Patient Estimation
Released in GoRev 2025.01.02, this module allows for dynamic generation of a Patient estimate document. This estimate can be based upon various data source options from configured contracts using our GoRev Contract Management module , our GoRev Integration with OpenCare Data for your out of network patients, or averages obtained from historical cases performed.
This guide will walk through the configuration of the estimation print services form (the PDF you'll present to the patient) and the use of the module itself.
Important: Depending on the state you operate in patient estimates may be considered a binding agreement between you and your patient upon which the patient can enforce your estimate as the total cost they will be responsible for. Many states call this a Good Faith Estimate (GFE). GoRev is not responsible for improper or inaccurate use of this estimation system.
Configuring the patient estimate form
As of release of 2025.01.02 you'll find a new standard template exists on your server called Patient Estimate. You can edit this template as shown below. Review this guide on all the features you can utilize to edit print services forms: Manage Print Services
Once in the edit UI for this new form you can tweak any part of the layout. Add any of the new "Estimate" print services fields, remove any, change the logo, change the verbiage, etc.
Generating a Patient Estimate
To generate a Patient Estimate, navigate to Navigating Patient Overview and click the Patient Estimate button.
The below screen will appear.
Rate source options
Towards the top left you will see toggle buttons. These let you pick which patient benefit set to use as well as pick which rate sources you would like utilized.
- Use In-Network Benefits vs Use Out of Network Benefits
- This toggle lets you pick which benefit set you would like to automatically pull into the calculation fields. These pull from the Real Time Eligibility system
- Use Contract Rates or Do Not Use Contract Rates
- This toggle lets you specify whether your actual contract rates configured through the GoRev Contract Management module should be utilized in the calculation.
- Use OpenCareData (OCD) Rates or Do Not Use OpenCareData (OCD) Rates
- This lets you specify whether or not to use the OpenCare Data system to bring in your competitors rates as you have configured here: GoRev Integration with OpenCare Data This is primarily used for out of network situations or if you need to develop a selfpay rate schedule and do not have a rate source to base from.
- Use Line-item posting Rates or Do Not Use Line-item posting Rates
- This toggle lets you specify whether you want your actual historical posted amounts to be utilized in the estimate calculation. This will bring in all line-item posted rates that are > $0.00.
Important: Rates are selected for calculation in a top down waterfall method. For example, if you have all rate sources toggled on as shown below the system will use a contract rate first, if it can't find a contract rate it will use an OpenCare Data rate, if it can't find an OCD rate it will use your line-item posting rates. Average, Median, and Percentile logic do not aggregate across all data sources. They apply to the first data source where a rate is found.
Pick a estimate calculation method
Calculation methods are strictly for OpenCare Data and Line-item posting rate sources. If a contracted rate is found it will use the exact contracted rate regardless of method selected.
- Average
- Selects the average of all rates found within the specific rate source for the specific procedure
- Median
- Selects the true Median of all rates found within the specific rate source for the specific procedure
- Percentile
- Selects the percentile specific rate of all rates found within the specific rate source for the specific procedure
Populate patient benefit information
Contract Code - Select the GoRev Contract Management code you'd like applied here
Deductible Remaining - Specify the current $ amount of the patient's remaining deductible to be met
Co-Payment - Specify the $ amount of any Co-pay the patient will be responsible for
Coinsurance (%) - Specify the % coinsurance the patient is responsible for
Coinsurance ($) - Specify the $ coinsurance the patient is responsible for (this will override the % auto calculation)
Anticipated Allowable - This field will update live as you enter values and contains the estimated total allowable for the service
Patient Estimate - The anticipated patient responsibility
Paid by Insurance - The anticipated amount insurance may pay
Expected Discount - The anticipated amount you may adjust off of your charged amount for this service
Manual Discount - This field lets you specify an additional discount which will reduce the Patient Estimate amount
Click Save Estimate to Generate
This will let you see the draft of the estimate in the pane to the right. If you need to change anything, make the changes and then click Refresh Estimate. This will cause the system to redo the calculations. Click Save Estimate again in order to preview in the pane to the right.
Send estimate to Patient
There are currently two ways to send the estimate to your patient. Clicking the 
Or
You will find Patient Estimate PDF has saved into Patient Overview into File Management. Access it here and you can deliver via other electronic means or print for physical signature.
Additional Resources
GOREV SUPPORT TEAM
If you have any additional questions or concerns regarding this tutorial, please contact the GoRev Support Team by phone at (317) 794-3900 or by email at
Note: Always submit an IT Support Ticket detailing the problem that you are experiencing with this portion of GoRev, if possible, as this will give GoRev Support Agents access to information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see the GoRev IT Support Ticket Creation Tutorial for assistance