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  1. Fonteum
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  5. No Surprises Act
Fonteum Data GlossaryRegulatory

No Surprises Act: Definition and Healthcare Context

Full name: No Surprises Act (Division BB of Consolidated Appropriations Act, 2021)

The No Surprises Act (Division BB of the Consolidated Appropriations Act, 2021) is a federal law effective January 1, 2022, that protects patients from unexpected out-of-network bills in specified circumstances. The law limits patient cost-sharing to in-network rates for emergency services, air ambulance services, and non-emergency care at in-network facilities when the patient had no informed choice of provider. It also established an independent dispute resolution (IDR) process for payment disputes between insurers and providers.

Last updated: 2026-06-20Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.

How it’s used

  • CMS NPPES NPI Registry: provider NPI is the linking key used in NSA compliance workflows to match billing providers against insurer network directories.
  • CMS No Surprises Act compliance data: Fonteum scores NSA compliance from federal IDR filing rates and machine-readable-file data published under the statute.
  • 29 CFR §2590.716 and 45 CFR §149.140: the NSA's DOL and HHS implementing regulations define the patient-protection requirements Fonteum's compliance research measures against.

Frequently asked questions

What does the No Surprises Act do?
The No Surprises Act prohibits balance billing patients for out-of-network emergency services, air ambulance transport, and unplanned out-of-network care at in-network facilities.
When did the No Surprises Act take effect?
The No Surprises Act protections took effect on January 1, 2022.
What is the IDR process under the No Surprises Act?
The Independent Dispute Resolution (IDR) process is a federal arbitration mechanism for providers and payers to resolve payment disagreements for NSA-protected services.

Related terms

  • Balance Billing
  • Prior Authorization
  • Machine-Readable File
  • CMS
  • Medicare

Authoritative sources

  • CMS: No Surprises Act overview↗
  • HHS: No Surprises Act consumer protections↗
← All glossary terms

The substrate, by the numbers

9.2Mgraph entitiesProviders, organizations, owners, and facilities
15.7Mlinked identifiersNPIs, CCNs, LEIs and more, resolved to entities
5Mgraph edgesSource-attested relationships between entities
44federal source familiesDistinct CMS, OIG, HRSA, FDA and peer datasets
35dataset pagesCitable, downloadable /data catalog pages
13reproducible studiesEach shipping the SQL behind its figures

Built on the authoritative federal record

The primary sources, named on every page.

These are the federal agencies whose public datasets Fonteum ingests and attributes — the issuing authorities, not customers or partners. Every figure on the site links back to one of them.

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Every figure traces to its federal source.

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Reproducible SQL

Each study ships the exact query behind its figures, run against the cited federal snapshot. Re-run it yourself.

Daily count checks

Published counts are checked against the upstream federal datasets on a daily cadence, with drift logged.

Named medical review

Reviewed by Jennifer Montecillo, MD, medical reviewer. Non-practicing medical reviewer.

Read the full provenance and attestation methodology →

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Reviewed by Jennifer Montecillo, MD, medical reviewer. Non-practicing medical reviewer.

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