Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot United States of America flag

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

Example Claim: PCT-GFE-Institutional-MRI

Page standards status: Informative

Generated Narrative: Claim PCT-GFE-Institutional-MRI

identifier: Placer Identifier/GFEProviderAssignedID0001MRI

status: active

type: Institutional

use: predetermination

patient: Eve Betterhalf female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)

created: 2022-02-02

insurer: Organization Umbrella Insurance Company

provider: Organization GFE Service Help INC.

priority: Normal

Payees

-Type
*Provider

referral: Referral Number

SupportingInfos

-SequenceCategoryCode
*1Type of Billexample-bill-type

Diagnoses

-SequenceDiagnosis[x]TypePackageCode
*1Unspecified focal traumatic brain injuryPrincipal DiagnosisHead trauma - concussion

Insurances

-SequenceFocalCoverage
*1trueCoverage: extension = No display for Extension ,No display for Extension ; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01

item

sequence: 1

revenue: Magnetic Resonance Technology (MRT) - Brain/brain stem

productOrService: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material

serviced: 2022-02-02

quantity: 1

Nets

-ValueCurrency
*266USD

Totals

-ValueCurrency
*266USD