The No Surprises Act: Protecting Americans from Surprise Medical Billing
Minimizing Balance Billing for Patients and Health Plans
Reducing Costs and Improving the Patient Experience
No Surprises Act: A Safeguard Against Unexpected Balance Billing
In the United States, two-thirds of adults worry about affording unexpected medical bills, a situation that 1 in 5 adults is all too familiar with.
With 18% of all emergency room visits resulting in at least one surprise bill, and the United States already spending more on healthcare costs than any other country per capita, Americans have long faced an urgent need for protection against surprise medical billing that often threatens financial stability.
The answer finally came in 2022: The No Surprises Act.
Learn more about this legislation—and how Vālenz Health® helps ensure compliance with solutions that emphasize pricing transparency and cost containment—below.
Containing Costs for Patients and Insurers
What is the No Surprises Act?
The No Surprises Act (NSA) is a federal law that protects people covered under individual and group insurance plans from balance billing (also known as surprise billing) when receiving:
- Most emergency services
- Non-emergency services from out-of-network (OON) providers at in-network facilities
- Services from OON air ambulance service providers
Under this law, patient cost-sharing for these services is capped, requiring providers to work with insurers and health plans to negotiate remaining bills. The NSA also establishes an independent dispute resolution (IDR) process for any OON payment disputes between plans and providers (including air ambulance providers), outlining the arbitration process used to determine reimbursement amounts.
The law also provides protections for those who are uninsured or choose not to use their insurance for a given service. Under the NSA, these individuals are entitled to a good faith estimate of the cost of their care upfront. If the ultimate charge exceeds this estimate by $400 or more, individuals can dispute the claim within 120 days of the billing date.
The No Surprises Act is part of a larger, ongoing effort by the U.S. federal government to improve healthcare pricing transparency, an initiative also supported by the Transparency in Coverage regulations.
Staying Compliant and Minimizing Costs
How Vālenz Health® Ensures NSA Compliance
As the leading platform to simplify healthcare, Valenz is dedicated to reducing costs, improving quality, and elevating the healthcare experience. Our fully integrated solution suite allows for industry-leading containment of healthcare costs—and ensures No Surprises Act compliance for health plan clients.
From member engagement and transparency to out-of-network claims processing and payment, we enable full compliance through every step of the healthcare journey.
We extend our longstanding commitment and proven methodology for fair, defensible, market-sensitive pricing on every claim to assure a uniform level of protection for OON emergency facilities and services, air ambulance transports, and services delivered or ordered from an in-network facility.
And, in the case of an appeal (a less than 1% occurrence rate), we manage the process from start to finish to ensure NSA compliance and prevent unexpected balance billing for plan members.
As part of our proactive commitment to fair, transparent pricing that reduces OON claims, we aggregate costs data and make it publicly available to plan members to encourage smarter healthcare choices.
With Valenz Bluebook, members can easily find and compare estimated costs for in-network and out-of-network providers, procedures, and facilities. Care navigators support members in their decision-making process, steering them toward low-cost, high-value care options that reduce the risk of unexpected or surprise billing.
IDR Risk Protection, Guaranteed
Mitigate Your Risk of Independent Dispute Resolutions
In addition to supporting your compliance with regulatory requirements, everything we do at Valenz fundamentally reduces or eliminates the risk of independent dispute resolutions (IDRs).
Other healthcare solutions providers claim IDRs are unavoidable—but not here at Valenz. We significantly reduce the risk of IDRs with a proactive approach to balance billing protections, powered by our tried-and-true Valenz Market-Sensitive (VMS®) repricing methodology.
To ensure fair, defensible, market-sensitive pricing, our Qualifying Payment Amounts (QPAs) are based on years of real-world data from Valenz-contracted networks, as well as additional layers of data from the broader Valenz platform.
We believe deeply in our data-driven approach. In the rare instances where providers appeal a QPA, we will always negotiate on your behalf.
Your Solution to NSA Requirements
Valenz Bluebook Comply:
An All-in-One Tool for NSA Compliance
In an industry plagued by skyrocketing, unexpected medical costs, staying compliant with the No Surprises Act is critical for health plans that want to improve their member experience.
Let Valenz take the responsibility off your shoulders with our data-driven, comprehensive compliance solution.
Valenz Bluebook's Comply feature addresses key mandates of both the No Surprises Act and the Transparency in Coverage regulations, including price comparison tools and machine-readable files (MRFs).
Built by industry experts who are actively involved with federal legislators and policy makers, Bluebook Comply is more than just a checklist; it's a strategic addition to your benefits strategy that delivers enhanced value beyond simple compliance.
Delivering Smarter, Better, Faster Healthcare
Contain Costs and Improve Care Outcomes with Vālenz Health®
Stay compliant with the No Surprises Act—and optimize the entire healthcare journey for patient, payer, provider, and plan—with our fully integrated solutions suite.
Secure NSA Compliance Today
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