No Surprises Act (Surprise Billing) and Impact to Claims

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been preparing for the 2022 implementation of the No Surprises Act since it was signed into law in late 2020. Guidance on various pieces of the act is still forthcoming.

Surprise Billing claims include claims 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.

At this time, the federal independent dispute resolution (IDR) portal to allow parties to initiate IDRs is not live yet. The Centers for Medicare and Medicaid Services (CMS) expects the portal to be live in early March.To ensure that claims are processed correctly and according to the mandate, Surprise Billing claims are being temporarily delayed. Once claims are released, we will provide additional details about the open negotiation and independent dispute resolution process.