Upon receiving a request for a timeframe for providing good faith estimate from an uninsured (or self-pay) individual or upon scheduling a primary item or service for an uninsured (or self-pay) individual, the convening provider or convening facility must contact all co-providers and co-facilities who are reasonably expected to provide items or services in conjunction with, and in support of, the primary item or service no later than 1 business day after scheduling or receiving the request.
The convening provider or convening facility must request that the co-providers or co-facilities submit good faith estimate information to the convening provider or facility. The request must also include the date that good faith estimate timeframe information must be received by the convening provider or facility.
Good Timeframe for Providing Good Faith Estimate
Convening providers and facilities must in timeframe for providing good faith estimate timeframe to uninsured (or self-pay) individuals within the following timeframes:
- When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished, the good faith estimate must be provided no later than 1 business day after the date of scheduling.
- When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished, the good faith estimate timeframe must be provided no later than 3 business days after the date of scheduling.
- When a good faith estimate is requested by an uninsured (or self-pay) individual, the good faith estimate must be provided no later than 3 business days after the date of the request.
Changes to the scope of the estimate timeframe for providing good faith estimate
If a convening provider, convening facility, co-provider, or co-facility anticipates or is notified of any changes to the scope of a good faith estimate (such as anticipated changes to the expected charges, items, services, frequency, recurrences, duration, providers, or facilities) previously furnished at the time of scheduling, the convening provider or convening facility must provide the individual with a new good faith estimate no later than 1 business day before the items or services are scheduled to be furnished.
If any changes in expected providers or facilities represented in a good faith estimate occur less than 1 business day before the item or service is scheduled to be furnished, the replacement provider or facility must accept the timeframe for providing good faith estimate for the relevant items or services being furnished that was provided by the replaced provider or facility.
For good faith estimates provided upon request of an uninsured (or self-pay) individual, upon scheduling of the requested item or service, the convening provider or convening facility must provide the individual with a new timeframe for providing good faith estimate for the scheduled item or service within the standard timeframes specified in the timeframes above.
Convening provider or convening facility: It is the provider or facility who schedules an item or service or who receives the initial request for a timeframe for providing good faith estimate from an uninsured (or self-pay) individual. A convening provider must provide a good faith estimate to the uninsured individuals, including any item or service that is reasonably expected to be provided in conjunction with a scheduled or requested item or service by another provider or facility.
Co-provider or co-facility: It is a provider or facility other than a convening provider or a convening facility that furnishes items or services that are customarily provided in conjunction with a primary item or service. For instance, if a patient schedules a surgery, the convening provider or facility might include in the timeframe for providing good faith estimate the cost of the surgery, and the co-provider or co-facility might include the costs of any labs, tests, or anesthesia that might be used during the operation. Know more details about a timeframe for providing good faith estimated timeframe from EMPClaims.