Member Cost Share and Provider Reimbursement for Services In-Scope for NSA

The “No Surprises Act” (NSA) is part of the federal Consolidated Appropriations Act (CAA) signed into law in 2020. The NSA includes patient billing protections effective January 1, 2022.

For plan and policy years starting on and after January 1, 2022 (and on 2022 renewal dates for existing clients), BCBSAZ will follow the requirements of the NSA in reimbursing out-of-network providers for emergency, air ambulance, and other professional services that are in-scope for the NSA.

  • For in-scope claims, we will calculate member cost share using the in-network level of benefits and based on the qualifying payment amount (QPA), which is determined according to a formula specified in federal rules.
  • In most cases, the initial payment to the out-of-network provider will also be based on the QPA, less the member cost-share amount. Providers have the right to dispute the initial payment amount. For more information, see below.
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