New legislation is changing the information that health insurance companies need to provide to members. As a result, healthcare organizations need to know what processes to update to be in compliance with the No Surprises Act, which takes effect on January 1, 2022. The Act’s primary goal is to protect patients from balance billing, also known as surprise medical billing. Two of the main requirements from the Act are updating ID cards and providing Advanced Explanation of Benefits (AEOBs).
ID Cards
Beginning in January 2022, the Act requires that member ID cards, both electronic and print, include in-network deductible, out-of-network deductible, maximum out-of-pocket limit, telephone number for member assistance, website URL for member assistance, and information on where to find in-network providers. In addition, some payers are considering different ways, such as QR codes, “to expand the real estate available to put information on ID cards,” said Eileen Lee, Vice President of Connect Solutions at Zelis.
According to Lee, the four most asked questions by payers about the ID card rules are:
1. What is the deadline for printing new cards?
“In my reading of the law, the insured party’s renewal date is the date by which payers need to be compliant,” said Lee.
2. Do these new rules apply to both printed and electronic ID cards?
“Yes, whether members have printed ID cards or electronic ID cards, both need to comply.
3. Can I add a QR code?
Lee says that “the addition of a QR is up to the interpretation of the law, and I believe the law is open to external electronic sources.
4. Do I need separate cards for dependents?
While the Act does not mention dependents, “if the policy or the plan design is different for dependents, then in our reading of the law, in order to meet the requirements, payers would have to print separate cards for that dependent,” said Lee.
Lee commented on the many ways to support payers in electronic adoption, such as creating ID card templates that meet compliance requirements, populating and delivering client-provided information ID cards, and promoting the overall adoption of electronic cards.
Advanced Explanation of Benefits
When a patient schedules a service, providers must submit a good faith estimate to the payer, and then the payer must provide the member with an Advanced Explanation of Benefits (AEOB). There are several requirements for the AEOBs, but they are “going to revolutionize the way payers bring information in front of patients before they go to the doctors,” commented Lee. “Payers will have an opportunity to use the Advanced Explanation of Benefits to tell their story. It’s an incredible strategic between the time a patient schedules an appointment and then attends that service. Payers will have an opportunity to communicate with them through an AEOB and include things like steerage, advertisements, and other benefits, such as suggesting telemedicine, which is a greater cost saving for both the patient and the plan.”
There are a great number of things that healthcare payers need to accomplish in the coming months in order to comply with the No Surprises Act, such as updating ID cards, creating compliant templates, and managing member preferences. To meet the looming deadlines, it’s a good idea to start planning as soon as possible for updating patient ID Cards and delivering Advanced Explanation of Benefits.
To learn more about how the No Surprises Act impacts ID Cards and Advanced Explanation of Benefits, click here.
