Sources

Every load-bearing claim on this site cites a primary source. We define primary sources as: congress.gov, uscode.house.gov, Cornell LII, ecfr.gov, cms.gov, nsa-idr.cms.gov, aspe.hhs.gov, and state DOI / state-legislature primary URLs. Below is the manifest.

Federal NSA primary sources

Public Law 116-260 (CAA 2021), Title I of Division BB — https://www.congress.gov/bill/116th-congress/house-bill/133
Consolidated Appropriations Act, 2021. Title I of Division BB is the 'No Surprises Act' (NSA), signed 2020-12-27. Subtitles: A (Patient Protection — balance-billing limits + IDR), B (Information for Patients — good-faith estimate), C (Air Ambulance), D (Other Provisions). Most patient protections took effect 2022-01-01.
Last verified: 2026-05-11
PHSA §2799A-1 (42 U.S.C. §300gg-111) — https://www.law.cornell.edu/uscode/text/42/300gg-111
Patient protections from out-of-network balance billing for emergency services and certain non-emergency services at in-network facilities. In-network cost-sharing requirement.
Last verified: 2026-05-11
PHSA §2799A-2 (42 U.S.C. §300gg-112) — https://www.law.cornell.edu/uscode/text/42/300gg-112
Independent Dispute Resolution (IDR) process between providers and group health plans / health insurance issuers — open-negotiation period followed by certified-IDR-entity baseball-style arbitration.
Last verified: 2026-05-11
PHSA §2799A-5 (42 U.S.C. §300gg-115) — https://www.law.cornell.edu/uscode/text/42/300gg-115
Air-ambulance protections under NSA. Federal preemption of state regulation of air-ambulance services under the Airline Deregulation Act (ADA) — NSA is the federal patient-protection layer.
Last verified: 2026-05-11
PHSA §2799B-1 (42 U.S.C. §300gg-131) — https://www.law.cornell.edu/uscode/text/42/300gg-131
Provider good-faith-estimate (GFE) obligations for self-pay / uninsured patients. Underpins the Patient-Provider Dispute Resolution (PPDR) pathway when actual bill exceeds GFE.
Last verified: 2026-05-11
PHSA §2799B-7 (42 U.S.C. §300gg-137) — https://www.law.cornell.edu/uscode/text/42/300gg-137
Patient-Provider Dispute Resolution (PPDR) process for uninsured / self-pay patients when actual charges exceed GFE by the threshold amount. Operationalized in 45 CFR Part 149 Subpart F.
Last verified: 2026-05-11
45 CFR Part 149 — https://www.ecfr.gov/current/title-45/part-149
HHS implementing regulations for the No Surprises Act. Subparts: B (preventing surprise billing), C (good-faith estimate for uninsured), D (additional protections), E (Federal IDR for provider/plan), F (Patient-Provider Dispute Resolution).
Last verified: 2026-05-11
45 CFR §149.510 — https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-149/subpart-E/section-149.510
Federal IDR process for provider/plan disputes — open-negotiation period (30 business days) and certified-IDR-entity initiation window (4 business days after open-negotiation expiry). Baseball-style arbitration: each party submits an offer; the IDRE selects one.
Last verified: 2026-05-11
45 CFR §149.620 — https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-149/subpart-F/section-149.620
Patient-Provider Dispute Resolution (PPDR) eligibility for uninsured / self-pay patients. Threshold: actual billed charges exceed the good-faith estimate by at least $400 (the GFE-vs-actual delta trigger). Filing window: 120 calendar days from receipt of bill. $25 administrative fee, payable by the patient.
Last verified: 2026-05-11
CMS — No Surprises Act landing — https://www.cms.gov/nosurprises
Primary CMS hub for NSA patient + provider resources. Consumer help desk: 1-800-985-3059.
Last verified: 2026-05-11
CMS — IDR / payment disputes (providers and plans) — https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans
CMS guidance on Federal IDR process between providers and health plans — open-negotiation rules, IDRE selection, batched-claims rules.
Last verified: 2026-05-11
CMS — PPDR for uninsured / self-pay patients — https://www.cms.gov/nosurprises/consumers
CMS consumer-facing guidance on Patient-Provider Dispute Resolution when self-pay billed charges exceed the good-faith estimate.
Last verified: 2026-05-11
Federal IDR portal — nsa-idr.cms.gov — https://nsa-idr.cms.gov/
CMS-administered portal where providers and plans file Federal IDR initiations and certified IDR entities resolve disputes. Patients do NOT file Federal IDR here — provider/plan only. Patient complaints route through 1-800-985-3059.
Last verified: 2026-05-11
CMS No Surprises Help Desk — 1-800-985-3059 — https://www.cms.gov/nosurprises/consumers/file-complaint
Free CMS consumer NSA complaint pathway. The unconditionally-surfaced first action for any balance-billed insured patient who believes the bill violates NSA. 90-day filing window from the date the patient knew or should have known of the violation.
Last verified: 2026-05-11
HHS ASPE — No Surprises Act evaluation reports — https://aspe.hhs.gov/no-surprises-act
HHS Office of the Assistant Secretary for Planning and Evaluation reports on NSA implementation outcomes, IDR data, and rule effects.
Last verified: 2026-05-11
CRS Report R48738 — NSA IDR Process Data Analysis — https://www.congress.gov/crs-product/R48738
Congressional Research Service analysis of Federal IDR data. Source for IDR-dispute-volume and provider-win-rate figures referenced in research. Re-verify report date and exact numbers when citing.
Last verified: 2026-05-11

State DOI consumer-protection entry points

The 50 state DOI consumer-protection pages and DC. Each is the primary entry point for filing an NSA-related complaint on state-regulated (fully-insured) plans. Self-funded ERISA plans escape state jurisdiction; route those to DOL/EBSA.

Supplementary sources (not load-bearing)

The following are useful background reading but are NOT the citation we hang any answer on. Use them to cross-check, not as primary authority:

Informational, not medical, legal, or insurance advice. Consult a healthcare-billing attorney or patient-advocate before acting on a No Surprises Act dispute. The free CMS NSA complaint pathway is 1-800-985-3059.