The No Surprises Act: Protecting Americans from Surprise Medical Billing
Minimize 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 price 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
Valenz is dedicated to reducing costs, improving quality, and elevating the entire healthcare experience. As such, our integrated solution suite allows for effective containment of healthcare costs — and No Surprises Act compliance for health plan clients.
From cost and quality navigation to out-of-network claims processing and payment, we enable full compliance through every step of the healthcare journey.
Comprehensive IDR Risk Protection
Mitigate Your Risk of Independent Dispute Resolutions
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 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.
In the rare instances where providers appeal a QPA, we will always negotiate on your behalf.
And, because we believe so deeply in our data-driven approach, if you do incur an IDR, we pay the fees for you.
Your Solution to NSA Requirements
Valenz NSA Claims Repricing: Full-Service NSA Compliance Support
The Valenz NSA Claims Repricing service takes the compliance burden off the shoulders of TPAs with comprehensive claims management.
From initial claim identification through final resolution, we handle every step of the process — including repricing, QPA support, and appeals — to support accuracy and compliance for your clients.
Serving as an extension of your team, we provide cost-efficient, time-sensitive support that saves you valuable time, money, and effort.
Support High-Value Healthcare
Contain Costs and Improve Care Outcomes with Vālenz Health®
Stay compliant with the No Surprises Act — and optimize the entire healthcare journey — with our connected solution suite.
Secure NSA Compliance Today
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