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Preparing for the No Surprises Act Sec. 116

The No Surprises Act includes several new requirements for health plans and providers effective January 1, 2022. These measures are designed to protect patients by improving the accuracy of provider directory information.

Health plans will be required to:

  • Verify provider information every 90 days (currently, we do this annually)
  • Remove providers from the directory if they do not respond to requests for information
  • Update the provider directory within two days of receipt of the information

Providers will be required to:

  • Submit to the health plan material changes to the content of the provider directory
  • Information including upon the request of the health plan

Providers are encouraged to update their digital contact information in the National Plan and Provider Enumeration System (NPPES) to facilitate secure care coordination and data exchange.

Providers will need to stay abreast of all required Quartz surveys and respond promptly. These include:

  • Facility Operations Form (FOF). The FOF will be sent out each January — providers are only required to complete it once per year. The FOF has information Quartz is required to collect from providers under CMS. NCQA, Wisconsin DHS, and now the No Surprises Act
  • No Surprises Act verification. This quarterly verification process requires providers to confirm minimal information listed in the Quartz provider directory as required by the No Surprises Act and CMS (including the newly required Digital Contact Information). This will replace the current CMS verification for Quartz Medicare Advantage contracted providers

In addition, Quartz will begin collecting additional information from providers. 

  • Per the Network Adequacy and Transparency Act, we will ask about their telehealth modalities used and display certain telehealth information in our provider directories.

To improve HEDIS measures and STAR ratings, we will ask providers to confirm the name of their Electronic Health Records (EHR)/Electronic Medical Record (EMR) system and if it is certified by an Office of the National Coordinator – Authorized Testing and Certification Body (ONC-ATCB).

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