Data Sheet: Navigating the No Surprises Act - The Right Tools for Health Plan Success

Navigating the No Surprises Act and Implementing TIC Solutions

The No Surprises Act (NSA) marks a significant regulatory milestone aimed at protecting consumers from surprise medical bills and enhancing transparency in healthcare. This legislation, part of the Consolidated Appropriations Act of 2021 (CAA-21), builds upon existing Transparency in Coverage (TIC) regulations, creating a comprehensive framework that health plans must adhere to.

HealthRules Payer® emerges as a critical solution for health plans navigating these evolving regulatory landscapes. Built by health insurance and claims experts, HealthRules Payer offers a flexible and configurable platform designed to adapt to the dynamic nature of claims and administrative requirements.

Key Features:

• Out-of-Network & Emergency Services Configuration: Easily designate and manage NSA services.
• Personalized Cost-Sharing Information: Utilize a price comparison tool for accurate cost-sharing details.
• Automated Claims Adjudication: Meet regulatory criteria and timelines with automated claims processing.
• Trial Claim Functionality: Generate precise claims details without triggering payments, crucial for pre-service pricing transparency.

HealthRules Payer supports health plans in maintaining compliance with both NSA and TIC regulations. Its advanced tools provide payers with the capability to manage payment policies for in- and out-of-network providers efficiently. Additionally, HealthRules Payer enables accurate and automated payments, even in the absence of contractually determined guidelines.

Benefits:

• Regulatory Compliance: Seamlessly integrate NSA and TIC requirements within existing workflows.
• Enhanced Accuracy: Leverage real-time APIs and trial claim functionalities for precise claims management.
• Future-Proof Flexibility: Stay ahead with ongoing upgrades that anticipate future regulatory changes.

HealthEdge®, the company behind HealthRules Payer, is a trusted partner for health plans across the nation. Their solutions are designed for evolution, ensuring that health plans can adapt to regulatory changes while maintaining efficient operations and improving member satisfaction.

By adopting HealthRules Payer, health plans can transform regulatory compliance into a strategic advantage, driving loyalty and positive brand perception through transparent and efficient care experiences.