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.
- 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 slides (PDF) and Recorded Presentation. (YouTube)
- 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) and Recorded Presentation. (YouTube)
- 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) and Recorded Presentation. (YouTube)
- The No Surprises Act’s Good Faith Estimates and Patient-Provider Dispute Resolution Requirements. Information for providers and facilities on the requirements to provide good faith estimates to uninsured/self-pay patients, and information on the patient-provider dispute resolution process. GFE and PPDR Requirements Slides (PDF) and Recorded Presentation. (mp4)
- A Demo for Providers and Facilities on the Patient-Provider Dispute Resolution (PPDR) Process. A webinar to guide a provider or facility who is party to a payment dispute with an uninsured or self-pay patient through the PPDR process and what they can anticipate as a party to this process. Recorded Presentation. (YouTube)
Frequently Asked Questions (FAQs)
- FAQs for providers about the No Surprises rules. Information for providers and facilities regarding No Surprises rules, independent dispute resolution, and exceptions to the new rules and requirements. Frequently asked questions for providers about the No Surprises rules. (PDF)
- FAQs on No Surprises Act implementation, including applicability, notice, and consent. These FAQs provide details about the No Surprises Act applicability to providers and facilities by category of service as well as requirements related to providing notice and obtaining consent to balance bill in certain circumstances. FAQs for providers on applicability, notice, and consent. (PDF)