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How Liminal Health Can Help You Navigate the No Surprises Act
Introduction
The No Surprises Act (NSA) was designed to protect patients from unexpected bills, but its effects on healthcare providers have been far-reaching. For out-of-network (OON) providers, the NSA introduces a time-consuming, complex, and error-prone process for securing fair reimbursement.
Healthcare providers are now required to use the Independent Dispute Resolution (IDR) process to secure payment adjustments, and payers have taken advantage of the system by underpaying providers. Liminal Health is here to help. We simplify every step of the NSA process to ensure providers recover lost revenue, reduce administrative burdens, and improve negotiating leverage.
How We Help Different Provider Types
Hospital-Based Physician Groups
Hospital-based physicians - like emergency department (ED) physicians, anesthesiologists, radiologists, and neuromonitors - are often out-of-network with major payers. Under the No Surprises Act, these providers must rely on the IDR process to dispute payments.
How Liminal Health Helps:
Recover Reimbursements: We increase payments through effective IDR management.
Reduce Administrative Burdens: Our team connects to your billing system to reduce manual effort.
Flexible Service Models: Choose between monthly fees or commission-based payments.
Hospital Systems
Hospitals face two scenarios where the NSA impacts them:
Contract Terminations -- Terminations leave hospitals exposed to reference pricing on emergency care.
Narrow Networks & Small Payers -- Revenue from narrow networks may be small but significant over time.
How Liminal Health Helps:
Dispute Management at Scale: Our system handles large volumes of disputes.
Revenue Recovery: We help recover reference-priced payments.
Negotiation Insights: Our data helps strengthen contract negotiations.
Air Ambulance Providers
Air ambulance providers frequently operate out-of-network. While they are now protected under the NSA, payers still reimburse them at lower-than-expected rates.
How Liminal Health Helps:
End-to-End Dispute Management: Our system handles IDR filings and responses.
Revenue Recovery: We secure payments higher than initial offers from payers.
Low-Risk Service Model: Choose between commission-based payments or flat monthly fees.
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Liminal Health's NSA ClearPath software and expert support simplify compliance, maximize reimbursements, and reduce administrative burdens.