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New Surprise Billing Rules Require Significant Effort by Healthcare Plans and Their Claim Payers
Lockton Link to more items from this source
[Guidance Overview]
July 12, 2021

"The new rules impose significant and detailed new notice obligations on the part of group healthcare plans, with one notice going to affected enrollees and another going to the out-of-network provider.... [The qualifying payment amount (QPA)], and how to calculate it, is the focus of most of the new rules' complexity and nuance.... The plan sponsor will want to take steps to ensure its plan's claim payor (the insurer or TPA) can make these calculations and do so correctly."

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