Medical Billing Terms N-O: No Surprises Act, NCCI Edits and NPI

The No Surprises Act is a federal law that limits surprise out-of-network bills and requires good faith estimates for some patients. This page defines it with the N terms from NAACOS to NPPES, including NCCI edits, NPI, NQTL and net collection rate. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms N-O: No Surprises Act - MCM South Medical Billing Service, LLC

Glossary pages

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Pages in N-O

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On this page (24 terms)

NAACOS
National Coverage Determination (NCD)
National Patient Safety Goals (NPSG)
NCCI Edits
NCPDP
NCQA
Net Collection Rate (NCR)
Netsmart
Network Adequacy
Network Rental (PPO Repricing)
Network Termination
Neuropsychological Testing
New Patient (CPT)
NextGen
No Surprises Act
Non-Facility Rate
Non-Participating Provider (Non-PAR)
Non-Quantitative Treatment Limitation (NQTL)
North Carolina Medicaid Managed Care
No-Show Fee
No-Show Rate
Notice of Privacy Practices (NPP)
NPI (National Provider Identifier)
NPPES

How to use these No Surprises Act definitions

Use this page as a quick reference for No Surprises Act, from NAACOS to NPPES. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm No Surprises Act details with the payer before you bill.

Checklist: put the no surprises act definitions to work

Check the no surprises act entries above before you send a claim that depends on them.
Share this no surprises act page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions no surprises act, find the matching entry and note the date you checked it.
Keep your no surprises act notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies no surprises act before you change a workflow.

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NAACOS

General (all payers)

Also called National Association of ACOs

Definition: A national association of accountable care organizations and value-based care participants.
Why it matters: Resource on ACO and value-based payment.
Illustrative example: A practice reads NAACOS resources on ACO participation.

Reference sourceNAACOSchecked 10/9/26

CategoriesValue-Based Care Terminology

National Coverage Determination (NCD)

Medicare

Also called NCD

Definition: A CMS decision about whether Medicare covers a service nationwide.
Why it matters: Applies across all MACs.
Illustrative example: An NCD sets nationwide coverage for a treatment.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms

National Patient Safety Goals (NPSG)

General (all payers)

Also called Joint Commission NPSG; NPSGs; patient safety goals

Definition: National Patient Safety Goals are requirements the Joint Commission has used to address specific patient safety problems in accredited organizations. Goals differ by accreditation program.
Why it matters: Accredited behavioral health organizations track the goals for their program, such as suicide risk reduction. Joint Commission announced National Performance Goals in 2025 for hospital and critical access hospital programs starting in 2026, so check what applies to your program.
Illustrative example: An accredited outpatient behavioral health organization checks its program's current goals during its survey preparation.

Reference sourceThe Joint Commission The Joint Commission, NPSG suicide risk FAQ (2/1/2022)checked 10/9/26

CategoriesQuality & Risk Adjustment Terms Audits & Compliance

NCCI Edits

General (all payers)

Also called National Correct Coding Initiative; NCCI; procedure-to-procedure edits; MUE

Definition: CMS edits that prevent improper payment when certain codes are billed together or in excess of medically unlikely units. Many commercial payers use similar edits.
Why it matters: Explains many bundling denials and the correct use of modifiers.
Illustrative example: A code pair is bundled under an NCCI edit unless an appropriate modifier applies.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS National Correct Coding Initiative (NCCI)checked 10/9/26

CategoriesClaims Processing Audits & Compliance

NCPDP

General (all payers)

Also called National Council for Prescription Drug Programs

Definition: A standards organization for pharmacy transactions, including e-prescribing standards.
Why it matters: Governs prescription data exchange used by psychiatric prescribers.
Illustrative example: An EHR sends e-prescriptions using NCPDP standards.

Related termsEPCS E-Prescribing (eRx)

Reference sourceNCPDPchecked 10/9/26

CategoriesEDI & Clearinghouse Terms EHR & Healthcare Technology Terms

NCQA

General (all payers)

Also called National Committee for Quality Assurance

Definition: A private nonprofit that sets quality standards, accredits health plans and credentialing operations, and publishes the HEDIS measures.
Why it matters: Many payers follow NCQA credentialing standards, which is why they require primary source verification.
Illustrative example: A health plan cites NCQA accreditation when explaining its credentialing steps.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment Quality & Risk Adjustment Terms

Net Collection Rate (NCR)

General (all payers)

Also called NCR; net collection percentage

Definition: The percentage of collectible revenue, after contractual adjustments, that a practice actually collects.
Why it matters: A core measure of billing performance.
Illustrative example: A practice collects $9,600 of $10,000 in collectible revenue: 96%.

