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Five Tips to Help Payors Navigate the No Surprises Act
Some healthcare payors continue to struggle to create an effective strategy to deal with No Surprises Act (NSA). In this post, Claritev offers five suggestions to help payors effectively navigate the new law.
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Six Common Questions About Reference-Based Pricing Answered
The beginning of the COVID-19 pandemic in 2020 gave rise to a new way in which payors, providers, employers, and employees look at healthcare. New questions emerged regarding the affordability of provider services, equality of access to healthcare services, and the overall model of how employers can offset organizational healthcare costs while ensuring affordable healthcare for their employees.
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Texas Court Rules Arbitrators Can’t Place Higher Importance on QPA in Surprise Bill Arbitration
Claritev discusses how the Texas Federal Court struck down the HHS’s interpretation of how the QPA should be used in the IDR process outlined in the NSA.
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The Basics of the Federal IDR Portal
The No Surprises Act requires a Federal Independent Dispute Resolution (IDR) portal to be used to initiate the Federal IDR process, select an IDR entity, and submit arbitration offers. Claritev discusses the basics of this portal.
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With Notice and Consent, Surprise Bill Protection Can Be Waived
The No Surprises Act allows providers to bill enrollees for the balance due after the health plan pays its portion in some circumstances if the enrollee signs a consent form. Claritev explores this exception to member balance billing.
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Understanding Provider Directory Requirements Under the No Surprises Act
Claritev examines providers' and health plans' requirements for provider directories under the No Surprises Act.
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The No Surprises Act: Continuity of Care Requirements
The No Surprises Act requires health plans or issuers to notify certain enrollees in a timely manner when a provider or facility is terminated from the network due to contract expiration or non-renewal. Claritev examines what this means.
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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.
Solution Area: Claims Intelligence
