Enhancements to FH® Online
May 19, 2022
FH® Online, which provides convenient, web-based access to the broad suite of FH® Benchmarks, has been enhanced with new features. Now FAIR Health’s surprise billing solutions can be accessed through FH Online, including FH® NSA Reference File. In addition, FH Online can provide access to custom codes and geozip areas.
FH Online makes it easy to look up cost information for medical and dental procedures by local area as contained in FH® Charge Benchmarks and FH® Allowed Benchmarks. Now FH Online makes the same ease of access available for FH NSA Reference File, a product launched this year in furtherance of the No Surprises Act (NSA), the federal surprise billing law that took effect on January 1, 2022.
The federal NSA applies to health plans in states that do not have a specific state law concerning surprise bills, and to self-insured health plans that are not covered by such state laws. The NSA requires plans to calculate patients’ cost-sharing responsibilities for certain surprise medical bills using the plan’s Qualifying Payment Amount (QPA). The QPA is the payor’s historic median contracted amount for each procedure code in each market and geographic area it covers. When payors have insufficient provider contracts to calculate the applicable median contract amount, they must use an independent database to calculate the QPA and determine the patient’s cost-sharing obligations. Plans can use FAIR Health data in the FH NSA Reference File—providing recent median allowed amount values for procedure codes at various levels of geographic aggregation—to help calculate the QPA in these situations. In addition, the data may inform the plan’s selection of an initial payment to out-of-network providers, potentially reducing disputes and the need for arbitration. The data may also prove useful for all stakeholders in preparation for arbitration and dispute resolution. The data in FH NSA Reference File can now be accessed through FH Online.
FH Online also offers convenient access to FAIR Health products that meet surprise billing needs in connection with state laws in Georgia, New Mexico and Texas. In addition, through FH Online, clients who prefer not to work with flat files loaded into their internal systems—or who seek to supplement access to the data beyond flat files—can easily search for data for the codes and percentiles in which they are interested. FH Online also can be configured for clients who want access to custom code sets on the web, downloading and printing information as needed.
FAIR Health President Robin Gelburd commented: “FAIR Health is pleased to offer clients an easy and quick way to look up data and support their surprise billing needs under the NSA. Clients can review data at multiple geographic levels to select the values they need and to compare them to their own data.”
For more information about FH Online, contact us by email at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.