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No Surprises Act Disclosure Generator

Create the required public-facing plain-language summary for your patients based exactly on the model CMS notice. Protect your practice in seconds.

Compliance Grade

Facility Details

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Good Faith Estimate (GFE)

Methodology & Legal Guidance

The No Surprises Act (NSA) establishes federal protections against surprise medical billing. Among its requirements, healthcare providers and facilities must provide a publicly available, plain-language disclosure explaining these rights to patients.

This generator populates the official Model Disclosure Notice developed by the Departments of Health and Human Services (HHS), Labor, and Treasury. It ensures your public-facing statement aligns precisely with the approved regulatory language regarding "balance billing" protections and Good Faith Estimate (GFE) rights for self-pay patients.

Official Resources

Important Legal Disclaimer

This generator produces draft documents using public, government-issued model language. It is an educational and reference tool only. Custody & Agency is a technology consultancy, not a law firm, and does not provide legal advice, compliance certification, or formal document approval. State laws regarding surprise billing may supersede federal protections; this tool does not automatically inject state-specific caveats. The generated output must be thoroughly reviewed, customized, and approved by your organization's qualified legal counsel and/or compliance officer before publication or distribution. Final responsibility and liability remain solely with your organization.

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