#United States #New York #FAIR Health #Healthcare Data #No Surprises Act

New FAIR Health Benchmark Data for NSA Compliance

FAIR Health, a national nonprofit organization dedicated to healthcare cost transparency, has unveiled its FH® NSA Reference File along with FH® Allowed Benchmarks. This innovative suite of data tools is specifically designed to meet the stringent requirements set by the Federal No Surprises Act (NSA), which aims to protect consumers from unexpected medical bills in non-emergency situations.

Overview of the No Surprises Act

The No Surprises Act, which took effect in January 2022, provides significant protections for consumers against unexpected healthcare costs, particularly those incurred from out-of-network providers. One critical component of this legislation is the implementation of an Independent Dispute Resolution (IDR) process. This process provides a framework for resolving payment disputes between providers and payers when there is disagreement on the reimbursement rates for out-of-network services.

FAIR Health’s FH NSA Reference File and FH Allowed Benchmarks are crafted to support this IDR process by providing essential data that adheres to the guidelines defined in the NSA. By offering a credible and independent source of median, in-network allowed amounts, these tools are pivotal for stakeholders in navigating disputes efficiently and effectively.

Key Features of the New Benchmark Data

The FH NSA Reference File includes:

• - Median In-Network Allowed Amounts: These amounts represent the average payments negotiated between commercial payors and in-network providers across various geographic areas, ensuring compliance with the NSA’s requirements.
• - Geographic Coverage: Data is provided for individual Metropolitan Statistical Areas (MSAs), encompassing all MSAs within each state, and breaking down totals for non-MSA regions as well.
• - Prohibited Factor Exclusions: The dataset explicitly avoids including factors banned by the NSA, such as provider-billed charges and public payer rates like Medicare and Medicaid, thereby ensuring the integrity and reliability of the information.

Furthermore, with years of experience in publishing healthcare benchmarks prior to the enactment of the NSA, FAIR Health assures users of the accuracy and relevance of its data. As a consequence, the FH Allowed Benchmarks now offer an extensive range of percentile values for in-network commercial allowed amounts, segmented by geozips (the first three digits of a zip code) to further enhance precision and usability.

Applications and Licensing of the Data

FAIR Health licenses its benchmark data to various stakeholders, including healthcare plans and providers. This licensing is critical as it equips these entities with the necessary data to perform accurate calculations under the NSA’s Qualifying Payment Amount (QPA) criteria. In instances where plans lack sufficient information to derive a QPA, the FH NSA Reference File proves invaluable, facilitating a smoother resolution process during disputes.

FAIR Health emphasizes its identity as an independent and nonprofit organization. It is essential to note that it is not controlled by any healthcare insurers or providers, further validating its unbiased role in the healthcare system. The organization boasts the most extensive repository of in-network allowable amount data in the country, uniquely positioning it to offer unmatched insights into commercial healthcare claims.

Commitment to Healthcare Transparency

As part of its mission, FAIR Health aims to enhance transparency concerning healthcare costs and health insurance information through its extensive range of data products and consumer resources. This commitment is highlighted by its substantial database, which currently contains over 49 billion claim records, a figure that continues to grow year by year.

In addition to serving insurers and providers, FAIR Health’s data products empower employers, government agencies, researchers, and consumers to make informed decisions concerning healthcare expenses. It streamlines such processes through a free consumer website laden with educational content and cost estimation tools available in both English and Spanish. This initiative underlines FAIR Health's dedication to promoting consumer insights into healthcare expenditures.

In conclusion, the introduction of the FH NSA Reference File and FH Allowed Benchmarks marks a significant step forward in supporting compliance with the No Surprises Act. These tools not only facilitate informed decision-making for consumers and stakeholders but also reinforce FAIR Health’s role as a national leader in data-driven healthcare transparency.

Contact Information:
Rachel Kent
Executive Director of Communications and Marketing
FAIR Health
646-396-0795
[email protected]