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Patient Payment Estimation

Increase price transparency and point-of-service collections with accurate patient payment estimates.

Improve patient engagement and collect more payments up front

Deliver a more transparent patient financial experience by providing accurate out-of-pocket cost estimates for medical services in advance. Engage patients early with our Patient Payment Estimation solutions.

Our market-leading technology and data drive highly accurate and reliable estimates for both healthcare providers and consumers. Our contracts-based engine produces credible estimates from payer-specific negotiated contracts, charge master information, historical charges and patient-specific benefits.

Patient Payment Estimation

Empower staff to more confidently address payment conversations upfront and improve collection efforts. Simplify the estimation process with an exception-based workflow that offers:

  • Touchless workflow — Automatically process steps necessary to complete a patient estimate.
  • Auto add technology — Automatically add procedure codes normally performed together in estimates, resulting in more accuracy.
  • Facility and professional charges — Combine both sets of charges into one estimate or break them out by group.
  • Medical necessity validation — Determine medical necessity prior to service to better inform patients of covered and non-covered services.
  • Easy-to-understand estimate letter — Help staff better understand and explain benefits and out-of-pocket costs to patients.

Our complementary solutions verify patient identity, eligibility and benefits, medical necessity and patient financial clearance.

Online Patient Estimation

Allow healthcare consumers to easily obtain meaningful online estimates for improved access to transparent pricing information on common procedures with a self-service, web-based solution that offers:

  • Accurate and reliable estimates — Leverage information from payer contracts, encounters data, charge description master and real-time insurance eligibility verification to produce a credible estimate of patient’s out-of-pocket costs.
  • Simple steps — Guide patients through how to quickly create an estimate on the provider’s website.
  • Mobile compatibility — Accommodate various screen sizes and devices through a responsive user interface.
  • Adherence to the 2021 CMS Price Transparency mandate — Meet both provisions required, including ability to search for 300 shoppable services and the machine-readable, hospital standard charge file.

Patient Engagement and Financing

Give patients more transparency and control over their medical payment options. Our unique partnership with VisitPay, empowers patients by offering:

  • Upfront views of costs associated with care.
  • Consolidated monthly bills and payments across household accounts in a single statement.
  • Customized payment options based on patient preference and financial ability.
  • Targeted patient engagement and adoption campaigns.

Quick Facts

A leader in healthcare revenue protection solutions

Accreditations

ClearIQ

ClearIQ Patient
Payment Estimation

1 HFMA staff and volunteers determined that this product met specific criteria developed under the HFMA Peer Review process. HFMA does not endorse or guaranty the use of these products.

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