FAIR Health Allowed Benchmark Data Meet the Requirements of the Federal No Surprises Act (NSA)

FAIR Health's FH^® NSA Reference File Specifically Designed to Support Stakeholders in Connection with the NSA

NEW YORK, Feb. 18, 2025 /PRNewswire/ -- The federal agencies responsible for implementing the No Surprises Act (NSA) independent dispute resolution (IDR) process previously notified certified IDR entities that they are permitted to consider pricing information from databases, as long as those databases do not include any factors prohibited from consideration by the NSA. FAIR Health's FH NSA Reference File and FH^® Allowed Benchmarks do not include any prohibited factors such as provider-billed charges, usual and customary rates (UCR) or public payor rates (such as Medicare and Medicaid). Instead, they reflect the in-network allowed amounts negotiated between commercial payors and in-network providers.

FH NSA Reference File and FH Allowed Benchmarks
FAIR Health developed the FH NSA Reference File specifically to support stakeholders as an independent, eligible third-party database source in connection with the NSA. It presents median, in-network, commercial allowed amounts in geographic areas that align with NSA requirements. Median allowed amounts are provided at the levels of individual Metropolitan Statistical Areas (MSAs), all MSAs in each state, all non-MSA areas in each state, all MSAs in each Census Division and all non-MSA areas in each Census Division.

FAIR Health has been publishing benchmarks based on commercial, in-network allowed amounts for several years before the enactment of the NSA. The FH Allowed Benchmarks include the median as well as a range of percentile values for in-network, commercial allowed amounts, organized by geozip. (A geozip is a geographic area that typically corresponds to the first three digits of a zip code.) Like the FH NSA Reference File, FH Allowed Benchmarks do not include any prohibited factors such as provider-billed charges, UCR or public payor rates. Accordingly, they may support stakeholders in connection with the NSA process.

Uses of the FH NSA Reference File and FH Allowed Benchmarks
FAIR Health licenses its FH NSA Reference File and FH Allowed Benchmarks to plans and providers for use in the NSA IDR process.

In addition, the FH NSA Reference File supports plans when they have insufficient information to calculate a Qualifying Payment Amount (QPA). FAIR Health meets the eligibility requirements for an independent "eligible database" used to calculate a QPA, as described in the NSA:

• FAIR Health is not affiliated with, owned or controlled by a healthcare insurer or provider. FAIR Health is a national, independent nonprofit organization.
• FAIR Health maintains a significant volume of in-network allowed amount data in its FH NPIC^® data repository—the largest database of commercial healthcare claims in the country.
• FAIR Health distinguishes commercial payors' allowed amounts for participating providers and facilities from all other claims data. Only the median, in-network allowed amounts are used to create FAIR Health's FH NSA Reference File—not nonparticipating provider or facility charges, and not amounts paid by public payors.

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About FAIR Health
FAIR Health is a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the federal tax code. It is dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation's largest collection of commercial healthcare claims data, which includes over 49 billion claim records and is growing at a rate of over 3 billion claim records a year. FAIR Health licenses its commercial data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D, which accounts for a separate collection of over 49 billion claim records; FAIR Health includes among the commercial claims data in its database, data on Medicare Advantage enrollees. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health's systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 Type 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish, which enables consumers to estimate and plan for their healthcare expenditures and offers a rich educational platform on health insurance. An English/Spanish mobile app offers the same educational platform in a concise format and links to the cost estimation tools. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. For more information on FAIR Health, visit fairhealth.org.

Contact:
Rachel Kent
Executive Director of Communications and Marketing
FAIR Health
646-396-0795
[email protected]

SOURCE FAIR Health