Patient Cost Transparency Implementation Guide
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Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

: PCT-GFE-Missing-Bundle-1 - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="PCT-GFE-Missing-Bundle-1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle"/>
  </meta>
  <type value="collection"/>
  <timestamp value="2024-03-27T11:01:00+05:00"/>
  <entry id="org1002">
    <fullUrl value="http://example.org/fhir/Organization/org1002"/>
    <resource>
      <Organization>
        <id value="org1002"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"/>
        </meta>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><a name="org1002"></a><a name="hcorg1002"></a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Organization &quot;org1002&quot;</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-davinci-pct-organization.html">PCT Organization</a></p></div><p><b>identifier</b>: National provider identifier/1234568095, Tax ID number/TAX-3211001</p><p><b>active</b>: true</p><p><b>type</b>: Healthcare Provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html">Organization type</a>#prov)</span></p><p><b>name</b>: Boston Radiology Center</p><p><b>telecom</b>: ph: 781-232-3200(WORK)</p><p><b>address</b>: 32 Fruit Street Boston MA 02114 US</p></div>
        </text>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NPI"/>
            </coding>
          </type>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1234568095"/>
        </identifier>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="TAX"/>
            </coding>
          </type>
          <system value="urn:oid:2.16.840.1.113883.4.4"/>
          <value value="TAX-3211001"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/organization-type"/>
            <code value="prov"/>
            <display value="Healthcare Provider"/>
          </coding>
        </type>
        <name value="Boston Radiology Center"/>
        <telecom>
          <system value="phone"/>
          <value value="781-232-3200"/>
          <use value="work"/>
        </telecom>
        <address>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode">
            <valueCoding>
              <system value="urn:iso:std:iso:3166:-2"/>
              <code value="US-MA"/>
            </valueCoding>
          </extension>
          <line value="32 Fruit Street"/>
          <city value="Boston"/>
          <state value="MA"/>
          <postalCode value="02114"/>
          <country value="US"/>
        </address>
      </Organization>
    </resource>
  </entry>
  <entry id="patient1001">
    <fullUrl value="http://example.org/fhir/Patient/patient1001"/>
    <resource>
      <Patient>
        <id value="patient1001"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"/>
        </meta>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Known Marital status of Patient">Marital Status:</td><td colspan="3"><span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}">unmarried</span></td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Details:</td><td colspan="3"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Languages spoken">Language:</td><td colspan="3"><span title="Codes: {urn:ietf:bcp:47 en-US}">English (United States)</span> (preferred)</td></tr></table></div>
        </text>
        <identifier>
          <system value="http://example.com/identifiers/patient"/>
          <value value="1001"/>
        </identifier>
        <name>
          <text value="Eve Betterhalf"/>
          <family value="Betterhalf"/>
          <given value="Eve"/>
        </name>
        <telecom>
          <system value="phone"/>
          <value value="781-949-4949"/>
          <use value="mobile"/>
        </telecom>
        <gender value="female"/>
        <birthDate value="1955-07-23"/>
        <address>
          <text value="222 Burlington Road, Bedford MA 01730"/>
        </address>
        <maritalStatus>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"/>
            <code value="U"/>
            <display value="unmarried"/>
          </coding>
        </maritalStatus>
        <communication>
          <language>
            <coding>
              <system value="urn:ietf:bcp:47"/>
              <code value="en-US"/>
              <display value="English (United States)"/>
            </coding>
          </language>
          <preferred value="true"/>
        </communication>
      </Patient>
    </resource>
  </entry>
  <entry id="coverage1001">
    <fullUrl value="http://example.org/fhir/Coverage/coverage1001"/>
    <resource>
      <Coverage>
        <id value="coverage1001"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"/>
        </meta>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><a name="coverage1001"></a><a name="hccoverage1001"></a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Coverage &quot;coverage1001&quot;</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-davinci-pct-coverage.html">PCT Coverage</a></p></div><p><b>Extension Definition for Coverage.kind for Version 5.0</b>: insurance</p><p><b>status</b>: active</p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href="Patient-patient1001.html">Patient/patient1001</a> &quot; BETTERHALF&quot;</p><p><b>relationship</b>: Self <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2021-01-01 --&gt; 2022-01-01</p><p><b>payor</b>: <a href="Organization-org1001.html">Organization/org1001</a> &quot;Umbrella Insurance Company&quot;</p><h3>Classes</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style="display: none">*</td><td>Plan <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#plan)</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><h3>CostToBeneficiaries</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>Copay Percentage <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="http://terminology.hl7.org/5.3.0/CodeSystem-coverage-copay-type.html">Coverage Copay Type Codes</a>#copaypct)</span></td><td>20</td></tr></table></div>
