tl&dr

  • Providers can sign-up for our free Instant GFE product here, launching this October.
  • Initial launch addresses all core NoSA requirements and streamlines the workflow.
  • Future releases help automate intelligent, accurate GFEs that flow to patients and payers for AEOB adjudication.

In 2020 and 2021, the No Surprises Act (NoSA) described a new, mandated process by which providers furnish Good Faith Estimates (GFEs) that can be understood by patients and pre-processed as Advanced EOBs by payers. The details were numerous, and provider resources are scarce. Just another Tuesday in healthcare.

For the better part of these two years, we’ve quietly begun working on products to support providers in furnishing GFEs. Today, we’re happy to announce our Instant GFE product officially launching in October. Oh and our just-launched Standard Services Packages (SSPs) library. OH! One more thing, they’re free!

So, what are the NoSA requirements for GFEs anyway?

The GFE mandated by NoSA has a few distinctive requirements. Each is potentially burdensome for providers:

  • Convened Estimates: If a patient requests an estimate for a service that involves multiple providers, the convening provider must coalesce all estimates into one. It’s hard enough to get my family to reply to my group chat. Now I need providers to answer my estimate request??
  • Time Sensitivity: In many NoSA scenarios, convening providers and convened providers have just one business day post-scheduling to convene an estimate. That’s pretty snappy, especially for complex procedures.
  • Accuracy: According to NoSA, if a GFE is off by more than $400 from the actual bill, a patient has recourse to challenge the bill through the Selected Dispute Resolution (SDR) process.
  • Documentation And Security: The GFE is a legal document that becomes part of the patient’s medical record. As such, providers need to make their GFE process play nice with existing software. Don't make us come over there.

Sound like a job for Instant GFE

At its core, Instant GFE is a free, HIPAA-compliant provider workflow tool for frictionless NoSA compliance. We’ll launch with this core functionality in October, 2022:

Invite Your Co-Providers to Convene Estimates: Think of this as a group order on Grubhub. (Tacos, anyone?) Each convened provider can draw on autofill data to quickly fill out an estimate and return it back to the convening provider.

Instant GFE workflow: Invite collaborators.

Input All Required Data Elements: NoSA is strict about which components must be included in a GFE. We’ve translated the CMS GFE template into an easier workflow while maintaining the original content.

Instant GFE workflow: Input patient information. We hope Jerry's OK.

Dashboard to Manage All GFEs: Track GFEs along their workflow journey, from initial request through delivery to the patient.

Instant GFE workflow: Estimates Dashboard. Feb 22 was a busy day.

Securely Deliver, Save and Distribute the GFE: Once a GFE is complete, you can store it as a PDF, send it to the patient, or print it. Future integrations with popular EHRs will seamlessly push the GFE into the patient’s record.

Preparing for AEOBs and Estimate Automation in 2023 and Beyond

Past the initial October release, we have a lot of exciting irons in the fire to help automate GFEs, optimize for accuracy, and answer the following questions:

Services are complicated. What charges should I put in an estimate?Healthcare encounters are complex. However, many shoppable services are commoditized and share the same recurring components. We thought a standard library for shoppable services that breaks common encounters into standard associated charges would help. So today, we’re launching our Standard Service Package (SSP) library (blog | website). This is an open library that providers and third parties can begin using today as a jumping off point for templatized GFEs. Think of it as a sourdough starter, with your organization’s custom estimates being the tasty bread.

Later this year, we’ll couple our Standard Service Package library with Instant GFE to streamline GFE creation. Awwwww. True love.

Our org is strapped for resources already. Will I have to manually create GFEs?
Luckily, Turquoise has ingested the public hospital rate data and payer rate data. Combined with our SSP library, transparency data acts as the sous-chef to generate an automatic GFE that you only need to approve before sending. You will also be able to manage your service packages for re-use directly in our interface.

We already have so many software platforms. Is this another one?
Over the coming months, we’ll roll out API integrations that will allow Instant GFE to work with your existing software. Developers can take advantage of the above features natively in your existing software. We also plan to integrate Instant GFE with forthcoming HL7 transmission standards to make it easier to pass GFEs and AEOBs back and forth.

There’s more NoSA rulemaking on the way. Yay!

I know I’ve made a lot of food analogies in this blog, but there’s a lot cooking at Turquoise (ba-dum-tss). There’s also a lot cooking in DC. We’re expecting additional NoSA rulemaking with further guidance on GFEs, AEOBs, and the dispute resolution process. Stay tuned for more updates. Bon appetit!