Lower Costs and Improve Efficiency with Full-Service NSA Claim Repricing
Managing No Surprises Act (NSA) claims requires strict adherence to regulatory requirements, proactive communication with providers, and careful management of time-sensitive administrative processes.
Often, that responsibility falls to third-party administrators (TPAs) already crunched for time when serving the ever-changing needs of their health plan clients.
Let Vālenz Health® take that burden off your shoulders with our comprehensive NSA claim management services.
From initial claim identification through final resolution, we handle every step of the process — including repricing, QPA support, and appeals — to support accuracy and compliance for your clients.
See how we can streamline the process and reduce your workload by contacting us today.
Stay ahead of NSA regulations while controlling out-of-network costs.
See how Valenz helps support your clients and reduce spend by contacting our team today.
Vālenz Health®: Your Partner in Successful NSA Claims Management
Since the very inception of the NSA, the legal and regulatory experts at Valenz have successfully managed and adapted to increasingly aggressive provider challenges — with less than 4% of claims appealed along the way.
Unlike others that base their claims repricing on only CMS and PPO network rates, we approach repricing with established reimbursement databases to support defensible, and market-sensitive reimbursement amounts for clients.
And, by employing an upfront IDR fee payment schedule, we reduce financial exposure for you and your health plan clients, reducing payment timing challenges at the most critical stage in the process.
The result: Cost-efficient, time-sensitive NSA management that saves you valuable time, money, and effort.
How We Streamline the NSA Claim Repricing Process
Valenz serves as an extension of your team throughout the NSA management process to simplify compliance, reduce workload, and contain costs.
From start to finish, we help you protect your plan payer clients with:
-
Claim Identification: We automatically identify NSA-eligible claims during out-of-network claim reviews.
-
Qualified Payment Amount Repricing: Claims are repriced using the QPA and treated as in-network for payment. We use only established reimbursement databases to ensure accuracy related to legislative requirements.
-
Open Negotiation: We initiate and fully manage the required negotiation period with the provider to reach an agreement.
-
Independent Dispute Resolution: If no agreement is reached, we manage the IDR process end-to-end, including submission and arbitrator selection. We also handle ongoing CMS portal administration and advance IDR fees upfront on behalf of the payer client to further reduce operational burden.
Lorem ipsum dolor sit amet consectetur adipisicing elit. Ratione hic quaerat magnam accusantium sequi inventore non quod, maiores veniam recusandae maxime repudiandae impedit, obcaecati atque, iusto molestiae repellendus veritatis commodi illo ex ab! Maxime harum est ad suscipit sint delectus.
Sarah Adams
Business Strategy Leader
NSA Repricing FAQs
Your Frequently Asked Questions, Answered
What is the No Surprises Act?
The No Surprises Act is a federal law designed to protect patients from unexpected medical bills for certain out-of-network services, including emergency care and services provided by out-of-network clinicians at in-network facilities. Health plans and TPAs are typically responsible for managing the payment, negotiation, and dispute resolution processes required by the law.
What is NSA Claim Repricing?
NSA Claim Repricing is the process of identifying claims subject to the No Surprises Act and determining the appropriate reimbursement using the qualified payment amount. It also includes the required provider negotiation and, when necessary, independent dispute resolution to resolve payment disputes while maintaining compliance with federal regulations. The ultimate reimbursement amount may be affected by negotiations or the Independent Dispute Resolution process.
How does Valenz simplify NSA compliance?
Valenz provides end-to-end support throughout the NSA process, including:
- Claim identification
- QPA repricing
- Provider negotiations
- IDR management and advancement
- CMS portal administration
- Upfront payment of IDR entity fees
By managing the entire NSA process, Valenz reduces administrative burden and helps clients maintain compliance.
How does Valenz calculate QPAs?
Instead of CMS and PPO network rates, Valenz uses established reimbursement databases consisting of robust claims, payment, cost, charge, and clinical data designed to produce accurate, defensible QPAs. This data-driven methodology supports regulatory compliance while helping payers control out-of-network reimbursement costs.
What happens if a provider disputes the payment amount?
If a provider disagrees with the initial reimbursement, Valenz manages the required open negotiation period. If an agreement cannot be reached, our team administers the IDR process from start to finish, including CMS portal submissions, arbitrator selection, documentation, communications, and deadline management.
Can Valenz help reduce out-of-network claim costs?
Yes. By combining data-driven QPA calculations, experienced negotiation strategies, and comprehensive IDR management, Valenz helps clients achieve defensible reimbursements while minimizing unnecessary provider payments, avoiding missed deadlines, and reducing overall administrative costs associated with NSA compliance.
With operational cost intelligence and expertly curated data sets informed by advanced analytics, the Valenz Out-of-Network Repricing solution unlocks significant savings for high-cost, low-utilization claims.
What makes the Valenz NSA claim repricing process different?
Valenz delivers more than compliant claim repricing. We provide full-service NSA administration by assuming ownership of the entire process, from claim identification through final resolution.
With data-driven reimbursement methodologies, experienced negotiation support, end-to-end IDR management, CMS portal administration, and upfront payment of IDR entity fees, we help clients reduce administrative workload, minimize compliance risk, and control out-of-network claim costs.
Disclaimer: Services are provided in accordance with applicable client agreements and are designed to support compliance with the No Surprises Act and applicable regulations. Ultimate compliance remains dependent upon client-specific facts, plan administration, and applicable law.