Bifurcated

New Hampshire No Surprises Act & IDR Rules

Last verified: July 2026 · For informational purposes only, not legal advice

Quick answer: New Hampshire is a bifurcated state. Some disputes are governed by New Hampshire's own specified state law, while others default to the federal No Surprises Act IDR process depending on the plan type and service involved.

How it works

New Hampshire's specified state law applies narrowly to out-of-network anesthesiologists, pathologists, radiologists, and emergency physicians, prohibiting balance billing when care was provided at an in-network hospital or ambulatory surgical center. The federal IDR process applies to most other emergency and non-emergency claims, plus air ambulance services.

Key dates

Federal No Surprises Act protections took effect January 1, 2022. State-specific protections vary — check the official source below for exact effective dates in this state.

Official source: Centers for Medicare & Medicaid Services — New Hampshire enforcement letter and specified state law documentation (cms.gov/nosurprises)

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