Comply with the No Surprises Act Using VerityStream

Comply with the No Surprises Act Using VerityStream's Provider Network Management Solution

Apr 25, 2023
  • Author:
    Noelle Abarelli

Medical Services Professionals (MSPs) have a lot to keep up with. Whether it be data management or resource management, MSPs are tracking multiple components that are critical to the success of a health plan’s operation. One major challenge health plans face today is navigating the No Surprises Act. But the good news is, they don’t have to tackle it alone, CredentialStream’s Network module can help.

The No Surprises Act

Congress passed the No Surprises Act as part of the Consolidated Appropriations Act of 2021 to eliminate surprise medical bills. It requires health insurers and healthcare practitioners to work together to ensure consumers are informed and protected from unexpected out-of-network bills.

The act also enacted a directory verification mandate for fully insured group health plans, individual health plans, and self-funded employer plans. The legislature aligns with the existing Centers for Medicare and Medicaid (CMS) mandates related to directory accuracy requirements, which require directory information to be updated every 90 days. Specifically, upon receipt of a practitioner or facility change, the plan has two days to update the directory. And, all consumer inquiries must be responded to within one business day upon receipt of the request.

Easily Meet the Requirements of the No Surprises Act

CredentialStream is an easy-to-engage with software solution for credentialing, enrollment, privileging, and evaluation, that enables MSPs to cover every angle of the provider lifecycle. CredentialStream’s Network module directly addresses payer needs with a focus on provider data management and the creation of downstream efficiencies. Separate workflows designed to support key demands include:

  • Provider relations
  • Delegated credentialing
  • Non-delegated credentialing
  • Network data management
  • Directory updates
  • And, more

More importantly, Network provides support for the No Surprises Act with its unique data structure, which establishes a dependable relationship between individuals, organizations, and the line of business.

Specifically, Network allows individual practitioners to be linked to your organization with a variety of different attributes, including:

  • A unique contract number
  • A unique status
    • Pending
    • Active
    • Participating
  • Effective date
  • Expiration date
  • Related office locations

And, more specifics can be added, such as:

  • Does the individual practitioner accept new patients for this location?
  • Specialty to display on the health plan directory
  • Whether telehealth is provided If the location is open or closed
  • The type of individual practitioner available at a specific location

Serving MSPs and Providers

Network allows credentialing specialists, provider relations staff, and network management staff the flexibility to login to manage practitioners, organizations, and lines of business from one centralized location.

CredentialStream also includes a Provider Hub, where providers can manage their own data. With access to a secure online portal, providers, individual practitioners, or their delegates are able to apply for initial credentialing, review re-credentialing details, and keep their own information up to date.

Automation and Reporting Delivered

Successfully managing the No Surprises Act starts with the ability to easily access and update directory information, which Network facilitates. Should provider or facility information change, key individuals at your organization will receive an email notification linking them straight to the Provider Hub, where they can review and accept changes as they filter in. The database is updated based on workflows you set up, ensuring data is updated accurately and in real time, within your required parameters.

Mass updating elements within CredentialStream and across workflows is also possible. Using the quick-edit functionality, you may select either one or 1000 records, and assign an attribute to them, for example, update their effective dates, and then save.

But the reporting capabilities within CredentialStream is where the solution really shines. So long as you have the data in CredentialStream, you can report off of it. That includes dashboard reports on your home page or an additional view section for dashboards. Better yet, you can share these links outside of CredentialStream, making it easier to share details with executives and other stakeholders. These details are updated and refreshed regularly, which means team members can access the same information from their own home screens.

Network Continues to Evolve as Your Business Evolves

Network is a one-stop shop for managing and monitoring provider networks for health plans, and it’s always being updated and improved! The next set of updates to be released include:

  • Support for roster reconciliation - Network currently imports roster data into CredentialStream, but the next update will allow data to be imported from delegated rosters and change sheets.
  • Contract management - View historical contracts and the terms previously recorded with that contract, manage alerts to upcoming contract renewals with a given practitioner or facility.
  • Improved features for organizational providers - A new initial application process for organizational providers via Apply and the Hub gathers and reviews key data from a particular location before accepting it into the system.
  • Thrive community - An existing forum for customers to submit and discuss ideas with the CredentialStream community at large.

Network was created with the needs of health plans in mind. This blog post only covers the basics of what is possible with the module. To find out more about its many workflows and upcoming features, be sure to watch our webinar, Manage Your Health Plan Business Demands with Network by VerityStream.