Knowledge Center

The Advanced Explanation of Benefits (AEOB) is a key component of the No Surprises Act (NSA) — legislation enacted under the Consolidated Appropriations Act of 2021 and effective January 1, 2022.

While the broader Act protects patients from unexpected medical bills for emergency and most non-emergency services delivered by out-of-network providers, the AEOB provision adds a new layer of transparency and administrative responsibility for both insurers and providers.

Under this requirement, health plans and insurers must issue an AEOB to covered patients before services are rendered, using information provided in a Good Faith Estimate (GFE) submitted by the treating provider or facility.

Although this rule is not yet active, implementation is expected once the necessary technical infrastructure and regulations are finalized. Additional federal guidance will define operational details and timelines.

What the AEOB Must Include

Each Advanced Explanation of Benefits will contain specific information that outlines how a patient’s coverage applies to their scheduled service:

• The network status of the provider or facility.
• The contracted rate, if the provider is in-network.
• Information directing patients to in-network alternatives.
• The Good Faith Estimate of billed amounts submitted by the provider.
• The estimated amount payable by the health plan.
• The patient’s expected cost-sharing amount.
• Deductible and out-of-pocket totals already met.
• Whether the service requires prior authorization or is subject to medical-management protocols.
• A disclaimer confirming that all figures are estimates.
• Any additional information the plan administrator determines appropriate under the Act.

Timing Requirements

When the rule becomes active, insurers will be required to deliver AEOBs within strict timeframes:

• For services scheduled 3–9 business days before the appointment, the AEOB must be sent within 1 business day of receiving the provider’s notification.
• For services scheduled 10 or more business days in advance, the AEOB must be delivered within 3 business days of notice.
• Patients will be able to choose electronic or mail delivery, and regulators will clarify defaults and mailing timelines if no preference is stated.

These timelines are designed to ensure patients receive coverage and cost information early enough to make informed care decisions.

What This Means for Independent Surgeons

For independent surgeons, the AEOB process introduces another layer of pre-service coordination between the practice and the payer. Once implemented, accurate and timely submission of Good Faith Estimates will be essential to avoid administrative delays or payment complications.

At CHRMS, we help out-of-network surgeons prepare for these evolving requirements. Our team stays current with all No Surprises Act developments, ensuring your practice understands not only what must be submitted, but how to align workflows, documentation, and communication with payors once AEOB implementation begins.

CHRMS: Guiding Surgeons Through New Compliance Demands

The No Surprises Act and its AEOB mandate add time, cost, and operational complexity for providers and insurers alike. CHRMS helps independent surgeons manage these changes strategically minimizing disruption, maintaining compliance, and protecting the integrity of your revenue cycle.

Need clarity on how AEOB requirements may affect your practice? CHRMS can help you interpret the rules, prepare your systems, and stay ahead of upcoming implementation deadlines.