No Surprises Act for Healthcare Providers: 2026 Guide

Direct answer: The No Surprises Act protects many patients from unexpected out-of-network bills for emergency care, certain non-emergency services delivered at in-network facilities, and covered air ambulance services. Healthcare providers must follow federal billing, disclosure, notice, consent, and dispute-resolution requirements when these protections apply.

Last reviewed: August 2026. This article provides general operational information and is not legal advice.

What Is the No Surprises Act?

The No Surprises Act is a federal law that took effect on January 1, 2022. It limits balance billing in specified situations where patients may unknowingly receive services from an out-of-network provider or facility.

Before these protections, a patient could visit an in-network hospital but receive a separate and unexpectedly high bill from an out-of-network clinician involved in the treatment. The law created patient protections and a process for resolving certain payment disputes between healthcare providers and health plans.

The requirements affect billing operations, claim submission, patient communications, payment review, denial management, and revenue cycle documentation.

When Do the Patient Protections Generally Apply?

The federal protections generally apply to:

• Emergency services provided by an out-of-network provider or facility.
• Certain non-emergency services delivered by out-of-network providers at participating healthcare facilities.
• Covered air ambulance services provided by an out-of-network air ambulance provider.

When the law applies, the patient’s cost-sharing responsibility is generally calculated using in-network rules. The provider usually cannot bill the patient for the difference between the provider’s charge and the amount paid by the health plan.

Specific requirements depend on the service, facility, health plan, state law, and whether a legally valid notice and consent exception is available. Some services cannot use the notice and consent exception.

Which Health Coverage Is Affected?

The federal requirements generally apply to group health plans and individual health insurance coverage, including certain Federal Employees Health Benefits plans.

Different rules may apply to Medicare, Medicaid, the Indian Health Service, Veterans Affairs healthcare, and TRICARE. Practices should confirm the patient’s coverage and the rules that apply before determining patient responsibility.

Important Provider Responsibilities

1. Identify Protected Services

Billing teams should determine whether a claim involves emergency care, an out-of-network provider at an in-network facility, or covered air ambulance services. This decision affects cost sharing, patient billing, payment disputes, and required communications.

2. Avoid Prohibited Balance Billing

When the No Surprises Act applies, providers should not send the patient a bill for an amount prohibited by federal or applicable state law. Accounts should be reviewed carefully before statements or collection notices are issued.

3. Provide Required Disclosures

Providers and facilities may be required to inform patients about their rights and protections against surprise medical bills. The disclosure should be displayed or delivered in the manner required by current federal and state rules.

4. Use Notice and Consent Carefully

A notice and consent process may be available for limited types of non-emergency services. It is not available for every service or provider category, and a patient should not be pressured to waive legal protections.

Because the requirements are detailed, practices should use current government forms and obtain legal or compliance guidance when necessary.

5. Provide Good Faith Estimates When Required

Providers generally must give uninsured or self-pay individuals a good faith estimate of expected charges when the federal requirements apply. A patient may be eligible to use the patient-provider dispute resolution process if the final bill is substantially higher than the estimate.

6. Maintain Complete Documentation

Practices should retain eligibility results, claim records, remittance information, notices, consent documents, correspondence, negotiation records, and supporting clinical or operational documentation.

Consistent records can reduce delays and help support an eligible payment dispute.

How the Federal Independent Dispute Resolution Process Works

The Federal Independent Dispute Resolution process, commonly called Federal IDR, allows eligible providers, facilities, air ambulance providers, health plans, and insurers to resolve certain out-of-network payment disputes.

1. Review the initial payment or denial: Confirm that the claim and service are eligible for the federal process.
2. Start open negotiation: The parties generally enter a 30-business-day negotiation period and attempt to agree on an out-of-network payment amount.
3. Initiate Federal IDR when necessary: If negotiation does not produce an agreement, an eligible party may initiate the dispute within the applicable deadline.
4. Select a certified IDR entity: The parties may agree on a certified entity, or one may be assigned under the federal process.
5. Submit offers and supporting information: Each party provides its proposed payment amount and permitted supporting information.
6. Complete payment and documentation: The parties follow the determination and payment requirements that apply to the dispute.

