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 ExplanationOfBenefit: PCT-AEOB-1

Page standards status: Informative

Generated Narrative: ExplanationOfBenefit PCT-AEOB-1

identifier: Unique Claim ID/?ngen-9?

status: active

type: Institutional

use: predetermination

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

created: 2021-10-12

insurer: Organization Umbrella Insurance Company

provider: Organization Boston Radiology Center

priority: Normal

claim: Identifier: http://example.com/identifiers/bundle/59688475-2324-3242-23473847

outcome: complete

Insurances

-FocalCoverage
*trueCoverage: 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

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

serviced: 2022-01-01

Nets

-ValueCurrency
*200USD

Adjudications

-ExtensionCategory
*Medical Management

Adjudications

-ExtensionCategory
*Medical Management
* Submitted Amount
* Member Liability

total

category: Submitted Amount

Amounts

-ValueCurrency
*200USD

ProcessNotes

-ExtensionText
*processNote disclaimer text

benefitPeriod: 2022-01-01 --> 2023-01-01

benefitBalance

category: Medical Care

unit: Individual

term: Annual

Financials

-ExtensionTypeAllowed[x]Used[x]
*Allowed$1.00 (USD)$1.00 (USD)