Provider requirements and resources

Provider requirements and resources

The Consolidated Appropriations Act of 2021 established several new requirements for providers, facilities, and providers of air ambulance services to protect consumers from surprise medical bills. These requirements are collectively referred to as “No Surprises” rules. Among other things, these include prohibiting balance billing in certain circumstances and requiring disclosure about balance billing protections, requiring transparency around health care costs, providing consumer protections related to continuity of care, and establishing requirements related to provider directories.

These requirements generally apply to items and services provided to consumers enrolled in group health plans, group or individual health insurance coverage, and Federal Employees Health Benefits plans. The requirements for transparency of health care costs and the requirements related to the patient-provider dispute resolution process also apply to uninsured consumers.

These requirements don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. These programs have other protections against high medical bills.

Resources

  • Summary of provider requirements.  A high-level summary of all of the No Surprises requirements for providers, facilities and air ambulance providers that become effective 1/1/22. High level overview of provider requirements (PDF)
  • Detailed balanced billing rules.   Information on the rules that prohibit providers, facilities and air ambulance providers from balance billing out-of-network patients, including for emergency services, air ambulance services, and for certain non-emergency services.   Detailed balanced billing rules (PDF)
  • Other surprise billing protections. Information for providers and facilities on these No Surprises rules: 1) balance billing disclosure requirements; 2) protections for certain continuing care patients whose plan terminates a contract with a provider; and 3) requirements to protect patients and improve the accuracy of provider directory information.   Other surprise billing protections  (PDF)
Page Last Modified:
01/04/2022 12:23 PM