No Surprises Act (NSA)
Definition
The No Surprises Act is a US federal law, in effect since 2022, that protects patients from many surprise medical bills. It also requires health plans to verify provider directory information at least every 90 days and update it within two business days.
By the Candor Health team
Last reviewed
What does the No Surprises Act require of provider directories?
Section 2799A-5 of the Public Health Service Act, codified at 42 U.S.C. 300gg-115, requires group health plans and health insurance issuers to:
- verify and update provider directory information at least once every 90 days
- update the directory within two business days of receiving a change from a provider
- remove providers whose information can't be verified
- respond to a member asking whether a provider is in network within one business day
What happens if a member relies on a wrong listing?
If a member sees a provider who was listed as in-network but wasn't, the plan generally can't charge more than in-network cost-sharing for that visit.