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nsahelper

sboghossian/nsahelper

Free OSS No Surprises Act demand-letter generator. PDF in 60 seconds. Not legal advice.

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NSAHelper

A free, open-source generator for No Surprises Act demand letters.

Drop in the bill details. Get three formatted PDFs back — one for your provider, one for your insurer, one for the federal No Surprises Help Desk at CMS. Optional fourth letter for IDR escalation. All 50 states, English and Spanish.

NSAHelper is a template-generation tool. It is not legal advice and does not create an attorney-client relationship. Consult a licensed attorney in your jurisdiction.

What it does

  • 3-step wizard captures the bill, the parties, and any additional facts.
  • Optional EOB upload — we extract the dates, amounts, and claim ID via Claude vision so you don't have to retype them.
  • Generates three letters per submission:
    1. Provider — formal demand to stop balance-billing and reissue the bill at the in-network rate (pre-pay) or refund the overpayment (post-pay).
    2. Insurer / health plan — adjudication request applying the in-network cost-sharing amount.
    3. CMS No Surprises Help Desk — complaint of an apparent NSA violation.
    4. IDR escalation cover letter (optional, if you want to escalate).
  • Cites the federal NSA (42 U.S.C. § 300gg-111 et seq.) plus the state-specific surprise-billing statute for CA, NY, TX, FL, and IL.
  • 250 programmatic-SEO pages (50 states × 5 primary bill types).
  • Stateless — nothing is persisted.

Stack

  • Next.js 15 App Router + TypeScript strict
  • Tailwind CSS
  • @anthropic-ai/sdk (Claude Sonnet 4.6 for drafting, vision for EOB OCR)
  • next-intl for English + Spanish
  • @react-pdf/renderer for the letter PDFs
  • Deployed to Cloudflare Pages via @cloudflare/next-on-pages

Run it locally

pnpm install
export ANTHROPIC_API_KEY="..."   # optional — fallback templates run without it
pnpm dev

Open http://localhost:3000 — the middleware redirects to /en.

Without ANTHROPIC_API_KEY you still get fully-formed letters from the deterministic fallback templates; the API key just upgrades the prose.

Build for Cloudflare Pages

pnpm dlx @cloudflare/next-on-pages
npx wrangler pages deploy .vercel/output/static --project-name=nsahelper

See DEPLOY.md for the exact commands.

Coverage

  • All 50 states plus DC.
  • Bill types: ER, anesthesiology, lab/pathology, radiology, hospitalist (the five with programmatic SEO pages), plus ground ambulance and air ambulance in the form.
  • State law overlays: California (AB-72, Cal. Health & Safety Code § 1371.9); New York (Surprise Bill Law, Fin. Serv. Law § 606 / Pub. Health Law § 24); Texas (SB 1264, Tex. Ins. Code Ch. 1467); Florida (HB 221, Fla. Stat. § 627.64194); Illinois (Network Adequacy Act, 215 ILCS 5/356z.3a). Every other state cites the federal NSA only.
  • Languages: English (en), Spanish (es).

What this is NOT

  • Not legal advice. (Said again. Everywhere.)
  • Not a billing dispute service — there is no human in the loop, no follow-up tracking, no escrow. You mail the letters yourself.
  • Not connected to CMS, your provider, or your insurer in any way.

License

MIT. See LICENSE.

Author

Stephane Boghossian — Head of Growth at HAQQ Legal AI. This is a personal OSS project, separate from HAQQ.