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End-to-end support for the No Surprises Act

The No Surprises Act (NSA) adds a new level of complexity to paying healthcare claims. From identifying surprise bills to offering support during arbitration, MultiPlan’s services address the entire lifecycle of a surprise bill.

Our End-to-End Surprise Billing Service

With expertise in every step of the process, we can administer the entire NSA process on your behalf. Our easy to implement services can help your organization achieve compliance quickly.

Identify Surprise Bill

We examine billing codes, facility network status and episodes of care for your primary network(s) and ours.
1

Calculate and Append QPA

We calculate the Qualifying Payment Amount (QPA) and include it on the processed claim so that you can complete the adjudication.
2
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Price and Edit Claim

We can reprice claims at QPA or an amount just below or above it. Alternatively, we can use another of our Analytics-Based services to determine a fair amount that providers are likely
to accept.
3

Negotiate Settlement

Providers that reject the initial payment contact us to start the process. We leverage technology, data, and experienced staff
to negotiate
a settlement.
4

Arbitrate

When settlement isn't reached, we’ll own the IDR process from start to finish. In calculating a payment offer, we analyze data from millions of claims, actual facility costs, and more.
5

How our flexibility helps you meet the new requirements

With the new requirements of the NSA fast approaching, the reality of the operational impacts is settling in with healthcare payors. Whether you leverage our end-to-end (No Surprises Act) NSA services or partner with us for specific needs, our flexible approach helps to implement more quickly.  Our team works with your organization to determine the right solution to help your organization comply.  

This isn’t new to us. In fact, we’ve been supporting our clients with many of these services for years. Whether negotiating to avoid arbitration, building complementary networks or determining the appropriate payment amount, we’re experts and can deliver top-level support for your organization’s NSA support needs. Let us build a NSA Machine that will work for your organization.

FAQs

Surprise medical bills occur when patients are treated by out-of-network (OON) providers under circumstances where they are unable to plan for or avoid the OON service (e.g., emergency care).  Surprise bills can also occur when a patient is unknowingly treated by an out-of-network provider at an in-network facility such as a hospital. Usually, the out-of-network provider sends a bill to the patient’s insurance company, which pays a certain amount for the services. The remainder, or balance, of the bill is then sent to the patient. 

The NSA covers claims related to emergency services from the point of a patient’s evaluation and treatment until they were stabilized and can consent to being transferred to an in-network facility. It covers air ambulances but not ground ambulances.

The NSA also covers claims related to non-emergency services when they are provided at an in-network facility by an out-of-network provider.

The new law takes effect for health plan years beginning on or after January 1, 2022.

QPA is a term introduced by the No Surprises Act (NSA). It is the plan’s median contracted rate for a specific service in the same geographic region within the same insurance market — the middle amount in an ascending or descending list of contracted rates, adjusted for market consumer price index in urban areas (CPIU). It’s important because it will be a key factor during the arbitration process if a provider does not agree with the payor’s initial payment, negotiations are unsuccessful and the Independent Dispute Resolution process is invoked.  In most cases, the member cost share is based on QPA rather than the allowed amount.

Payors and providers go to arbitration under the NSA when they cannot agree on the amount of a payment for the providers’ services.  Before bringing a case to arbitration, the parties must try to negotiate a settlement on their own. Either party has up to 30 days after the payor makes an initial payment to begin the negotiation process, and the negotiation must be open for at least 30 days. If the two sides can’t negotiate a settlement, either party can initiate the independent dispute resolution (IDR) process, also known as arbitration. 

New requirements begin in January 2022

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