No Surprises Act Payment Dispute

If you’re reviewing a claim with Remark Code N859, it was processed in accordance with the federal No Surprises Act (NSA). 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.