What is the No Surprises Act?
The No Surprises Act (NSA) and the July 2021 interim final rules generally prohibit balance billing and limit cost sharing for emergency services provided by nonparticipating providers and nonparticipating emergency facilities. It can also apply to nonemergency services provided by nonparticipating providers that perform services within a participating healthcare facility, as well as air ambulance services provided by nonparticipating providers of air ambulance services.
In limited circumstances, when applicable requirements are present, nonparticipating providers and nonparticipating emergency facilities may balance bill for certain post-stabilization services, and for certain nonemergency services furnished with respect to a visit to a participating healthcare facility, if patients are provided notice and give consent to waive surprise billing protections.
The July 2021 interim final rules of the No Surprises Act require that cost-sharing for out-of-network emergency services and applicable nonemergency items and services cannot be greater than the requirements that would apply had the services been provided by a participating provider, participating emergency facility, or participating air ambulance provider.
Rates for the applicable services must be calculated using the lesser of the billed charge or the Qualifying Payment Amount (QPA). The QPA is generally the median contracted rate for the same or similar services when provided by an in-network provider in the same geographic region. Blue Cross certifies the Qualified Payment Allowance was determined in compliance with the Federal No Surprises Act and applied for purposes of the recognized amount and calculation of member cost sharing.
Government resources
Learn more about the No Surprises Act on the CMS and Department of Labor websites.
The No Surprises Act applies to:
The No Surprises Act was created to provide protections against surprise medical bills for participants, beneficiaries, and enrollees in a group health plan or individual health insurance coverage, including Federal Employees Health Benefits Program (FEHB) enrollees, offered by a health insurance issuer with respect to certain out-of-network services.
The No Surprises Act applies to nonparticipating providers and nonparticipating emergency facilities furnishing emergency services, as well as to nonparticipating providers furnishing certain nonemergency services in connection with an individual’s visit to certain participating facilities, and to nonparticipating providers of air ambulance services.
The No Surprises Act does not apply to:
The balance billing protections of the No Surprises Act requirements do not apply to providers or facilities in connection with furnishing items or services to beneficiaries or enrollees in federal programs such as Medicare (including Medicare Advantage), Medicaid (including Medicaid managed care plans), Veterans Affairs Health Care, the Indian Health Service, or TRICARE. These programs have other protections in place to address high medical bills.
Contact
No Surprises Act contact information
To submit an Open Negotiation Request or to initiate Federal Independent Dispute Resolution, email csrn.requests@bluecrossmn.com, along with the appropriate documentation, within 30 business days of receiving notice of payment or notice of denial of payment.
- For out-of-network services not provided in Minnesota, direct your request to the local plan where services were rendered, as that would be the plan the provider’s remittance advice would have been sent from, regardless of which Blue plan the member’s benefits are administered by.
- Nonparticipating services rendered through remote monitoring should be submitted to the plan in the state where the practitioner doing the monitoring is located, with the exception of FEHB claims as those should be submitted to the state where the provider group who employs the remote monitoring practitioner is located.
For contracted providers that have received a remittance with an NSA remark code, reach out to your Provider Partner or Network Management Consultant to have the claim reviewed.
Remittance advice from Blue Cross and Blue Shield of Minnesota can be found in Availity.
Availity Essentials, the exclusive provider portal for Blue Cross, gives you free, real-time access through your browser. It’s ideal for direct data entry, from eligibility to authorizations to filing claims, and getting remittances.
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