Commercial Claims Processed under the No Surprises Act (NSA)

For providers who receive an electronic remittance advice (ERA, also known as an 835) for an NSA claim submitted for payment under one of THP’s commercial plans, the QPA is the same amount as what is shown as the allowed amount. The QPA was calculated in accordance with the NSA. Member cost share for NSA claims is calculated in compliance with the NSA and is calculated using the lesser of the QPA and billed charges.

To dispute an NSA claim’s payment amount, a provider must timely initiate a 30-business-day open negotiation period in accordance with the NSA. Contact information for the appropriate office to initiate open negotiation of an NSA claim submitted for payment under one of THP’s commercial policies is: NSA@healthplan.org The Health Plan, Attn: NSA Negotiations, 1110 Main Street, Wheeling, WV 26003; 1.877.847.7901. If the dispute is not resolved within the open negation period, the provider may be able to initiate the federal Independent Dispute Resolution (IDR) process if they promptly act within four days after the end of the open negotiation period.

For more information about the No Surprises Act, click here.