No Surprises Act
The No Surprises Act becomes effective January 1, 2022. This law represents a significant change in the way non-contracted and out-of-network providers can bill and be reimbursed by HealthPartners. The Act prohibits balance billing of members by non-contracted and out-of-network providers for the following:
- Out-of-network emergency items and services
- Covered medical items and services (nonemergency) performed by an out-of-network provider at an in-network HealthPartners contracted facility
- Out-of-network air ambulance (rotary and fixed wing) items and services
For each item or service identified with remark codes N859 and N860, the payment amount listed for each item or service is the Qualifying Payment Amount (QPA). The QPA applies for purposes of the recognized amount, or, in the case of air ambulance services, for calculating the applicable member cost sharing. Each QPA has been determined in compliance with the requirements of the No Surprises Act. Noncontracted providers may initiate a 30-day open negotiation period for purposes of determining the amount of total payment by contacting HealthPartners Provider Relations Network Management to initiate open negotiation. You may initiate the No Surprises Act independent dispute resolution process within 4 days after the end of the 30-day open negotiation period if a determination of the total payment, including cost-sharing, is not reached.
Contact informationProvider Relations Network Management