A good faith estimate issued to an uninsured or self-pay individual must contain the patient's name and date of birth; a plain-language description of the primary item or service and its scheduled date; an itemised list, grouped by provider or facility, of the items and services reasonably expected for the period of care from the convening provider and from co-providers and co-facilities, with applicable diagnosis codes, expected service codes and expected charges (the cash pay rate reflecting any self-pay discount); the name, National Provider Identifier and Tax Identification Number of each provider and facility and the State and location where services are expected; a list of items or services that will need separate scheduling with a disclaimer above it that separate estimates will be issued; and disclaimers that other recommended items may need separate scheduling, that the estimate is only an estimate and actual charges may differ, that the patient may start the patient-provider dispute resolution process if billed charges are substantially in excess (with instructions and a statement that doing so will not affect care quality), and that the estimate is not a contract and does not oblige the patient to use the listed providers. Co-provider information sent to the convening provider must carry the patient details, the itemised list with codes and charges, the co-provider identifiers and the not-a-contract disclaimer.
The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.