Section title: Requests for Interpretation
No Surprise Act/State OON Medical Emergency Notice and Consent Notification to Payers (837)

How should noncontracting providers advise payers that the required NSA notice and consent has been obtained/not obtained from the patient in the 837?


Under the No Surprise Act, noncontracting providers must get notice and consent to balance bill. Emergency and other hospital based providers are prohibited from getting consent to balance bill. This may also apply under some comparable state OON Medical Emergency regulations.

To ensure clear communication with payers for accurate cost-sharing responsibility (provider verses member liability), the provider is obligated to communicate that they have obtained the required consent or that consent was not obtained.

RFI Response

The PWK segment in the 2300 Claim Information or 2400 Line Supplemental Information loops is used to relay that a paper or electronic attachment will follow the claim. The PWK at the Claim Level is used when the supplemental information is related to the entire claim, and the PWK at the Line Level is used when the supplemental information is only related to a particular line. The PWK at the line level does not override the PWK at the claim level, it is additional information pertaining specifically to that line. The CK qualifier in the PWK01 indicates the attachment is a Consent form(s). The PWK02 reports how the attachment will be sent.

See related RFI # 1074.