Concerned about the No Surprises Act?

Register for the WEDI Virtual National
No Surprises Act Summit

Event Contact: Michael McNutt

WASHINGTON DC USA -- HIT/HIPAA UPDATE NEWS SERVICE™ -- NOVEMBER 10, 2021: You need to attend the WEDI National Summit November 16th to share your perspectives on the GFE and AEOB! This event, free to attend, will feature industry experts leading the discussion on the challenges associated with the statutory requirements and identifying solutions for implementing the GFE and AEOB.

Topics to be Discussed

Workflow Issues: GFE prior to scheduled service?

  • Initiation of the GFE process-for all scheduled services, or just at the request of the patient
  • How will multiple services/providers be handled
  • Role of "convening" providers/facilities
  • GFE and the uninsured/not submitting claim to payer
  • How will CPT/ICD codes be identified prior to service
  • Unpredictability and wide variation of potential services
  • Plan workflow-communication issues regarding insufficient data from provider/facility
  • Plan workflow- AEOB to be based on actual processing or prior experience?
  • How will the AEOB be handled when multiple plan products (secondary insurance) are involved
  • Plan workflow-communicating the AEOB to consumer
  • Should the AEOB information sent back to the provider be different from that sent to the consumer
  • What is most useful info for the consumer vs the provider
Technical Specifications
  • Contents of the GFE (insured/uninsured)
  • Transmission of the GFE from provider to payer (CPT/ICD)
  • Transmission of message from payer to provider regarding missing, incomplete, or inaccurate
  • information (FHIR, X12)
  • Transmission of the AEOB to the consumer
  • Transmission of the AEOB to provider/facility
Implementation Issues
  • Staging issues (what can be done, and when)
  • Can providers/plans offer a reduced level of information to start (i.e., in vs out of network
  • charges)?
  • Implementation glidepath once a standard(s) is identified
  • Enforcement
  • Industry education
Discussion of next steps

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