State Law vs. The No Surprises Act
In addition to the federal No Surprises Act, many states have their own laws that protect consumers from surprise medical bills. In the states with their own laws, Claritev examines which law takes precedence.
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How the No Surprises Act Changes Reimbursement
The No Surprises Act (NSA), effective January 1, 2022, changes the reimbursement process for claims identified as surprise bills. Claritev explains how.
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What Plans and Services Are Impacted by the No Surprises Act
As 2022 rings in, so does the No Surprises Act (NSA). While the healthcare industry has been preparing for the NSA for over a year, there may still be some confusion over what types of plans are impacted by the new law as well as what types of services.
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No Surprises Act and Its Impact on Self-Funded Plans
This interview explores the impact of the No Surprises Act on reference-based pricing and self-funded health plans.
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Reference-Based Pricing Is Here to Stay
Claritev explores why the No Surprises Act will have minimal impact on reference-based pricing.
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September 30th Interim Final Rule Brings Clarity to the Arbitration Process
The 2nd Interim Final Rule for the No Surprises Act clarifies the arbitration process and the importance of the QPA.
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Post Pay Negotiation and Baseball-Style Arbitration Replace Balance Billing for Surprise Bills
“Baseball-style” arbitration under the No Surprises Act is designed to encourage payors and providers to reach agreement before formal dispute resolution. By requiring arbitrators to choose between final payment offers rather than splitting the difference, the process incentivizes both sides to submit reasonable proposals and settle disputes more efficiently without prolonged arbitration.
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What Is QPA?
The Qualifying Payment Amount (QPA) is a central component of the No Surprises Act, representing the median in-network rate used by health plans to determine out-of-network reimbursement. Understanding how QPA is calculated and applied is critical for payors and providers navigating payment decisions and the IDR arbitration process.
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Surprise Billing and the Impact for Payors
Surprise billing has created significant challenges for healthcare payors, increasing costs and administrative complexity. The No Surprises Act aims to protect patients while shifting payment disputes to payors and providers, making it essential for organizations to understand its impact on reimbursement, negotiations, and the overall claims process.