contact us!

© 2023 Strategic Communications Group, Inc.
Privacy Policy      |      Terms of Service

No Result
View All Result
  • Home
  • About
  • Banking
  • Insurance
  • Categories
    • Digital Transformation
    • Customer Experience
    • Cybersecurity & Risk
    • Regulation & Compliance
    • Claims Management
  • Contact Us