​New federal mandates: Please stay informed

January 6, 2022

​Certain provisions of the Consolidated Appropriations Act, including the No Surprises Act, and the Transparency in Coverage Rule, went into effect January 1, 2022. These federal mandates will have a direct impact on patients, payors, and providers alike.

With that in mind, we want to be sure that as a provider, you are aware of how these new rules could impact you.

  • Provider Directory Verifications and Updates: Health plans will be required to verify and update their provider directory information every 90 days. That means we will need you to review and verify the information listed in our provider directory more frequently. If you do not comply by the dates required, your information will not display in our provider directory (though you will remain in our network). We will provide more information about this verification process prior to the first due date of April 1, 2022.
  • Public-Facing Machine-Readable Files with Fees and Rates: Starting July 1, 2022, health plans will be required to make public machine-readable files available that include negotiated rates for covered items and services. While you are not required to take any action with respect to these files, we do want you to be aware of these files, as you may get questions from patients or colleagues.
  • Advance Explanation of Benefits: Patients will have the ability to request an advance Explanation of Benefits (EOB), which will include cost estimates on what they will be expected to pay for all scheduled services you are ordering or will be performing. The mandate currently requires speedy turnaround of this information (within 24 hours or three days, depending on the scheduled services). We will keep you informed about this requirement, since the timing and process for collecting and sharing these costs is still under discussion.

The requirements for implementing these mandates are evolving. AmeriHealth is committed to meeting all requirements by the mandated compliance dates and to keeping you informed of the changes that impact you.

Check this article for more information about the No Surprises Act.​