The No Surprises Act was designed to protect healthcare consumers against surprise billing. For payers, it has made processes more complex, especially relating to ensuring that reasonable and acceptable reimbursements are established and benchmarked by procedure, by provider, and by geography.

On September 30, 2021, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury along with the Office of Personnel Management released an interim final rule, which further explains requirements related to the Independent Dispute Resolution (IDR) process and Qualified Payment Amounts.

Greg Tackett, Senior Vice President of National Accounts and Strategy at Zelis, joined our Future Healthcare Today podcast to further explore these new rules and how median in network solutions can help ensure reasonable and acceptable reimbursements.

“When payers who are not used to going through arbitration today, or if they do go to arbitration, it's on a very small amount of claims, they're going to need help and support to put the best argument forward on why what they have paid the provider is fair and reasonable, because providers will probably push back on what they're paid,” said Tackett.