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August 26, 2022

Final Rules Released to Clarify Federal Process to Protect Against Surprise Billing

On August 19, the U.S. Departments of Labor, HHS, and Treasury announced the issuance of final rules on the various standards related to the arbitration process implementing the “No Surprises Act.”  This bipartisan Act aims to protect consumers from surprise medical bills. The final rules seek to make certain medical claim payment processes more transparent to help providers and health care facilities in negotiations with issuers and plans, and to better inform potential offers those facilities may submit to independent entities involved in resolving claim disputes.   

The rules clarify the arbitration process for providers and health insurance companies to resolve potential disputes over the payment amount for out-of-network services for which surprise billing is prohibited by the Act. The parties may use the federal Independent Dispute Resolution Process to resolve these disputes. 

Additionally, in July 2021, the interim final rule included requirements for payors to provide specific information about claims and payment processes to providers and facilities with certain information about billed claims and payment processes. The final rules require payors to provide additional information  if they change the service code a provider used for billing purposes to one of lesser value.   

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