As the Payer market continues to evolve and the complexities continue to grow, so does the demand for higher quality data around providers at locations and accurate credentials. Despite these market dynamics, most of the state and federal source data that payers require to stay compliant with legislation remains stagnant, with quality levels that cause more challenges for the industry.
The No Surprises Act is going into effect in January 2022. While we wait for the regulation details to materialize, it is important to understand your baseline today to get ahead of what’s to come.
With political changes also come regulation changes. Though surprise medical billing has long been an issue, Congress recently passed HR 3630 containing the “No Surprises Act”, to remedy the problem. This latest bill applies to all group and individual health plans, with an effective date of January 2022. Among other things, this regulation requires that provider directories be updated on a regular basis, every 90 days.
The new “No Surprises Act” requires health plans to verify and update provider directory information at least every 90 days, which includes both individual providers and facilities. If you don’t have a plan to meet the requirements of the new regulation, it’s a good time to start.