Plan and Issuer Disclosure on Patient Protections Against Balance Billing

Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in

CMS-10780 - Model Disclosure Notice Regarding Patient Protections Against Surprise Billing

Plan and Issuer Disclosure on Patient Protections Against Balance Billing

OMB: 0938-1401

Document [pdf]
Download: pdf | pdf
File Typeapplication/pdf
File TitleModel Disclosure Notice Regarding Patient Protections Against Surprise Billing Instructions for Providers and Facilities
AuthorCMS/CCIIO
File Modified2021-06-28
File Created2021-06-28

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