US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.140(d)-(f): Disclose the QPA and its basis with each initial payment or denial, provide the further information a provider requests within 10 business days, and submit to audit

What does 149.140(d)-(f) require?

With each initial payment or notice of denial of payment for an item or service subject to the surprise billing rules the plan or issuer must disclose in writing the QPA for each item or service, a statement that the QPA is the recognized amount for cost sharing (where it is) and that each party may start open negotiation and then the Federal IDR process, the contact information for open negotiation, and, where a claim was downcoded, a statement of that fact with the original and altered codes and the QPA that would have applied. On request the plan must within 10 business days tell the provider whether the QPA includes contracted rates not on a fee-for-service basis, the related service code used for a new code, the database used, and the geographic region. Plans and issuers must comply with audits of the QPA methodology by the Secretary or a State.