Webinar on FAIR Health Product Supporting the Federal No Surprises Act (NSA)
May 18, 2023
On Tuesday, May 23, from 1 to 1:30 pm ET, FAIR Health President Robin Gelburd will host a webinar entitled “FAIR Health Federal Surprise Billing Solutions,” which will illuminate the FAIR Health data that help health plans, providers and arbitrators determine reimbursement amounts under the federal surprise billing law, the “No Surprises Act” (NSA).
In the upcoming 30-minute webinar, Ms. Gelburd will discuss guidance from the departments implementing the NSA on the use of an “eligible database” to calculate the “qualifying payment amount” (QPA). The QPA is used by plans to determine patient cost sharing under the NSA. Ms. Gelburd will describe FAIR Health’s solution, the FH® NSA Reference File, which makes available median in-network allowed amounts for procedure codes in geographic areas that align with NSA requirements, which plans can license as a point of reference in calculating a QPA when the plan has insufficient contracts.
Ms. Gelburd will also discuss recent guidance from the Centers for Medicare & Medicaid Services regarding the ability of parties to introduce information from databases in disputes arbitrated under the federal independent dispute resolution (IDR) process. Ms. Gelburd will describe how FAIR Health’s FH NSA Reference File, as well as data from FH® Allowed Benchmarks products, may be licensed by payors and providers for use in the IDR process—including during the prescribed negotiation period, and to inform disputes before IDR entities.
Other surprise billing situations will be addressed as well. For example, Ms. Gelburd will discuss the initial payment amount requirements under the NSA, as well as separate individual states’ surprise billing laws that were in place prior to the enactment of the NSA and that continue to apply to insured plans in those states. In five states—Connecticut, Georgia, New Mexico, New York and Texas—FAIR Health data already serve in a variety of ways as an official reference point for state surprise billing laws. Ms. Gelburd will highlight the FAIR Health data products available for use in connection with these state laws.
FAIR Health data products, including the FH NSA Reference File and FH Allowed Benchmarks, are created with in-network allowed amount values from FAIR Health’s independent, nationally representative database of over 41 billion private healthcare claim records.
Click here to register for FAIR Health’s free, 30-minute webinar to learn more about how FAIR Health supports stakeholders in furtherance of the No Surprises Act.