Register for the upcoming 2027 Change Provider Trainings

Join our Provider Relations team members for the virtual provider collaboration session(s). Register Now

Show More

No Surprises Act Payment Dispute

If you’re reviewing a claim with one of the below remark codes, it was processed in accordance with the federal No Surprises Act (NSA).

  • Non-migrated members: Remark Code N859 will display.
  • Migrated members: Remark Code(s) N442, N830, N869 or N877 will display.

If you disagree with the payment amount, you may be able to request a review through the NSA payment dispute process.

NSA Payment Dispute Process

Use the steps below to request review of a payment amount under the No Surprises Act.

Step 1: Open negotiation

  • Start the open negotiation process within 30 days of receiving the initial payment
  • Email your request to ProviderContracting@bcbsnd.com
  • Your request must include:
    • Claim number or patient identifier
    • Service code (e.g. CPT code) and date of service
    • Initial payment amount or denial of payment
    • Proposed out-of-network rate
    • Contact information for the initiating party    

Step 2: Independent Dispute Resolution (IDR)

  • If you and BCBSND do not reach an agreement during the open negotiation period, you may be eligible to use the federal IDR process
  • Submit your IDR initiation through the federal process
  • In general, initiation must occur within 4 business days after the end of the open negotiation period
  • Learn more about the federal IDR process on the CMS website

Qualified Payment Amount (QPA)

Payer/Plan certifies that the QPA was determined in compliance with the Federal No Surprises Act and applied for purposes of calculating the recognized amount and member cost sharing.