FAIR Health Allowed Benchmark Data Meet the Requirements of the Federal No Surprises Act (NSA)
March 20, 2025
The federal agencies responsible for implementing the No Surprises Act (NSA) independent dispute resolution (IDR) process previously notified certified IDR entities that they are permitted to consider pricing information from databases, as long as those databases do not include any factors prohibited from consideration by the NSA. FAIR Health’s FH® NSA Reference File and FH® Allowed Benchmarks do not include any prohibited factors such as provider-billed charges, usual and customary rates (UCR) or public payor rates (such as Medicare and Medicaid). Instead, they reflect the in-network allowed amounts negotiated between commercial payors and in-network providers.
FH NSA Reference File and FH Allowed Benchmarks
FAIR Health developed the FH NSA Reference File specifically to support stakeholders as an independent, eligible third-party database source in connection with the NSA. It presents median, in-network, commercial allowed amounts in geographic areas that align with NSA requirements. Median allowed amounts are provided at the levels of individual Metropolitan Statistical Areas (MSAs), all MSAs in each state, all non-MSA areas in each state, all MSAs in each Census Division and all non-MSA areas in each Census Division.
FAIR Health has been publishing benchmarks based on commercial, in-network allowed amounts for several years before the enactment of the NSA. The FH Allowed Benchmarks include the median as well as a range of percentile values for in-network, commercial allowed amounts, organized by geozip. (A geozip is a geographic area that typically corresponds to the first three digits of a zip code.) Like the FH NSA Reference File, FH Allowed Benchmarks do not include any prohibited factors such as provider-billed charges, UCR or public payor rates. Accordingly, they may support stakeholders in connection with the NSA process.
Uses of the FH NSA Reference File and FH Allowed Benchmarks
FAIR Health licenses its FH NSA Reference File and FH Allowed Benchmarks to plans and providers for use in the NSA IDR process.
In addition, the FH NSA Reference File supports plans when they have insufficient information to calculate a Qualifying Payment Amount (QPA). FAIR Health meets the eligibility requirements for an independent “eligible database” used to calculate a QPA, as described in the NSA:
- FAIR Health is not affiliated with, owned or controlled by a healthcare insurer or provider. FAIR Health is a national, independent nonprofit organization.
- FAIR Health maintains a significant volume of in-network allowed amount data in its FH NPIC® data repository—the largest database of commercial healthcare claims in the country.
- FAIR Health distinguishes commercial payors’ allowed amounts for participating providers and facilities from all other claims data. Only the median, in-network allowed amounts are used to create FAIR Health’s FH NSA Reference File—not nonparticipating provider or facility charges, and not amounts paid by public payors.