NSA for Non-Par Providers

Ohio’s surprise billing law and the Federal No Suprises Act (NSA) were created to protect members from receiving and paying surprise medical bills above their in-network rate from health care providers for emergency care or, in certain circumstances, unanticipated out-of-network care.

In accordance with Ohio Administrative Code 3901-8-17, a provider, facility, emergency facility, or ambulance may choose to negotiate in lieu of accepting the health plan’s reimbursement for unanticipated out of network care. If choosing to negotiate, the provider, facility, emergency facility, or ambulance must notify the health plan within thirty business days of receiving reimbursement for unanticipated out of network care.

To request negotiation of reimbursement for unanticipated out of network care, please complete the following and include a copy of the related Explanation of Payment (EOP).