When an uninsured or self-pay individual initiates patient-provider dispute resolution (within 120 calendar days of the first bill whose total billed charges for the provider or facility are at least $400 above that provider's expected charges in the estimate) the provider or facility must not move the disputed bill into collection or threaten to, must cease collection if it has begun, must suspend late fees until the process concludes, and must not take or threaten retributive action against the individual. Once the Selected Dispute Resolution entity confirms eligibility the provider or facility must supply within 10 business days the copy of the estimate, the bill, and the documentation showing the difference between the billed charge and the estimate reflects a medically necessary item or service based on unforeseen circumstances; if the parties settle (financial assistance, a lower amount or payment in full) before the determination the provider or facility must notify the SDR entity within 3 business days with the settlement amount, date and documentation of agreement.
The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.