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Qualifying Payment Amounts

Qualifying Payment Amounts

Healthcare Price Transparency Tool

QPAs

Qualifying Payment Amounts (QPAs) apply in-network median rates to out-of-network, emergency, and air ambulance provider services, setting a baseline for the patient’s cost-sharing obligation. QPAs are obtained through PayerCompass’ pricing platform, Visium™, which compares the median of contracted rates for the same or comparable items, services, and provider specialty within a particular geographic region. This median is then adjusted annually in line with the Consumer Price Index for All Urban Consumers (CPI-U).

With this one-of-a-kind process trail:

  • Gain never-before-seen transparency into claim pricing details
  • Manage contracts, provider demographics, and fee schedules
  • Compile analytics at plan and claim levels
  • Comply with all state and federal guidelines, including the No Surprises Act