No Surprises Act Automation | Macedon Technologies

The Challenge: Impact of No Surprises Act on Healthcare Providers

While the No Surprises Act (NSA) was developed to protect patients from unexpected medical bills, the act puts administrative and financial pressure on healthcare providers. NSA outlines a process for healthcare providers to receive payment that is overseen by the Centers for Medicare and Medicaid Services (CMS) and includes Out-of-Network Billing Protections, an Open Negotiation Period (ONP), and Independent Dispute Resolution (IDR). Meeting the ONP and IDR deadlines requires extensive manual effort.

Manual tools, such as Excel and Smartsheets, can’t handle the volume of work needed to maintain NSA compliance. If healthcare providers take too long to manage disputes or fail to meet deadlines for appeals, they face revenue loss.

Macedon’s No Surprises Act (NSA) solution provides the market’s most complete, AI-powered answer for healthcare providers. Macedon’s solution for NSA transforms compliance from a burden into a competitive advantage, by solving a problem that negatively impacts revenue.

Our NSA accelerator combines the power of the Appian platform’s native tools with pre-built automations from Macedon for an out-of-the box solution that deploys quickly, enabling healthcare organizations to scale workflows and gain confidence in their ability to recover revenue.

2-The Challenge-Impact of No Surprises Act on Healthcare

Our Solution: Built on Appian, Enhanced by Macedon

AI Skills

AI speeds responses to time-critical emails by ingesting the work as it comes through and answering select emails based on your business criteria. This includes reading attachments through Document Extraction.

Case Management

Case Management allows Healthcare Providers to see the full history of any claim and take relevant action at any point.

Robotic Process Automation (RPA)

RPA automates integrations where traditional integrations are not accessible - such as to the CMS website.

Data Fabric

Data Fabric brings together information from your existing systems as well as our NSA solution, to provide more comprehensive and responsive reporting.

Outline of sewing machine in dark purple on a transparent background

Tailored to You

You are in control - our NSA Solution is configurable to meet your particular organization's strategy, including your personalized IDRE selection rules, decision thresholds, and more.

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Secure

Our NSA Solution is built on Appian, which is compliant with HIPAA security requirements, as well as FDA 21 CFR Part 11 compliant, Health Information Trust Alliance (HITRUST) CSF certified, and more. Click to view the full list.

How the Macedon NSA Solution Stands Out

No other NSA Solution automates as much of the medical billing dispute and negotiation process as ours - while still leaving the overall process in your hand, customized to your particular business rules. The Macedon NSA solution goes beyond RPA to achieve full digital transformation for medical service organizations.

The Macedon NSA solution provides unique features, such as:

End-to-end Email Parsing
IDR Entity Selection Automation based on your specific rules
Embedded Payer Strategies

Core Capabilities

Macedon’s NSA solution incorporates AI Automation to accomplish the wide range of tasks required to complete a complex regulatory process. These core capabilities include email triage, dispute lifecycle automation, and real-time revenue tracking. Each core capability delivers benefits, such as:

Never missing deadlines
Revenue accountability
Audit time reduction

Business Value Delivered

Protecting Revenue
Boosting Dispute Throughput
Cutting Processing Time

Reducing Burnout
Accelerating Payment Cycles
Increasing Legal Team Time and ROI

What are our Clients Saying?

“Thanks for your thoughtful solutions,
your anticipation of needs, and just being a great partner to work with.”

Product Owner at a
Regional Bank

“[Macedon] made this project
seem easy. Always prepared,
always on target.”

Product Owner at a Healthcare Organization

“[Macedon] proactively suggests process improvement items that had never occurred to me.”

Sponsor and AVP at an Insurance Organization

Macedon's NSA Solution Success Stories

3-Success Story-Global Medical Response (GMR)

An emergency services provider’s revenue management cycle was especially vulnerable to the new standards set by the NSA.

Macedon’s NSA solution automates over 85% of the No Surprises Act process, from the beginning of the ONP all the way through the IDR process to a final determination.

With the Macedon NSA solution, they open 80+ disputes a day with an average value of $28K per dispute, for a total value of over $2 million daily. The system currently has over 9,100 open disputes, which translates to managing about $250 million.

Emergency Services Provider

Macedon tailored a robust NSA solution especially for this organization's unique existing systems and business rules.

The solution streamlines processes by eliminating manual steps, reducing dependence on external contractors, and enabling current associates to manage case and claim volumes efficiently.

The project incorporates several key integrations, including automated IDR process initiation through RPA, with the CMS IDR Portal, and connections to systems like NextGen, Trizetto, and in-house applications for a seamless solution that brings together their existing IT investments.

Service Provider in Operating Room Services, specializing in ECMO, IONM, and more

Resources

Deep Dives

No Surprises Act: How Automating can Increase Revenue

Why Appian + Macedon

As a Premier Appian Partner, Macedon has early access to features and custom extensions for AI platform solutions. Our library of hardened Appian accelerators sets us apart by enabling Macedon to deliver speed, quality, and flexibility.

The Macedon No Surprises Act solution supports strict billing dispute deadlines, privacy requirements, and enterprise-grade scaling. By helping healthcare organizations meet NSA compliance, the solution reduces revenue and reputational risk. With the Macedon NSA solution, healthcare service providers can automate over 85% of the dispute lifecycle, from negotiation to resolution

Find Out More

In partnership with Appian, Macedon provides NSA solutions for high-volume claims organizations, such as:

Emergency Services
Anesthesiology Services
Radiology Services
Surgical Support Services
Institutional Providers

Blog Post: Navigating the No Surprises Act's Challenges for Healthcare Providers

The healthcare landscape has undergone significant changes with the introduction of the No Surprises Act, enacted on January 1, 2022.

While this legislation aims to protect patients from unexpected medical bills, it has also introduced administrative headaches for healthcare providers. We have worked with customers to overcome these new complexities in a scalable way, to make sure they can continue to get paid for their critical services.

Automated and Scalable No Surprises Act (NSA) Compliance

Proud winners of 2025 Appian Partner Innovation Award for our No Surprises Act (NSA) solution for Healthcare Providers