The Patient Estimates feature allows you to easily create Good Faith Estimates as required by the No Surprises Act. Providers and billers can now create estimates of patient responsibility at the time of service for uninsured, self-pay patients, or high deductibles and copays. Once an estimate is created (from either an appointment or a claim), users can print the estimate, send a statement, collect payments in the patient payment portal, create payment plans for the estimate, and much more.
Follow the instructions below to create a patient estimate from a claim.
Important Note: You must have the Real-Time Eligibility and the Patient Estimates features enabled and configured in order to create Patient Estimates. For more information on turning these services on, please visit our Manage Real-Time Eligibility and Manage Patient Estimates Help Articles.
- Select Claim > Claim.
Use the Search field to search for your claim.
Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.
Open the claim.
- Locate and click Estimate from the right-hand side panel.
Click New Estimate.
Select the type of estimate:
The contract amount is required in order to create an accurate estimate unless the patient is Self Pay. For more information visit our Patient Responsibility Estimates FAQs.
Auto Estimate: Works directly with the payer’s eligibility system to determine the patient’s amount due based on the services and the latest plan information about remaining deductibles and other limitations.
Verify the estimate and click Save.
Quick Estimate: This is the most common option and will quickly create an estimate based on the patient’s copay amount. This option uses the copay that is set on the patient's Insurance policy (check the Patient > Insurance Info tab within the appointment).
Verify the copay estimate and click Save.
Custom Estimate: Works directly with the payer’s eligibility system to determine the patient’s amount due based on the services and the copay and coinsurance. For example, if both a copay and coinsurance are set, then it will use the copay. If you get rid of the copay, then it uses the coinsurance.
Check the box to calculate the amount based on copay, deductible, and coinsurance; or manually enter the copay, remaining deductible, and/or coinsurance amounts.
Once finished with the appointment, click Save.