Deadlines are important. A missed negotiation, initiation, submission, or payment deadline can affect the outcome of a dispute.

What Changed in 2026?

Federal agencies finalized additional operational rules in 2026 intended to improve the Federal IDR process, increase transparency, and reduce administrative friction.

Important developments include:

• Additional information that plans and insurers must provide with an initial payment or notice of denial.
• Expanded use of claim adjustment reason codes and remittance advice remark codes.
• Updated procedures for open negotiation, dispute initiation, eligibility review, and IDR entity selection.
• New requirements supporting payer registration and use of the Federal IDR technology system.
• Operational rules addressing batched disputes, bundled payments, withdrawals, and certain extensions.
• A reduction of the administrative fee from $115 to $15 per party for disputes initiated on or after June 11, 2026.

Not every 2026 provision became applicable on the same date. Some requirements depend on the availability of new Federal IDR Gateway functions. Billing teams should check the current federal implementation timeline instead of relying on an older procedure manual.

No Surprises Act Checklist for Medical Practices

• Verify network status and patient coverage before billing.
• Identify claims that may qualify for federal or state surprise-billing protections.
• Keep patient cost sharing consistent with applicable in-network requirements.
• Review accounts before sending patient statements or collection notices.
• Use current disclosure, notice, consent, and good faith estimate forms.
• Document the date each negotiation or dispute deadline begins.
• Save remittance advice, denial codes, payment calculations, and correspondence.
• Train scheduling, front-desk, clinical, billing, and collection personnel.
• Review state surprise-billing laws because they may provide additional protections.
• Periodically update workflows when CMS publishes new guidance.

How Medical Billing Support Can Help

A structured billing process can help practices identify affected claims, review payment and denial information, maintain supporting documentation, and track time-sensitive follow-up tasks.

Medical Billing and Transcription supports healthcare organizations with medical billing, accounts receivable follow-up, denial management, prior authorization, credentialing, and revenue cycle services. Services are tailored to the practice’s workflow and do not replace legal or compliance advice.

Contact our team to discuss your billing workflow and revenue cycle needs.

Frequently Asked Questions

Does the No Surprises Act apply to every medical bill?

No. It applies to specified services and coverage situations. The patient’s plan, the provider’s network status, the care setting, state law, and the type of service can all affect whether the federal protections apply.

Can an out-of-network provider ever ask a patient to waive these protections?

A notice and consent exception may be available for certain non-emergency services, but it is restricted and does not apply in every situation. Providers should use current official forms and verify that all timing and consent requirements are satisfied.

How long is the Federal IDR open negotiation period?

The parties generally have a 30-business-day open negotiation period before an eligible dispute can proceed to Federal IDR.

What is a good faith estimate?

A good faith estimate describes the expected charges for scheduled or requested care provided to an uninsured or self-pay individual. Federal rules specify when it must be provided and what information it should contain.

Do state surprise-billing laws still matter?

Yes. State laws may apply to some plans, providers, facilities, or services and may offer protections beyond the federal requirements. Practices should evaluate both federal and applicable state rules.

Is the 2026 Federal IDR administrative fee still $115?

No. CMS states that the administrative fee was reduced to $15 per party for disputes initiated on or after June 11, 2026.

Official Resources

• CMS No Surprises Act overview
• CMS Federal Independent Dispute Resolution information
• CMS provider requirements and resources
• CMS 2026 Federal IDR implementation timeline

Disclaimer: This information is provided for general educational and operational purposes. It is not legal, regulatory, coding, or reimbursement advice. Requirements can vary by service, payer, plan, state, and circumstance. Consult qualified legal or compliance professionals regarding your organization’s obligations.