The Transparency in Coverage Rule (TiC), published October 2020, provides consumers better insight into the cost of services before obtaining care and receiving a bill.
We know what youre thinking. The deadline for compliance is rapidly approaching.
Weve got your back.
We also provide legislative expertise and guidance to help plans manage the complexity introduced by both the NSA and the TiC Rule.
And while these new requirements will add complexity to healthcare claim processing and administration, both pre- and post-service, the ruling's most significant impact lies in two key areas: transparency and member engagement and out-of-network (OON) claim processing and payment.
Zelis Machine-Readable Files will address out-of-network (OON) MRF data requirements for Zelis-priced OON claims. We will also offer in-network (INN) MRF data with median INN rates for clients whose primary networks are owned or managed by Zelis.
Zelis Member ID will enable enhanced ID card capabilities to print compliant ID cards with additional required information including member deductible, out-of-pocket maximum, and information on where to find in-network providers.
Zelis Member Communications will publish compliant AEOBs (both print and digital) with the ability to handle increased volume.
Zelis will offer compliant directories for clients whose primary networks are owned or managed by Zelis.
Zelis Market-Based Pricing offers payers a fully outsourced solution that meets No Surprises Act (NSA) compliance immediately upon implementation. Moreover, we provide the Qualifying Payment Amount (QPA), provider payment amount, provider settlement, and support in an Independent Dispute Resolution (IDR.)
Market-Based Pricing calculates reasonable and acceptable reimbursements benchmarked by procedure, provider, and geography.
Zelis Claims Negotiation succeeds through a combination of expertise, proactive provider outreach, and a demonstrable validity of market rates, driving a high rate of successfully retained savings prior to payment.
Because providers can no longer balance bill the member for NSA claims, their billing practices on these claims are likely to change. Zelis will offer expert guidance for negotiating with providers and incorporating market median data for NSA claims.
Zelis Claims Settlement manages the settlement process on your behalf to ensure compliance by defending, negotiating, and providing data needed for successful settlement, all within the timeframes required by the NSA.
As part of the IDR process, Zelis Claim Resolution will leverage our negotiations and claim settlement expertise, provide data, analytics, and reporting to support and defend clients in IDR, all within the time frames specified in the NSA.
Some providers may use the threat of arbitration to persuade payers to settle for higher reimbursements. Zelis will help you understand the impact of various pricing strategies and their likelihood of acceptance. Zelis will collect, aggregate, and analyze claims settlement and arbitration data to develop a predictive model that illustrates the overall effectiveness of pricing and arbitration results, and how those evolve over time.
The No Surprises Act and Transparency in Coverage Rule will impact all healthcare organizations, from large health plans and systems to small medical offices and individual providers. As such, leaders across the healthcare industry must directly understand the details of the legislation prior to implementation or have a trusted advisor with legislative expertise who can guide them to appropriate solutions.
Zelis can help.
To further explore getting started with NSA compliance, reach out to your Zelis representative or contact us here.
For access to additional information, visit Zelis No Surprises Act Information Hub.
As a leading payments company in healthcare, Zelis prices, pays, and explains healthcare for payers, providers, and healthcare consumers. Zelis was founded on the belief that there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment. We partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care.
