Provider Disputes Related to Payment for Claims In-Scope for NSA Protections
Within 30 business days of receiving a claim payment, out-of-network providers may request open negotiation to dispute the initial payment for commercial and Federal Employee Program® (FEP®) claims in-scope for the NSA.
In-scope NSA services include the following out-of-network services:
- Emergency services
- Air ambulance services
- Non-emergency professional and ancillary services rendered in an in-network facility
The disputes are resolved through the NSA negotiation/arbitration process, which includes a 30-business-day open-negotiation period between the provider and the payer. The parties attempt to negotiate a resolution. If they can’t agree within the 30-day time frame, the dispute may be referred to a certified independent federal arbitrator.
To the extent that BCBSAZ is required by A.R.S. § 20-3102(F) to have a process for resolving payment disputes, BCBSAZ has adopted the NSA process for all claims considered in-scope for the NSA. In this type of dispute scenario, the NSA negotiation/arbitration process replaces the BCBSAZ provider grievance process for disputing the claim payment amount.
For more information, you can visit the federal NSA resource page.