Are You Ready for the 01.01.2022 Deadline?

The new requirements of the No Surprises Act (NSA) in the year-end Consolidated Appropriations Act are fast approaching, and with the holidays coming up, it’s no surprise the reality of the operational impacts is setting in with healthcare payers. These regulations add a new layer of complexity to healthcare claims processing and a further interdependence with our trading partners. As a key, trusted system vendor, it’s our duty to enable our customers’ compliance and move them along. Will you be ready to meet the requirements of the NSA?

Designed to protect patients from surprise medical bills and balance billing for certain out-of-network (OON) care, these provisions place a heavy burden on the entire network involved in delivering and paying for healthcare claims. But Beacon has you covered. We’ve been following surprise billing regulatory developments closely and have woven processes in all the critical control points for comprehensive support of OON claims processing and payment under the NSA. From working with your trading partners to identify surprise bill situations to automatically calculating and processing claims using the submitted Qualifying Payment Amount (QPA) or Recognized Amount (RA), Beacon’s solution addresses the entire lifecycle of a surprise bill allow you to automate a great percentage of these newly complex claim requirements.

Our End-to-End Surprise Billing Solution

New data presented in incoming EDI files can help you identify a surprise bill. However, some scenarios can escape notice by even your trusted PPOs. For that, SpyGlass has existing detection tools that can help identify possible surprise bill scenarios.

SpyGlass receives and stores the QPA or RA, when submitted by your trading partners to correctly calculate appropriate cost-shares for NSA situations. Beacon will offer data subscriptions from trusted vendors to help you calculate reasonable RA amounts that are likely to withstand arbitration.

If the data is provided by your trading partner, SpyGlass can automatically identify an NSA situation and indicate when consent was received by the patient, acknowledging that services will be rendered by a non-participating provider. For your PPO’s that send attachments, SpyGlass can automatically attach the signed notice and consent form to the claim for examiner review. This allows for the automation of claims that do carry the required consent.

SpyGlass auto-calculates the correct costs shares in NSA situations using the submitted RA or QPA. For claims examiners, the system indicates and draws attention to data conditions unique to surprise bills and other critical NSA information for easy recognition and automated processing. Questionable conditions can be queued for review or audit.

Payers, health plans, and self-funded employers shouldn’t have to shoulder the burden of keeping up with all of the mandates, changes, and compliance requirements alone. This isn’t new to Beacon. In fact, we've anticipated these changes and have done groundwork implementing these requirements in a way that is clear, intuitive, and easy to use. When your plan receives electronic claims, SpyGlass can handle and process those with the same dramatically high automation rates that we offer for the already complex range of real-world claims that come at you. In addition, Beacon has gone to great lengths to ensure that our system gives you the flexibility to meet new requirements with confidence.

This is only the beginning of the regulatory changes. In addition to Beacon’s solutions for the No Surprises Act, we’ve created an implementation plan based on the impact and timing of the pending requirements of the Transparency in Coverage Rule. Every plan has different goals for managing and complying with new regulations. With SpyGlass and our new NSA solutions, Beacon aims to minimize the impact of the new requirements and create easy-to-implement solutions with strong automation to achieve compliance quickly. In addition to enhancing our solutions to address new regulations, Beacon will offer guidance throughout the implementation of these new processes in order to help clients answer these questions and manage the new complexities introduced.

Enable Compliance & Be Prepared

The No Surprises Act and Transparency in Coverage rules have wide-ranging implications for the healthcare ecosystem. Beyond compliance, Beacon sees these new regulations as an opportunity to innovate, smoothing out complex processes for the members and families covered by our customers.

There is a clear need in the marketplace for innovative solutions that help payers address compliance requirement deadlines. Despite these challenges and complexities, we’re eager to show our efforts to meet this legislation. Schedule a demo to see firsthand how Beacon’s end-to-end support for the No Surprises Act and ongoing planning and preparation for Transparency in Coverage Rule can help you stay ahead of the curve and navigate the forthcoming regulations.

Ready to Learn More?

To see Beacon’s solution for the No Surprises Act yourself, register for a live, personalized demo with our team. Modernize your health claims processing with Beacon’s leading-edge solutions.