No Surprises Act patient notice checklist

A session-only checklist for confirming NSA-required patient notices and protections before billing out-of-network charges.

Updated July 20, 2026

Use this session-only checklist to confirm No Surprises Act (NSA) protections and notice requirements before billing out-of-network charges. The applicable payer, facility, and patient circumstances remain the controlling sources — this tool does not determine whether a specific charge is protected.

Progress

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Confirm whether the service was emergency or non-emergencyEmergency services from an out-of-network provider or facility trigger NSA protections at the point of stabilization; non-emergency services at an in-network facility trigger different notice rules.Verify whether the provider is out-of-network at an in-network facilityConfirm the billing provider's network status against the facility's contracted plan; NSA notice and balance-billing limits apply when an out-of-network provider works at an in-network facility.Confirm the required NSA notice was providedVerify that the applicable Notice and Consent document, or the standard disclosure notice for out-of-network services, was given in the form and timeframe the NSA requires.Verify a Good Faith Estimate was provided for self-pay patientsFor uninsured or self-pay patients scheduling services, confirm a GFE was issued within the required timeframe before the scheduled service.Check applicable state law that supplements the NSASome states impose additional balance-billing limits, network requirements, or disclosure rules; confirm whether state law applies on top of the federal floor.Confirm eligibility for the federal Independent Dispute Resolution processFor disputed out-of-network payment amounts, verify the dispute is eligible for the federal IDR process and that the qualifying payment amount is documented.Document patient consent where balance billing is permittedWhere notice and consent allow balance billing, confirm the consent form meets NSA content standards and was signed within the required window before service.Verify no balance billing in NSA-protected situationsConfirm that emergency services, ancillary services at in-network facilities, and related care are not balance billed beyond the in-network cost-share amount.

Use this checklist safely

This tool does not provide legal advice and stores no selections. Keep claim-specific information in the approved secured system.

Related Knowledge

What Is the No Surprises Act?
Overview of NSA balance-billing protections and notice requirements.
Good Faith Estimates for Self-Pay Patients

Related Knowledge

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