Availity responds to HHS FAQ on the 'No Surprise Act'
Availity responds to HHS FAQ on the 'No Surprise Act'
At Availity, we strongly support the intent and purpose of the 'No Surprises Act' to provide federal consumer protections against surprise medical bills. Like any piece of legislation, success will depend upon the implementation of the law. Availity is prepared to offer guidance and leadership to help ensure the success of the No Surprise Act.
Even before the No Surprises Act passed in December of 2020, Availity monitored the bill as it progressed through the legislature. We focused on three themes in the bill that will have a significant impact on health plans and healthcare providers:
  • Health plans to provide a patient with an Advanced Explanation of Benefits (AEOB)
  • Healthcare providers must notify the payer of scheduled service
  • Out-of-network rates to be paid by health plans if appropriate notification is not made 
With Availity's extensive network of payers and providers, and its unique position within the pre-service workflow, we stand ready to lead the technical conversations related to the requirements of the Act. We have been working with our clients, industry organizations, and business partners to develop solutions to address these requirements. Most of the functionality needed to meet these mandates already exist within our current solutions.   
In its August 21, 2021, FAQ document, the Department of Health and Human Services (HHS) announced that the AEOB and good-faith estimate requirements will remain, but will extend the original implementation deadline from January 1, 2022. We agree with HHS that building the technical infrastructure to provide such information will take more time than the current deadline allowed. We also believe that providing good-faith estimates and AEOBs is where the industry needs to go, and that it's the right thing to do for our members and patients.
We are prepared to work with HHS to keep momentum strong around this critical initiative and chart the best path forward. As an industry leader, our team will continue to work with health plans, providers, and vendor partners to implement these solutions as quickly as possible.

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Availity responds to HHS FAQ on the 'No Surprise Act' - by Margaret Kelly - 10-05-2021, 05:18 AM

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