No Surprises Act and Good Faith Estimate

Jana 2 years ago in Industry News/Discussion updated 2 years ago 8

Hello, is anyone currently using or in the process of creating a Good Faith Estimate for cost of service (as required for the No Surprises Act)?  Just wanting to team up on this if possible so we are not recreating the wheel if someone is already underway with something.   thanks!

Good Faith Estimate Example.pdf

I just came across this Good Faith Estimate Example from the CMS website.  Not sure if this will help anyone but I remembered this thread so I thought I'd share.


I wonder if procentive could create a form like this that we could all use?


Procentive actually has a form already created - just reach out via ticket and they will share.  :)

What is that form name and #?

PRO-1621 "Good Faith Estimate" (but I believe you have to request Procentive add it/turn it on in your database.

Thanks for that information.  

Thank you, Jana! That form will be great to use and have available right in the chart. Are you using your billable amount or reimbursable amount in your Good Faith Estimates? 

We are using the billable amount.