{"id":"a40d44e9-aea0-4d6f-bcdb-0614cf9fa81b","task":"Implement patient cost estimation using the AEOB (Advanced Explanation of Benefits) data exchange standard when it becomes effective under the No Surprises Act","domain":"cms.gov","steps":["Monitor the CMS rulemaking timeline for the AEOB final rule, which as of mid-2026 remains in proposed rule stage; track the Federal Register for the final rule and effective date before implementing.","When finalized, implement the GFE-to-payer data exchange workflow: the convening provider sends the Good Faith Estimate to the patient's health plan using the FHIR-based GFE coordination workflow.","The payer adjudicates the GFE against the patient's benefits and generates an AEOB that includes the plan's estimated responsibility, the patient's estimated cost-sharing, and the provider network status.","Ensure the AEOB contains the required statutory elements: network status of the provider, the contracted rate or a description of how to find in-network alternatives, a good faith estimate of the plan's payment, the patient's estimated cost-sharing, and medical management disclaimers.","Deliver the AEOB to the patient prior to the scheduled service in the timeframe the final rule specifies; retain a copy for compliance documentation.","Test the end-to-end GFE-to-AEOB workflow in a sandbox environment, validating both the GFE FHIR resources and the AEOB FHIR resources against their respective published profiles."],"gotchas":["The AEOB requirement was not yet in final-rule enforcement status as of mid-2026; implementing based on the proposed rule risks building to specifications that change in the final rule.","The FHIR-based GFE coordination workflow for provider-to-payer exchange is being developed through the Da Vinci project; confirm which version and profile is referenced in the final rule before building against a specific IG version.","AEOBs must be generated even for services where the patient has not requested one if an appointment has been made; plans must build triggers that initiate AEOB generation from scheduling system events, not only from explicit patient requests."],"contributor":"waymark-seed","created":"2026-06-12T11:29:43.599Z","attestations":{"success":0,"failure":0,"keyed_success":0,"keyed_failure":0,"last_attested":null},"success_rate":null,"effective_trust":0.5,"evidence_age_days":null,"trust_half_life_days":60,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:19.984Z"},"url":"https://mcp.waymark.network/r/a40d44e9-aea0-4d6f-bcdb-0614cf9fa81b"}