Ready to Submit Your Air Ambulance Claims Report? Reports are Due on 3/31/2023

While many health plans have rightly been focused on complying with the new price transparency tool requirements that went into effect on January 1, 2023 (part of the Transparency in Coverage rules), there is another compliance deadline fast approaching.

The No Surprises Act includes a lesser talked about provision that requires health plans and air ambulance providers to submit data on air ambulance claims paid or incurred during calendar years 2022 and 2023.

Specifically, for health plans, section 106(b) of the No Surprises Act requires submission of a report to the Centers for Medicare and Medicaid Services (CMS) that includes all air ambulance claims incurred or paid during the previous calendar year—and this submission must take place no later than 90 days after the end of the year. For example, all air ambulance claims incurred or paid in 2022 need to be reported by 3/31/2023, and likewise, all 2023 claims need to be reported by 3/30/2024.

This requirement is somewhat like the Prescription Drug Cost Reporting (RxDC) from the standpoint that CMS is looking to better understand the air ambulance marketplace—much like they are looking to understand the prescription drug marketplace with RxDC. After the two-year reporting period concludes, the Secretary of Health and Human Services must issue a report with their findings based on the data submitted. The goal is to provide policymakers with better insight into this part of the industry that typically leads to high-dollar claims.

The Federal departments (collectively the Departments of Health and Human Services, Labor, and Treasury) released proposed rules on September 16, 2021, with comments due by October 18, 2021. It has been crickets since then. It’s now January 2023 and we have still not seen final rules or technical guidance specific to health plans (air ambulance providers did receive some limited guidance). You may download that guidance here.

The departments will need to release guidance soon so plans and air ambulance providers can prepare and submit their reports by the March 31 deadline. It’s also possible that the deadline will be extended. For now, we can glean some idea of what’s required through the proposed rules.

According to the proposed rules, for each air ambulance claim received or paid during the previous calendar year, a health plan, or their third-party administrator (TPA), must provide the following data at the claim-level:

• NPI
• Date of service
• CPT/HCPCS
• Aircraft type (fixed wing or rotary)
• Pick-up and drop-off zip codes
• Whether the transport was emergent or non-emergent
• Whether the transport was interfacility
• Whether the transport originated in a rural or urban area
• Whether the transport provider was contracted
• Whether the claim was paid, denied, or appealed
• Appeal outcome, if applicable
• Denial reason code, if applicable
• Billed charge
• Member cost-share amount
• Type of delivery model: Hospital-owned or sponsored program, municipality-sponsored program, hospital independent partnership (hybrid) program, independent program, or tribally operated program in Alaska *if plans collect this data

Health plans should be asking their TPA if they are preparing to comply with the new requirements. Likewise, TPAs should be talking to their claims vendor if they delegate claims processing. While we don't have final rules yet, we generally know what the structure of the report will look like based on the key requirements above. Ideally, whichever claims software the plan or TPA uses, it will be able to export this data with minimal customization.

Finally, self-funded plan sponsors must remember that they are ultimately responsible for delivering the reporting on time, even if they delegate to a TPA or another party to submit on their behalf.