No Surprises Act
Federal law effective January 1, 2022 that protects patients from surprise medical bills for emergency services, non-emergency services at in-network facilities by out-of-network providers, and air ambulance services.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Primary sources
- 1
- Workspace handoff
- compliance binder →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS NSA prohibits balance billing in defined scenarios, requires good faith estimates for uninsured/self-pay, requires patient notice and consent for OON balance billing where permitted, and establishes the IDR process for OON payments.
How it shows up in your practice
Train front desk on notice-and-consent rules. Track OON encounters subject to IDR. Update Notice of Privacy Practices to reference NSA rights.
Sources
- CMS — No Surprises Acthttps://www.cms.gov/nosurprises
Adopt NSA policies in the Compliance Binder
Open compliance binder →Related terms
- PayerGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
- PayerIndependent Dispute Resolution (IDR)Under the No Surprises Act, the arbitration process for resolving payment disputes between OON providers and payers for protected services.
- PayerPatient-Provider Dispute ResolutionUnder the No Surprises Act, the process by which uninsured or self-pay patients may dispute a bill that exceeds the Good Faith Estimate by $400 or more.
- PayerAdvance Explanation of Benefits (AEOB)Under the No Surprises Act, the advance benefit statement that insurers must provide to insured patients before scheduled services (implementation deferred).
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryAdvance Explanation of Benefits (AEOB)Under the No Surprises Act, the advance benefit statement that insurers must provide to insured patients before scheduled services (implementation deferred).
- GlossaryGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
- GlossaryIndependent Dispute Resolution (IDR)Under the No Surprises Act, the arbitration process for resolving payment disputes between OON providers and payers for protected services.
- GlossaryPatient-Provider Dispute ResolutionUnder the No Surprises Act, the process by which uninsured or self-pay patients may dispute a bill that exceeds the Good Faith Estimate by $400 or more.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
- CompliancePECOS Provider Enrollment Verification (2026) — Quarterly ChecklistQuarterly PECOS provider enrollment verification workflow: who to check, the exact lookup steps, the audit log columns, and the revalidation escalation path.
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryACA Marketplace PlanHealth plans sold through the federal or state-based health insurance marketplaces under the Affordable Care Act.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.