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Appendix 2 - Good Faith Estimate.pdf

115259501.pdf

Preview of Appendix 2 - Good Faith Estimate

🔗 Source: omb.report

📊 Size: 246 KB

📄 Pages: 10 pages

⬇️ Downloads: 28

Summary

The form must be used by January 1, 2022, and provided within 3 business days of request or scheduling.

Key Points:

Purpose: Inform uninsured individuals (not enrolled in a plan or Federal health care program) or self-pay individuals about expected charges for healthcare services.
Timeline:

Provide Good Faith Estimate within 3 business days of request.
Schedule-based information must be given:
Within 1 business day of scheduling an item/service to be provided in 3 business days.
Within 3 business days of scheduling an item/service to be provided in at least 10 business days.
Content: The estimate should include:
Patient information (name, date of birth, identification number).
Primary diagnosis and requested/scheduled service or item.
Summary of expected charges with a detailed list attached.
Contact information for the provider/facility offering the services.
National Provider Identifier (NPI) and Taxpayer Identification Number (TIN) for the provider/facility.
* Valid OMB Control Number: 0938-XXXX. Estimated completion time: 1.3 hours per response.

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Description

Document en en

Technical Information

File Format: PDF
File Size: 246 KB
Pages: 10
Language: EN
Total Downloads: 28
Last Updated: 1 week ago

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This PDF document about Appendix 2 - Good Faith Estimate provides comprehensive information and guidance. Whether you're a beginner or advanced user, this resource offers valuable insights into Appendix 2 - Good Faith Estimate.