A Good Faith Estimate a patient can read.
For uninsured and self-pay patients you must give a written estimate before scheduled care. Enter the expected codes and your charges; the builder fills descriptions, shows the Medicare benchmark beside each line, and prints the estimate with the notice language patients are entitled to. Patient and provider details stay in this browser.
Provider or facility
Your charge master
0 codes on this deviceLoad your own charges once and every estimate uses them: one line per code, code and charge separated by a comma. Kept in this browser; nothing is uploaded. Lines without a charge fall back to the Medicare benchmark.
Patient and service
Stays in this browserItems and services
National benchmarkLook up each code to fill the description and the Medicare benchmark, then enter your own expected charge per unit. The benchmark is a reference; the estimate must state your charges.
Needed before preview: provider name, patient name, date of service and at least one looked-up code.