Daffodil Health 推出《无 surprises 法案》争议管理解决方案
Daffodil Health Launches No Surprises Act Dispute Management Solution
Daffodil Health，一家人工智能健康计划管理平台，周四推出了一项新解决方案，旨在帮助付款方管理《无 surprises 法案》争议。
《无 surprises 法案》通过让患者免于卷入保险商与医疗服务提供者之间的支付争议，保护他们免受意外医疗账单的困扰。根据该法律，保险商和医疗服务提供者必须首先花费30天时间协商报销事宜。如果双方未能达成协议，任何一方都可以启动独立争议解决（IDR）程序，双方提交拟议支付金额，由一名独立仲裁员（称为 IDR 实体）选择其中一个报价。
然而，许多付款方认为，IDR 程序正被一些医疗服务提供者滥用，提供者发起绝大多数案件，并且大多数时候以显著虚高的裁决金额获胜。《无 surprises 法案》最初出台时，估计每年会有17,000起仲裁案件，但仅在2025年上半年，就超过了120万起。
由以下机构呈现赞助帖子缩小工作场所心理健康中的质量与可负担性差距在一次采访中，Kyan Health 联合创始人兼首席商务官 Konstantin Struck 讨论了 Kyan 如何以可负担的价格点，为中端市场和企业雇主提供优质劳动力心理健康服务。
作者：Stephanie Baum
Daffodil 的新版 NSA 争议管理解决方案旨在解决这一问题。当付款方收到来自医疗服务提供者的争议时，系统会读取争议，进行分类和归类，然后自动生成给提供者的回复，付款方可以审核并发送。
此外，当提供者对索赔提出异议时，系统通过分析定价、基准和仲裁数据，评估哪些索赔应支付、哪些应还价、哪些应提交仲裁。这“确保你只在重要的事情上花费时间和金钱，”Daffodil Health 首席执行官兼联合创始人 Navin Nagiah 表示。
对于进入仲裁的 NSA 索赔，系统会提议一名仲裁员，并自动生成仲裁包供付款方审核。最后，该解决方案允许付款方轻松向其雇主团体展示他们如何管理 NSA 争议。
“付款方需要能够以最低限度的劳动力成本增加甚至不增加的情况下处理日益增长的争议量；即使提供者在周五下午扔来2,352起争议，也能毫不犹豫地回应；提高仲裁胜率，并通过轻松快速分享努力和结果，让雇主团体相信他们拥有支持雇主的基础设施，”Nagiah 说。“这正是 Daffodil 的 NSA 解决方案所能做到的。”由以下机构呈现赞助帖子2026年全球劳动力顶级7家现代AI驱动的EAP提供商发现2026年顶级AI驱动的EAP提供商。比较 Kyan Health 和 Spring Health 等平台的分诊速度、全球覆盖范围和临床质量，以转变劳动力福祉。
作者：Tiffany Cabasso，Kyan Health 运营总监 | 心理学家，FSP Daffodil 并不是唯一一家寻求解决 NSA 争议流程问题的科技公司。Zelis 最近也推出了一项解决方案，应对付款方的 IDR 挑战。
归根结底，NSA 争论并不是真正的“付款方与提供者之争”的故事，Nagiah 说。
“这是一个关于双方整条中间商产业链的故事，他们的收入依赖于人为虚高的账单金额、‘纸张’节省、争议保持复杂和对抗性等等。系统中的摩擦越多，就会有越多的中间商宣称增加价值并‘抽成’，”他说。“有远见的付款方应当停止使用中间商，减少医疗管理支出，既提高自身利润率，又帮助降低其雇主客户的保费。”照片：KLH49，Getty Images
Daffodil Health, an AI health plan administration platform, unveiled a new solution on Thursday that aims to help payers manage No Surprises Act disputes.
The No Surprises Act shields patients from unexpected medical bills by keeping them out of payment disputes between insurers and providers. Under the law, insurers and providers must first spend 30 days negotiating reimbursement. If they fail to reach an agreement, either party can initiate the Independent Dispute Resolution (IDR) process, in which both sides submit proposed payment amounts and an independent arbitrator, known as an IDR entity, selects one of the offers.
However, many payers are arguing that the IDR process is being abused by some providers, with providers initiating the vast majority of cases and winning most of the time at significantly inflated award levels. When the No Surprises Act was first introduced, it was estimated that there would be 17,000 arbitration cases a year, but in just the first half of 2025, there were over 1.2 million cases.
Daffodil’s new NSA dispute management solution aims to solve this issue. When a payer receives disputes from a provider, the system reads the disputes, triages and categorizes them, and then automatically creates responses to the providers that the payer can review and send.
In addition, when a provider pushes back on claims, the system assesses which claim to pay, which one to counteroffer and which one to take to arbitration by analyzing pricing, benchmarking and arbitration data. This “ensures that you spend time and money only where it matters,” said Navin Nagiah, CEO and co-founder of Daffodil Health.
For NSA claims that go into arbitration, the system proposes an arbitrator and automatically creates an arbitration package for the payer to review. Lastly, the solution allows the payer to easily show their employer groups how they’re managing NSA disputes.
“Payers need to be able to handle the rising volume of disputes with minimal to no increase in labor costs; respond to providers without batting an eyelid even if they dump 2,352 disputes on a Friday afternoon; increase their win-rate [with respect to] arbitrations, and give confidence to their employer groups that they have the infrastructure to help support the employers by sharing both their efforts and results with them easily and quickly,” Nagiah said. “That is exactly what Daffodil’s NSA solution allows you to do.” Daffodil isn’t the only tech company looking to solve issues with the NSA dispute process. Zelis also recently launched a solution that is tackling payer IDR challenges.
Ultimately, the NSA debate isn’t really a “payer-versus-provider story,” Nagiah said.
“It’s a story about an entire industry of middlemen, on both sides of the table, whose revenue depends on artificially billed amounts, ‘paper’ savings, disputes staying complicated and contentious, etc. The more friction in the system, the more middlemen come in professing to add value and ‘take a cut,’” he said. “It behooves forward-looking payers to stop using middlemen, reduce healthcare admin spend, and both improve their own margins and help reduce premiums for their employer customers.” Photo: KLH49, Getty Images