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

Netsmart

General (all payers)

Also called Netsmart Technologies; myAvatar

Definition: A vendor of software for behavioral health, human services, and post-acute care, used by community providers. Listed for reference; not an endorsement or partnership.
Why it matters: Common among larger behavioral health and community organizations.
Illustrative example: A community clinic uses Netsmart for EHR and billing.

Reference sourceNetsmartchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Network Adequacy

General (all payers)

Also called network adequacy standards; access standards

Definition: Standards regulators and accreditors set for how many providers of each type, within what distance and time, a health plan must have available.
Why it matters: Underlies gap exceptions and regulatory attention on behavioral health access.
Illustrative example: A regulator reviews whether a plan has enough in-network therapists in a county.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesContracting & Network Management

Network Rental (PPO Repricing)

General (all payers)

Also called network rental; PPO repricing; network access fee; repricing

Definition: A practice in which a third-party network's discounted rates are applied to claims from plans that rent that network.
Why it matters: Explains why a claim may be paid at a rate different from a direct contract, and why the contract and the remittance both need a close read.
Illustrative example: An ERA shows a repricing note for a rented network.

Related termsContracted Rate Underpayment

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms Payment & Reimbursement

Network Termination

General (all payers)

Also called provider termination; contract termination

Definition: The end of a provider's participation in a payer's network, initiated by either side under contract terms.
Why it matters: Termination changes reimbursement and can require patient notice and continuity-of-care handling.
Illustrative example: A payer terminates a therapist for failure to recredential.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesContracting & Network Management Credentialing & Enrollment

Neuropsychological Testing

General (all payers)

Also called neuropsych testing; 96132; 96133; 96137

Definition: Testing that assesses brain-behavior relationships, with separate evaluation and administration codes.
Why it matters: Requires careful time documentation and often authorization.
Illustrative example: A neuropsychologist documents testing hours and interpretation time.

Related termsPsychological Testing CPT Code

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesBehavioral Health Specific Terms Claims Processing

New Patient (CPT)

General (all payers)

Also called CPT new patient; new patient definition; three year rule

Definition: Under CPT, a new patient is one who has not received professional services from the physician or another physician of the exact same specialty and subspecialty in the same group practice within the past three years.
Why it matters: New patient status decides whether you use 99202 to 99205 or 99211 to 99215. The definition is about the group, so an intake for a returning patient may be established.
Illustrative example: A patient last seen by a group psychiatrist four years ago is a new patient to the group.

Reference sourceAMA, CPT code set overviewchecked 10/9/26

CategoriesClaims Processing

NextGen

General (all payers)

Also called NextGen Healthcare

Definition: A vendor of EHR and practice management software for ambulatory practices. Listed for reference; not an endorsement or partnership.
Why it matters: Used in specialty and behavioral health settings.
Illustrative example: A group uses NextGen for its EHR.

Reference sourceNextGen Healthcarechecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

No Surprises Act

General (all payers)

Also called NSA; surprise billing law

Definition: A federal law that limits surprise out-of-network bills in certain situations and requires good faith estimates for some uninsured or self-pay patients.
Why it matters: Sets rules on estimates for self-pay behavioral health patients.
Illustrative example: A practice provides a good faith estimate to a self-pay client before the first session.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS No Surprises Actchecked 10/9/26

CategoriesAudits & Compliance Patient Financial Responsibility Terms

Non-Facility Rate

General (all payers)

Also called non-facility payment rate; office setting rate

Definition: The Medicare payment level used when the service is delivered in a non-facility setting such as a practitioner's office.
Why it matters: Some payers apply it to telehealth under certain conditions.
Illustrative example: An office visit is paid at the non-facility rate.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Physician Fee Schedulechecked 10/9/26

CategoriesPayment & Reimbursement Claims Processing

Non-Participating Provider (Non-PAR)

General (all payers)

Also called non-par; out-of-network provider; OON provider

Definition: A provider who has no contract with a payer. Claims are paid, if the plan has out-of-network benefits, under different rules and reimbursement.
Why it matters: Determines whether the patient can be billed the difference between charge and allowed amount.
Illustrative example: A therapist without a contract gives the patient a superbill to submit for out-of-network reimbursement.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesContracting & Network Management

Non-Quantitative Treatment Limitation (NQTL)

General (all payers)

Also called NQTL; nonquantitative treatment limit

Definition: A parity term for a limit on the scope or duration of benefits that is not expressed numerically, such as prior authorization, step therapy, or network admission standards.
Why it matters: Plans must be able to show NQTLs for mental health are comparable to those for medical benefits.
Illustrative example: A payer's credentialing standards are examined as an NQTL.

