Infographic: A Member Journey After the No Surprises Act
The implementation of the No Surprises Act (NSA) has significantly transformed the healthcare landscape, particularly in how health plans manage regulatory mandates and ensure member satisfaction.
A Member Journey After the No Surprises Act
The implementation of the No Surprises Act (NSA) has significantly transformed the healthcare landscape, particularly in how health plans manage regulatory mandates and ensure member satisfaction. One compelling example is Janelle, who required knee surgery and carefully chose an in-network surgeon to avoid unexpected costs.
YourHealth, Janelle's health plan, exemplifies successful NSA compliance through the advanced capabilities of HealthRules® Payer. By leveraging this modern core administrative processing system, YourHealth can:
- Configure out-of-network claims using NSA criteria.
- Auto-adjudicate claims using the Qualified Payment Amount, ensuring accurate and fair payments.
- Offer personalized cost information via the Trial Claim Feature, enabling members to make informed decisions before receiving care.
Before and After the NSA
Before the NSA: Janelle would have faced a surprise $600 bill from an out-of-network anesthesiologist, leading to dissatisfaction and potential disengagement from follow-up care.
After the NSA: Janelle now uses a price comparison tool to confirm surgery costs upfront. Claims are processed applying in-network cost sharing, protecting her from unexpected expenses.
Impact on Health Plans and Members
Enhanced Member Experience: The integration of HealthRules Payer ensures seamless NSA compliance, improving overall member satisfaction and trust. Members like Janelle benefit from transparent cost information and protection from unforeseen medical bills.
Operational Efficiency: HealthRules Payer's flexibility allows health plans to stay ahead of evolving regulations, automate complex claim processes, and negotiate better contracts with providers.
Future-Ready Solutions: With tools like the Trial Claim Feature, YourHealth is poised to meet upcoming regulatory changes, such as advanced explanations of benefits (AEOBs), ensuring continuous compliance and enhanced service delivery.
