Preparing for the No Surprises Act: How automation can help solve the provider directory problem – MedCity News

The No Surprises Act (NSA) goes into effect on January 1, 2022. We know what this means for patientsa welcome reprieve from unexpected medical bills arising from circumstances beyond their control. But what about other stakeholders, like insurance companies? One of the provisions of the No Surprises Act requires health plans to update their provider directories more frequently. This gets to the root cause of surprise billing, which is patients ability to easily identify which providers are in-network. If payers can make updates to their directories in just 48 hours, as the law mandates, patients will have a much better chance of finding care thats actually covered by their plans.

Sounds reasonable, right?

Except for the fact that health plans are processing an avalanche of provider data at any given time. And the data are not streaming in seamlessly through a shared platform between payers and providers. Payers are literally receiving Excel spreadsheets from hundreds of different provider groups, each with their own unique and ever-changing templates. The data is so messy that all plans have dedicated staff whose job is to assess, interpret, clean up, and then enter it into the plans system. Its no surprisepun intendedthat these updates can take weeks, cost millions of dollars a year, and still have accuracy rates as low as 60%. Thats hugely problematic, since plans rely on this information not only to update their provider directories, but also to determine which providers should be paid contracted rates, for specialty and licensing updates, and for billing information changes that are necessary to properly pay claims.

While historically it has been challenging for payers to solve for all these issues, recent advances in machine learning and artificial intelligence now make it possible to automate the millions of human hours spent cleansing and keying in this data every year, as well as improve its accuracy. Think of it this way: landscapers have machines that help them shovel, so they can focus on making a yard beautiful. And to give an example from another industry in which human lives are on the line, pilots make all the flying decisions, not the planes.

These are two examples of technology that help humans safely and easily perform large amounts of work. If plans use those technologies, they will not only achieve compliance with the No Surprises Act, they will also be empowered to get employees back to their core business: keeping members healthy.

How payers should be thinking about automation

There are three main things to keep in mind over the next few months as health insurers consider leveraging automation to help them comply with the No Surprise Act.

January 1, 2022 may seem like its still far away, but factoring in upcoming holidays and the time off that people typically take in the fourth quarter of the year, the No Surprises Act deadline is practically around the corner. Payers that want to be in compliance with its provider directory provision must act now.

Photo: fizkes, Getty Images

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Preparing for the No Surprises Act: How automation can help solve the provider directory problem - MedCity News