<aside> đź“… Last updated October 3, 2025.
</aside>
Integration with Goodbill is simple and straightforward. It will look like many other integrations within your existing claim flow.
This document intends to describe a high-level look at integrating with Goodbill.
Goodbill offers three products, which can be implemented separately or combined for maximum savings.
| Goodbill Service | Description | Member Engagement Required? |
|---|---|---|
| 501(r) | Goodbill’s 501(r) product saves members and plans money by streamlining and automating the 501(r) financial assistance application process. Members may receive up to 100% off their responsibility for a hospital visit. Likewise, plans may save significant money by repricing the claim to the hospital’s AGB, versus the originally contracted (or out-of-network) rates. | ✅ |
| Claim Review / Itemized Bill Review | Goodbill’s claim review product saves members and plans money by performing hospital claim reviews and identifying errors and overages. Supports DRG Validation and Itemized Bill Review. | |
| Using EHR Integration | Customers can enable member engagement to allow members to integrate their MyChart/medical record account directly with Goodbill. | âś… |
| Without EHR Integration | Goodbill can retrieve records directly from the Provider without member engagement. | ❌ |
| Direct Contract Repricing | Efficiently, transparently, and accurately reprice claims to complex, multi-fee schedule, tiered contracts. | ❌ |
| Document Retrieval | Goodbill automates itemized bill and medical record retrieval for eligible claims, fetching them 3x faster and saving, on average, 30 minutes labor time per claim. | ❌ |
Below is a 6min video explaining how Goodbill’s claim flow works for each of our products individually and combined.
https://www.loom.com/share/8717c99e6afa455c9e49b5183581b205?sid=8cf14371-d05d-4af6-b235-6aad6b761c34
| Owner | Step | Product | Details |
|---|---|---|---|
| TPA | Receives claim from provider | All | |
| TPA | Sends Goodbill 837 | All | |
| Goodbill | Engages member | 501(r), Claim Review with EHR | This may take a few days, while we get them to integrate their EHR and complete initial 501(r) eligibility. |
| Goodbill | Determines initial 501(r) eligibility | 501(r) | Based on household size, income, and hospital, we’ll do an initial check on 501(r) eligibility. |
| Goodbill | Reviews claim | Both Claim Review types | Using the complete (digital) medical record and the claim, a full coding and clinical review will be performed. |
| Goodbill | Sends 501(r) application to hospital | 501(r) | Hospitals typically respond to 501(r) applications in 30-60 days. |
| Goodbill | Returns 837 | 501(r), Claim Review, Direct Contract Repricing | In the case of claim review, an edited 837 will be returned. If 501(r) is also applied, the 837 will be returned as denied with specific CARC/RARC codes. |
| TPA | Adjudicates 837, pends payment | 501(r), Claim Review, Direct Contract Repricing | Adjudicate the claim in order to satisfy ERISA, but pend payment until determination of the 501(r) application. |
| TPA | Adjudicates 837, sends EOB, payment | 501(r), Claim Review, Direct Contract Repricing | |
| Goodbill | Gets 501(r) result | 501(r) | Goodbill manages all provider communication and follow-up in order to receive a timely and correct 501(r) determination. |
| Goodbill | Reprice 837 to AGB | 501(r) | Goodbill will reprice the claim to the hospital’s AGB, providing both plan and member savings. |
| Goodbill | Returns 837 | 501(r) | We will return an edited and repriced claim with specific CARC/RARC codes. |
| TPA | Re-adjudicate 837 | 501(r) | Re-adjudicate the claim now, with correct AGB pricing. |
| TPA | Send EOB, payment to provider | 501(r) |
For technical implementation details, please see:
Technical Implementation Guide