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The No Surprises Act - 2021 Annual Report on Provider Enrollment - YouTube
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at the end of 2020 congress passed the
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no surprise act
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as part of the consolidated
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appropriations act of 2021 to eliminate
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surprise medical billing
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the act requires health insurers and
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health care providers to work together
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to ensure consumers are informed and
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protected
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it also enacted a new provider director
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verification mandate
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for fully insured group health plans
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individual health plans as self-funded
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employer plans
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the legislature
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legislation aligned with existing
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cms mandates for provider director
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accuracy and for those of you who may
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have attended that those i think that we
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we've talked a little bit about that
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when those surveys were done for the
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medicare advantage product for cms we
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saw that when cms did their audits there
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wasn't a move of the dial in terms of
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the correctness of provider data it
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stayed consistent within three survey
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periods conducted by cms
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so the covid relief bill that was signed
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into law in december of 27 2020 includes
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the no surprise act
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number one
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internet based comparison tool
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this feature
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must allow an enrollee with respect to
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the applicable plan year
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and participating providers to compare
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the amount of cost sharing that the
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individual would be responsible for
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paying under the plan with respect to
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furnishing a specific service the health
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plan must offer price comparisons
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guidance over the phone
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number two database of contractor
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providers
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database on public websites listing each
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provider important facility that has a
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direct or indirect contractual like
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relationship under the plan
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including the name the address the
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specialty phone number and digital
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contact information of the provider
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facility there must be a verification
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process for the provider
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facilities on the directory
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the process procedure with a request for
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information for that provider that has a
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contract with the health plan
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the process of procedure on the provider
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director which includes that the
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information as of the date was printed
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in addition health plan member billing
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implications as to the information the
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directory
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for in-network or auto network so the
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principle behind that is that when you
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see a provider you will and then get
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there are some discussions uh because
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the rule was recently uh just published
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as you can see here uh the cms website
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here you'll want to take a look at that
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the rule was posted out there for
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feedback
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so there's a lot of open-ended
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thought processes out there and the fact
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that the actual uh requirements to
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provide patients like ourselves when
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something is going to be in network and
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out of network there may be some that
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effective date may be moving out
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onto january 1st beyond january 1st 2022
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from an enrollment
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perspective i think number three is a
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big one
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january 1st 2022 health plans must
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establish provider directory
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verification process
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this includes a policy and procedure to
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remove providers and
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facilities that are
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that are unverified what does that mean
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not less than every 90 days
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health plans will be required to verify
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and update the provider directory
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upon receipt of a provider facility
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change the health plan
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which i i think a lot of us are going to
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be really surprised the health plan has
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two days to update the directory
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organizations that i'm talking with when
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you go back to the fact that every 90
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days health plans have to verify and
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update the provider directory there are
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communications that are going out to the
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providers or the contracted entities of
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which health plans have to verify the
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correctness of that data
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providers
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organizations are having to develop
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policies and procedures because there
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may be instances when a provider does
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not respond and the question is does
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that entity that health plan does that
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organization make that decision to
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remove that provider off the directory
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and at what point do they do that do
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they give them one or two or three
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quarters to do that or is that upon that
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first opportunity that they make that
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decision
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consumer inquiries are required to
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responded to be surrounded responded in
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one business
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day of receiving that request
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mgma wrote to the us department of
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health and services urging the
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agency to delay the implementation and
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enforcement of this resp the surprise
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billing medical
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requirements
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that we've discussed here i have only
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touched
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the top of the iceberg
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the content of the no surprise act and
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the resources i've provided you here are
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much more detailed i think it's it's a
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value-added a conversation that i wanted
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to make certain that i included this as
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a hot topic for industries with for the
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enrollment
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health plan and credentialing
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organizations that are attending this
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call
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