Free ‘No Surprises Act’ Provider Data Consult Helps Health Plans Navigate Impact

Perspecta, a leader in provider data management solutions, has created a free program to assess and manage a compliance roadmap. The new regulation from the Centers for Medicare & Medicaid Services (CMS) creates new guidelines designed to eliminate “surprise” medical billing for healthcare consumers. Simply put, the legislation promotes the idea that patients should not be responsible for out-of-network costs that they did not agree to pay.

“The legislation addresses surprise medical billing at the Federal level and can create an additional burden impacting provider data management programs,” Howard Koenig, CEO said. “We feel it is important to offer guidance to health plans so that they can be prepared for the January 1, 2022, compliance deadline.”

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A few notable requirements include:

Transparency in Coverage and Provider Costs

1. Transparency in coverage regarding in-network and out-of-network deductibles & out-of-pocket limitations on health coverage ID cards.

2. Maintenance of provider price transparency and comparison tools that allow patients to understand and compare expected out-of-pocket costs for items and services across multiple providers.

3. Machine-readable files with in-network negotiated rates, out-of-network average charges and payments, and prescription drug rates.

4. Individual Disclosure including estimation for shoppable services and patient estimation.

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Provider Directory

Protecting patients with an accessible provider directory with a verification process & response protocol with a publicly accessible provider database.

“With proven industry expertise and ongoing customer relationships and collaboration, Perspecta is uniquely positioned to help health plans and prfoviders navigate the impact of these regulations; we can mitigate the complexity of the provider data management impact,” Perspecta COO, April Stiles, said. “Our program is designed to assess the current state of an organization’s provider network data infrastructure, identify gaps, and create a roadmap to successful compliance ahead of schedule.”