Reference sourceU.S. Department of Labor, EBSA CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance Behavioral Health Specific Terms

North Carolina Medicaid Managed Care

Medicaid (state-specific)

Also called NC Medicaid; Standard Plans; Tailored Plans

Definition: North Carolina's Medicaid managed care program, which includes standard plans and specialized plans for people with significant behavioral health needs.
Why it matters: North Carolina is a served state; plan types affect where behavioral health claims go.
Illustrative example: A provider checks whether a member is in a standard or tailored plan before billing.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms BCBS, UHC & Commercial Payer Terms

No-Show Fee

General (all payers)

Also called late cancellation fee; missed appointment fee

Definition: A fee a practice charges a patient for a missed or late-canceled appointment, which insurance typically does not pay.
Why it matters: Payer contracts may limit charging insured patients, so policies must be written and consistent.
Illustrative example: A client is charged a fee under a signed policy.

Related termsPatient Statement Card on File

Reference sourceHFMAchecked 10/9/26

CategoriesPatient Financial Responsibility Terms

No-Show Rate

General (all payers)

Also called missed appointment rate

Definition: The percentage of scheduled appointments that patients miss without notice.
Why it matters: Directly affects revenue and schedule use.
Illustrative example: A practice sees 6% no-shows.

Related termsCancellation Rate No-Show Fee

Reference sourceMGMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

Notice of Privacy Practices (NPP)

General (all payers)

Also called NPP; HIPAA notice; privacy notice

Definition: A notice of privacy practices is the document a covered entity gives patients that explains how it may use and share their health information and describes their rights under HIPAA.
Why it matters: Providers with a direct treatment relationship generally give the notice at the first service and post it. Keep proof that it was provided.
Illustrative example: A practice hands new patients the notice at intake and keeps the signed acknowledgment.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance

NPI (National Provider Identifier)

General (all payers)

Also called NPI number; National Provider Identifier

Definition: A unique 10-digit identification number assigned to health care providers under HIPAA and used on all standard transactions.
Why it matters: Every claim must carry the correct NPI; the wrong one causes rejections.
Illustrative example: A therapist uses their individual NPI on claims; a group uses a separate group NPI.

Reference sourceCMS (Centers for Medicare & Medicaid Services)NPPES (NPI Registry)checked 10/9/26

CategoriesProvider Data Management Terms Credentialing & Enrollment

NPPES

General (all payers)

Also called National Plan and Provider Enumeration System; NPI registry

Definition: The CMS system where providers apply for an NPI and keep their NPI record up to date.
Why it matters: Outdated NPPES data (address, taxonomy) can cause claim edits and directory errors.
Illustrative example: A practice moves offices and updates its address in NPPES.

Reference sourceCMS (Centers for Medicare & Medicaid Services)NPPES (NPI Registry)checked 10/9/26

CategoriesProvider Data Management Terms

Quick answer: No Surprises Act

What is the No Surprises Act?

No Surprises Act is a federal law that limits surprise out-of-network bills in certain situations and requires good faith estimates for some uninsured or self-pay patients. Sets rules on estimates for self-pay behavioral health patients.

Frequently asked questions: No Surprises Act

What is an NPI?

NPI (National Provider Identifier) is a unique 10-digit identification number assigned to health care providers under HIPAA and used on all standard transactions. Every claim must carry the correct NPI; the wrong one causes rejections.

What are NCCI edits?

CMS edits that prevent improper payment when certain codes are billed together or in excess of medically unlikely units. Many commercial payers use similar edits. Explains many bundling denials and the correct use of modifiers.

What is an NQTL?

Non-Quantitative Treatment Limitation (NQTL) is a parity term for a limit on the scope or duration of benefits that is not expressed numerically, such as prior authorization, step therapy, or network admission standards. Plans must be able to show NQTLs for mental health are comparable to those for medical benefits.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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