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No Surprises Act

PAYMENT DISPUTES UNDER THE NO SURPRISES ACT

 

The No Surprises Act, which was effective January 1, 2022, protects patients from surprise balance billing for the following types of claims:

  • Emergency services at out-of-network hospitals and free-standing emergency facilities
  • Out-of-network health care professionals at in-network facilities
  • Out-of-network air ambulance carriers

The law applies to those UMWA Funds’ beneficiaries in the 1993 Benefit Plan who are not enrolled in Medicare.  You can find your patient’s Benefit Plan on the Funds health card.

Non-contracted providers may initiate a payment dispute under the No Surprises Act by emailing the required documentation to us at:  [email protected] or by calling 888-865-5290.

Please provide the beneficiary’s name, UMID # and Trans (claim) #.  In addition, you must include the U.S. Federal Open Negotiation Notice with at least the following information:

  • The date(s) of service
  • The procedure code of the service in dispute
  • The initial payment amount or notice of denial of payment, as applicable
  • An offer for the out-of-network rate
  • Contact information of the party sending the open negotiation notice.

The required Open Negotiation Notice can be viewed and printed here:

Open Negotiation Standard Notice