Information Related to the No Surprises Act – Qualifying Payment Amount (QPA) and Open Negotiation Period
The No Surprises Act (NSA) was passed in December 2020. It was issued “to restrict surprise billing for patients in job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.”1
As payment for their service, non-participating providers will receive a Qualifying Payment Amount (QPA) which is the median contracted rate for the same or similar service for a geographic region. The NSA also created a process for insurers and providers to settle differences when special exceptions are needed.
Surprise Billing claims that are being temporarily held to ensure they were processed according to the legislation and supporting regulations will soon be released in batches.
In the event you’d like to initiate an open negotiation period to dispute the QPA received, we require that you fill out the form at bluecrossnc.com/qpa. All fields must be completed with accurate information to ensure processing. If a field is incomplete or contains inaccurate information, the dispute will be rejected via email, and you will need to resubmit it. If we cannot come to an agreement after 30 business days, you may pursue the independent dispute resolution process designed by the Centers for Medicare & Medicaid Services (CMS) as outlined in the No Surprises Act.
Get more information on the No Surprises Act .
1 Overview of rules & fact sheets. (n.d.). Retrieved April 4, 2022