Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
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
| Page standards status: Informative |
Generated Narrative: ExplanationOfBenefit PCT-AEOB-1
Service Description: Example service
In Network Provider Options Link: http://example.com/out-of-network.html
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: Processing Complete
| Focal | Coverage |
| true | Coverage: extension = insurance,false; 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
Value Currency 200 United States dollar Adjudications
Extension Category Medical Management
| Extension | Category |
| Medical Management | |
| Submitted Amount | |
| Member Liability |
total
category: Submitted Amount
Amounts
Value Currency 200 United States dollar
| Extension | Text |
| processNote disclaimer text |
benefitPeriod: 2022-01-01 --> 2023-01-01
benefitBalance
category: Medical Care
unit: Individual
term: Annual
Financials
Extension Type Allowed[x] Used[x] Allowed $1.00 (USD) $1.00 (USD)
IG © 2023+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pct#2.0.0-ballot based on FHIR 4.0.1. Generated 2024-11-20
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change