09-09-2022
On Aug. 19, the Biden administration released “Requirements Related to Surprise Billing: Final Rules” 
. These rules finalize certain provisions of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act of 2021 (CAA).
Things to know:
- Certified independent dispute resolution (IDR) entities must first consider the Qualifying Payment Amount (QPA), and then all additional permissible information submitted by each party to decide which offer best reflects the appropriate out-of-network rate.
- Insurers will be required to submit additional information to the provider, facility or air ambulance service provider about the QPA when they downcode a billed claim.
- The rules of air ambulance IDR determinations now largely mirror those for other providers and facilities.
More information – including a fact sheet, FAQs and process status update – is available on the Department of Labor website. Any new requirements that differ from previous interim final rules will apply to items and services provided 60 days following the publication of the final rule in the Federal Register.
While we are providing this information regarding key aspects of the CAA, we do not provide groups with legal or compliance advice. Group customers must contact their legal advisors if they have questions about the proposed rules and the new regulations, what they will require and how they will affect their benefit plans if finalized.