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Zelis Helps Address New NSA and TiC Regulations - HealthLeaders Media
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- The NSA Warns That US Adversaries Free to Mine Private Data May Have an AI Edge - WIRED - March 27th, 2024 [March 27th, 2024]
- Five ways to implement zero-trust based on NSA's latest guidance - SC Media - March 27th, 2024 [March 27th, 2024]
- Intel analyst shared classified information on Discord, investigators say - The Washington Post - March 27th, 2024 [March 27th, 2024]
- Water Systems Vulnerable To Cyber Attacks, NSA And EPA Warn Governors - Forbes - March 27th, 2024 [March 27th, 2024]
- Amritpal Singhs mother, kin of other NSA detainees go on hunger strike, want them to be shifted to Punjab jail - The Tribune India - February 24th, 2024 [February 24th, 2024]
- Rob Joyce leaving NSA at the end of March - CyberScoop - February 24th, 2024 [February 24th, 2024]
- NSA cyber director to step down after 34 years of service - Nextgov/FCW - February 24th, 2024 [February 24th, 2024]
- Behind Khattar govts U-turn on NSA against farm leaders, fear of rural blowback, Congress gain - The Indian Express - February 24th, 2024 [February 24th, 2024]
- Payday dispute prompts maintenance worker walkout at NSA Naples - Stars and Stripes - February 24th, 2024 [February 24th, 2024]
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- India now cooperating with Nijjar probe: Canada's NSA - IndiaTimes - January 30th, 2024 [January 30th, 2024]
- Google, WhiteSnake, Outlook, NSA, Juniper, Jason Wood, and More SWN #358 - SC Media - January 30th, 2024 [January 30th, 2024]
- Readout of NSA Jake Sullivan's Meetings with PM Srettha and DPM/FM Parnpree - US Embassy in Thailand - USEmbassy.gov - January 30th, 2024 [January 30th, 2024]
- NSA Admits Secretly Buying Your Internet Browsing Data without Warrants - The Hacker News - January 30th, 2024 [January 30th, 2024]
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- NSA is buying Americans internet browsing records without a warrant - TechCrunch - January 30th, 2024 [January 30th, 2024]
- As NSA buys up Americans' browser records, Uncle Sam is asked to simply knock it off - The Register - January 30th, 2024 [January 30th, 2024]
- NSA buys sensitive data on Americans without any court order - KJZZ - January 30th, 2024 [January 30th, 2024]
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- How the FBI, NSA are preparing for deepfakes and misinformation issue ahead of 2024 elections - CNBC - January 14th, 2024 [January 14th, 2024]
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- NSA Director Paul Nakasone to Step Down in Early February - Bloomberg - January 14th, 2024 [January 14th, 2024]
- NSA says cybersecurity will gain many benefits with generative AI - ReadWrite - January 14th, 2024 [January 14th, 2024]
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- NSA: Benefits of generative AI in cyber security will outweigh the bad - ITPro - January 14th, 2024 [January 14th, 2024]
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- AI is helping China-backed hackers but it's also helping to hunt them down, NSA says - TechRadar - January 14th, 2024 [January 14th, 2024]
- Top 10 misconfigurations: An NSA checklist for CISOs - The Stack - October 20th, 2023 [October 20th, 2023]
- CISA and NSA Issues New Identity and Access Management Guidance for Vendors - TechRepublic - October 20th, 2023 [October 20th, 2023]
- How to Protect Against Evolving Phishing Attacks - National Security Agency - October 20th, 2023 [October 20th, 2023]
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- NSA calls for a 'root and branch' review of Red Tractor - Farmers Guardian - October 20th, 2023 [October 20th, 2023]
- Israel's NSA warns of US intervention as Gaza conflict escalates - IndiaTimes - October 20th, 2023 [October 20th, 2023]
- The U.S. government is still in its Tumblr era. - Slate - October 20th, 2023 [October 20th, 2023]
- Biden's Cyber Command and NSA nominee seen as a pick for continuity - The Record from Recorded Future News - July 17th, 2023 [July 17th, 2023]
- 5 Reasons to Work for the NSA - ClearanceJobs - ClearanceJobs - July 17th, 2023 [July 17th, 2023]