        </text>
        <extension
                   url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind">
          <valueCode value="insurance"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared">
          <valueBoolean value="false"/>
        </extension>
        <status value="active"/>
        <subscriberId value="PFP123450000"/>
        <beneficiary>🔗 
          <reference value="Patient/patient1001"/>
        </beneficiary>
        <relationship>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
            <code value="self"/>
            <display value="Self"/>
          </coding>
        </relationship>
        <period>
          <start value="2021-01-01"/>
          <end value="2022-01-01"/>
        </period>
        <payor>🔗 
          <reference value="Organization/org1001"/>
        </payor>
        <class>
          <type>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
              <code value="plan"/>
              <display value="Plan"/>
            </coding>
          </type>
          <value value="Premim Family Plus"/>
          <name value="Premim Family Plus Plan"/>
        </class>
        <costToBeneficiary>
          <type>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/coverage-copay-type"/>
              <code value="copaypct"/>
              <display value="Copay Percentage"/>
            </coding>
          </type>
          <valueQuantity>
            <value value="20"/>
          </valueQuantity>
        </costToBeneficiary>
      </Coverage>
    </resource>
  </entry>
  <entry id="org1001">
    <fullUrl value="http://example.org/fhir/Organization/org1001"/>
    <resource>
      <Organization>
        <id value="org1001"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"/>
        </meta>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><a name="org1001"></a><a name="hcorg1001"></a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Organization &quot;org1001&quot;</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-davinci-pct-organization.html">PCT Organization</a></p></div><p><b>identifier</b>: Electronic Transmitter Identification Number/ETIN-3200002</p><p><b>active</b>: true</p><p><b>type</b>: Payer <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(<a href="http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html">Organization type</a>#pay)</span></p><p><b>name</b>: Umbrella Insurance Company</p><p><b>telecom</b>: ph: 860-547-5001(WORK)</p><p><b>address</b>: 680 Asylum Street Hartford CT 06155 US</p></div>
        </text>
        <identifier>
          <type>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS"/>
              <code value="ETIN"/>
            </coding>
          </type>
          <value value="ETIN-3200002"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/organization-type"/>
            <code value="pay"/>
            <display value="Payer"/>
          </coding>
        </type>
        <name value="Umbrella Insurance Company"/>
        <telecom>
          <system value="phone"/>
          <value value="860-547-5001"/>
          <use value="work"/>
        </telecom>
        <address>
          <extension
                     url="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode">
            <valueCoding>
              <system value="urn:iso:std:iso:3166:-2"/>
              <code value="US-CT"/>
            </valueCoding>
          </extension>
          <line value="680 Asylum Street"/>
          <city value="Hartford"/>
          <state value="CT"/>
          <postalCode value="06155"/>
          <country value="US"/>
        </address>
      </Organization>
    </resource>
  </entry>
  <entry id="PCT-DeviceRequest-1">
    <fullUrl
             value="http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1"/>
    <resource>
      <DeviceRequest>
        <id value="PCT-DeviceRequest-1"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest"/>
        </meta>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><a name="PCT-DeviceRequest-1"></a><a name="hcPCT-DeviceRequest-1"></a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource DeviceRequest &quot;PCT-DeviceRequest-1&quot;</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-davinci-pct-devicerequest.html">PCT GFE DeviceRequest</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: proposal</p><p><b>code</b>: KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki">(HCPCSReleaseCodeSets#L1820)</span></p><p><b>subject</b>: <a href="Patient-patient1001.html">Patient/patient1001</a> &quot; BETTERHALF&quot;</p></div>
        </text>
        <status value="active"/>
        <intent value="proposal"/>
        <codeCodeableConcept>
          <coding>
            <system
                    value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
            <code value="L1820"/>
            <display
                     value="KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT"/>
          </coding>
        </codeCodeableConcept>
        <subject>🔗 
          <reference value="Patient/patient1001"/>
        </subject>
      </DeviceRequest>
    </resource>
  </entry>
</Bundle>