Don’t Let the No Surprises Act Catch You Off Guard

If you’re a health plan, offer an internal health plan, or you contribute provider information to a health plan, you should know the ins and outs of the updated The No Surprises Act, that went into effect on January 1, 2022.

What is the No Surprises Act?

Simply put, the No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.

What inspired the No Surprises Act?

According to a Kaiser Health Tracking Poll, most privately insured adults (67%) say they worry about unexpected medical bills. Seeing as about 1 in 5 emergency claims and 1 in 6 in-network hospitalizations include at least one out-of-network bill, this concern isn’t surprising. This issue was a primary driver for the No Surprises Act which establishes new federal protections against most surprise out-of-network medical bills.

These new federal protections will:

• Apply to most surprise bills for emergency care
• Apply to non-emergency services provided by out-of-network providers at in-network facilities
• Allow consumers to appeal disputes over coverage of surprise medical bills to an external reviewer

One of the goals of the new federal protections is to help diminish the underlying worry patients feel. If a patient receives what they believe is a surprise medical bill for care, the No Surprises Act provides them with protections and a variety of ways to get help. It’s important to note that this complex law is being enforced by both federal and state agencies, and that Congress has set up a dispute resolution center to support patients and providers.

What the No Surprises Act means for you…

With this new act in place, providers are prohibited from billing patients more than the applicable in-network cost sharing amount in the situations mentioned above. This means that providers need to find out a patient’s insurance status before submitting an out-of-network bill to a health plan. It should be noted that patients can give written consent to waive their rights under The No Surprises Act, though this is expected to happen in very limited circumstances.

The latest updates to the No Surprises Act will require unprecedented transparency and turnaround times for provider directory updates.

Under the new guidelines:

• Health plans must provide an accurate public-facing provider directory. To achieve this they must:
• Verify their directory every 90 days and remove any providers that are not verified
• Update their provider directory within two business days of a provider's information change
• Respond to inquiries regarding a provider's or facility’s network status within one business day (in-network or out-of-network)
• Providers must submit regular updates to group health plans and insurers to assist with the verification and provider directory update processes.

CredentialStream can help you ensure compliance with the No Surprises Act

The demand for near-real-time directory maintenance will require ongoing updates with agile technology and auditing systems that can meet the requirements for faster turnaround times. As the most comprehensive provider lifecycle management solution available, CredentialStream includes all of the features you need to help you maintain compliance with The No Surprises Act. In our upcoming webinar, we’ll discuss how you can use CredentialStream to:

• Create an automated notification every 90 days that reminds providers to verify their directory information.
• Use workflows to create a simple checklist that includes a timeline that providers need to adhere to when reviewing their directory information and link that workflow to notifications.
• Use surveys to request providers to attest to the accuracy of their directory information.

Join the webinar to learn more. Don’t let the No Surprises Act catch you off guard, we can help.