- I will do my best as NSA: Ribadu promises - FRCN HQ - Federal Radio Corporation of Nigeria - July 17th, 2023 [July 17th, 2023]
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- 7th Deputy NSA Meeting of Colombo Security Conclave held in ... - ANI News - July 17th, 2023 [July 17th, 2023]
- Young shepherd from region wins NSA North Sheep trophy ... - Darlington and Stockton Times - July 17th, 2023 [July 17th, 2023]
- HBO film based on NSA leaker Reality Winner slated for May 29 ... - Military Times - May 18th, 2023 [May 18th, 2023]
- Tina Satter on why her NSA whistleblower film Reality is stranger than fiction - Financial Times - May 18th, 2023 [May 18th, 2023]
- Gen. Paul Nakasone Plans to Step Down as NSA Director ... - Executive Gov - May 18th, 2023 [May 18th, 2023]
- Readout of NSA Jake Sullivan's Meeting with CCP Politburo ... - US Embassy & Consulates in China - May 18th, 2023 [May 18th, 2023]
- Young sheep farmers to be given genetic boost by new NSA giveaway - The Scottish Farmer - May 18th, 2023 [May 18th, 2023]
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- Intercepted: The Biggest Whodunnit of the Century - The Intercept - May 18th, 2023 [May 18th, 2023]
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- PM Narendra Modi e-inaugurating new office complexes of CBI at Shilong, Pune and Nagpur, commemorating the CBI diamond jubilee on Monday. Also seen... - April 4th, 2023 [April 4th, 2023]
- Special Collection Service - Wikipedia - March 31st, 2023 [March 31st, 2023]
- What is the NSA and how does it work? - SearchSecurity - February 5th, 2023 [February 5th, 2023]
- Watch: NSA Ajit Doval is Ambitious, Very Good at Sniffing Power and Being on the Right Side of itAS Dulat - The Wire - December 21st, 2022 [December 21st, 2022]
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- EFCC secures forfeiture of N755m, luxury assets from ex-AGF, former aide to NSA The Nation Newspaper - The Nation Newspaper - November 23rd, 2022 [November 23rd, 2022]
- What is the National Security Agency? - Norwich University - October 25th, 2022 [October 25th, 2022]
- Cyber Security Today, Oct. 19, 2022 A warning from the NSA about nation-state attacks, and more - IT World Canada - October 21st, 2022 [October 21st, 2022]
- In the Alphabet Soup of Regulations, the NSA, GFE and AEOB Have Yet to Coalesce - RACmonitor - October 6th, 2022 [October 6th, 2022]
- Do not ignore any communication shared by NSCS, NSA: PM Modi to ministers - The Hindu - October 6th, 2022 [October 6th, 2022]
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- CISA, FBI, NSA, Treasury, Cyber Command, and International Partners Release Advisory on Malicious Cyber Actors Affiliated with Iranian Government... - September 20th, 2022 [September 20th, 2022]
- NATFORCE: Buhari Finally Disbands Security Outfit After Senate Ignored NSA To Recognize Body The Whistler Newspaper - The Whistler Nigeria - September 20th, 2022 [September 20th, 2022]
- China Accuses NSA of Hacking Its Military Research University - VICE - September 9th, 2022 [September 9th, 2022]
- Behind the Toque: An Interview with NSA Noodle Bar Executive Chef Brooke Apfelbaum - greenpointers.com - September 9th, 2022 [September 9th, 2022]
- In the Garden: Tour gives Omahans a chance to see how a 'Bloom Box' works - Omaha World-Herald - September 9th, 2022 [September 9th, 2022]
- Three area teams pickup wins to start football season - The Suffolk News-Herald - Suffolk News-Herald - September 9th, 2022 [September 9th, 2022]
- NSA to reveal identities of big men behind oil theft in Nigeria Presidency - Daily Post Nigeria - August 22nd, 2022 [August 22nd, 2022]
- Former US Cyber Command and NSA chief makes the case for a cyber competition strategy | The Strategist - The Strategist - August 22nd, 2022 [August 22nd, 2022]
- Inaugural India-Central Asia NSA meeting to be held in December - WION - August 22nd, 2022 [August 22nd, 2022]
- Home | Open Source @ NSA - August 8th, 2022 [August 8th, 2022]
- Kennesaw State named top institution for cybersecurity outreach - Kennesaw State University - August 8th, 2022 [August 8th, 2022]
- US city of Boston to mark 75th anniversary of India's Independence with two-day extravaganza - NewsDrum - August 8th, 2022 [August 8th, 2022]