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Federal Law

Title 29-Labor-Chapter 18-Subchapter I-Part 7-Subpart B. Other requirements

12/14/2021 29 USC Sections 1185e and 1185f

Preventing surprise medical bills; Ending surprise air ambulance bills

OON-Payment Issues, Prompt Payment Deadlines
Ama Policy

Universal Explanation of Benefits Forms H-390.865

10/15/2019
Fee Schedules, Prompt Payment Deadlines
Federal Law

Title 42-The Public Health And Welfare-Chapter 6A-Subchapter XXV-Part D. Additional Coverage Requirements

12/15/2021 42 USC Sections 300gg-111 and 300gg-112

Preventing surprise medical bills; Ending surprise air ambulance bills

OON-Payment Issues, Prompt Payment Deadlines
Federal Law

Title 26-Internal Revenue-Chapter I-Subchapter D-Part 54. Pension Excise Taxes

08/30/2022 26 CFR Sections 54.9816-1T, 54.9816-2T, 54.9816-3T, 54.9816-4T, 54.9816-5T, 54.9816-6, 54.9816-6T, 54.9816-7T, 54.9816-8T, 54.9817-1T, 54.9817-2T

Basis and scope (temporary); Applicability (temporary); Definitions (temporary); Preventing surprise medical bills for emergency services (temporary); Preventing surprise medical bills for non-emergency services performed by nonparticipating providers at certain participating facilities (temporary); Methodology for calculating
qualifying payment amount, Methodology for calculating qualifying payment amount (temporary); Complaints process for surprise medical bills regarding group health plans (temporary); Independent dispute resolution process, Independent dispute resolution process (temporary); Preventing surprise medical bills for air ambulance services (temporary); Independent dispute resolution process for air ambulance services (temporary)

OON-Payment Issues, Prompt Payment Deadlines
Federal Law

Title 29-Labor-Subtitle B-Chapter XXV-Subchapter L-Part 2590-Subpart D. Surprise Billing and Transparency Requirements

12/16/2021 29 CFR Sections 2590.716-1, 2590.716-2, 2590.716-3, 2590.716-4, 2590.716-5, 2590.716-6, 2590.716-7, 2590.716-8, 2590.717-1, and 2590.717-2

Basis and scope; Applicability; Definitions; Preventing surprise medical bills for emergency services; Preventing surprise medical bills for non-emergency services performed by nonparticipating providers at certain participating facilities; Methodology for calculating qualifying payment amount; Complaints process for surprise medical bills regarding group health plans and group health insurance coverage; Independent dispute resolution process; Preventing surprise medical bills for air ambulance services; Independent dispute resolution process for air ambulance services

OON-Payment Issues, Prompt Payment Deadlines
Federal Law

Title 45-Public Welfare-Subtitle A-Subchapter B-Part 149. Surprise Billing and Transparency Requirements

12/16/2021 45 CFR Sections 149.10, 149.20, 149.30, 149.110, 149.120, 149.130, 149.140, 149.150, 149.410, 149.420, 149.430, 149.440, 149.450, 149.510, and 149.520

Basis and scope; Applicability; Definitions; Preventing surprise medical bills for emergency services; Preventing surprise medical bills for non-emergency services performed by nonparticipating providers at certain participating facilities; Preventing surprise medical bills for air ambulance services; Methodology for calculating qualifying payment amount; Complaints process for surprise medical bills regarding group health plans and group and individual health insurance coverage; Balance billing in cases of emergency services; Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating health care facilities; Provider and facility disclosure requirements regarding patient protections against balance billing; Balance billing in cases of air ambulance services; Complaint process for balance billing regarding providers and facilities; Independent dispute resolution process; Independent dispute resolution process for air ambulance services.

OON-Payment Issues, Prompt Payment Deadlines
Ama Policy

Retroactive Assignment of Patients by Managed Care Entities H-285.947

03/13/2019
Prompt Payment Deadlines, Risk—Physicians Taking
Ama Policy

Inappropriate Bundling of Medical Services by Third Party Payers D-70.983

12/30/2021
Payment Edits, Prompt Payment Deadlines
Ama Policy

Required Timely Reimbursements by all Health Insurers H-190.981

03/13/2019
Prompt Payment Deadlines