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

OMB 0938-1401

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10780 Information Related to Qualifying Payment Amount to be Shared with Nonparticipating Providers or Nonparticipating Emergency Facilities Form and Instruction
Information Related to Qualifying Payment Amount to be Shared with Nonparticipating Providers or Nonparticipating Emergency Facilities Form and Instruction
Plan and Issuer Disclosure on Patient Protections Against Balance Billing Other-Model Notice