The NSA (No Surprise Act) has added significant new burdens on healthcare doctors and other providers simply to get paid for services they've rendered. At it's core the No Surprise Act requires insurance carriers pay a rate equal to the median in-network rate of all same specialty doctors/providers in your metropolitan statistical area (MSA). This is the QPA (qualifying payment amount) and is one of many reasons we developed OpenCare Data.
You can sign up, search for, and find this median in-network rate now via our website. If you are using our GoRev revenue cycle management software you now get access to this data directly in GoRev! With it you can dynamically generate appeals with a couple clicks. Below is a quick example of how this process works along with a No Surprise Act QPA Appeal template.
Simply check the No Surprise Act QPA Appeal with OpenCare Data print forms template and click Generate PDF.
Click GoRev Generation to view.
And this PDF will render. Print, stuff, mail, or e-fax off to the insurance carrier.
Click No Surprise Act Appeal Template to view.
This NSA Appeal template dynamically pulls in the actual allowed amount paid by the insurance carrier by charge item and then merges in the in-network median rate for the same charge from OpenCare Data. A delta is then calculated and a summary (claim level) set of data is supplied. Combine this with the fact you can generate dynamic appeal templates on multiple accounts with one click in GoRev and we believe this will revolutionize your NSA appeal procedures.
If you are interested in learning more about this process within GoRev please visit us online at www.gorev.com. Interested in integrating this data via API with OpenCare Data? We'd love to talk! Submit requests via the Contact Us page directly on this website.