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

Resource Profile: PCTAdvancedEOB - Mappings

Page standards status: Trial-use Maturity Level: 2

Mappings for the davinci-pct-aeob resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

PCTAdvancedEOB
ExplanationOfBenefitEvent
   identifierEvent.identifier
   identifier (INTER)Event.identifier
   identifier (uniqueclaimid)Event.identifier
   statusEvent.status
   typeEvent.code
   patientEvent.subject
   createdEvent.occurrence[x]
   entererEvent.performer.agent
   insurerEvent.performer.agent
   facilityEvent.performer.location

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

PCTAdvancedEOB
ExplanationOfBenefit
   identifierFiveWs.identifier
   identifier (INTER)FiveWs.identifier
   identifier (uniqueclaimid)FiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   subTypeFiveWs.class
   useFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   billablePeriodFiveWs.done[x]
   createdFiveWs.recorded
   entererFiveWs.author
   insurerFiveWs.author
   providerFiveWs.source
   referralFiveWs.cause
   facilityFiveWs.where[x]
   claimFiveWs.why[x]
   careTeam
      providerFiveWs.actor
   item
      serviced[x]FiveWs.done[x]
      location[x]FiveWs.where[x]
   addItem
      providerFiveWs.source
      serviced[x]FiveWs.done[x]
      location[x]FiveWs.where[x]

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

PCTAdvancedEOB
ExplanationOfBenefit
   identifier
   identifier (INTER)
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   identifier (uniqueclaimid)
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   priorityRequest.priority
   claim
      identifier
         useN/A
         typeCX.5
         systemCX.4 / EI-2-4
         valueCX.1 / EI.1
         periodCX.7 + CX.8
         assignerCX.4 / (CX.4,CX.9,CX.10)
   insuranceCoverage

Mappings for RIM Mapping (http://hl7.org/v3)

PCTAdvancedEOB
ExplanationOfBenefitEntity. Role, or Act
   textAct.text?
   containedN/A
   modifierExtensionN/A
   identifier
   identifier (INTER)
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   identifier (uniqueclaimid)
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   related
      idn/a
      extensionn/a
      modifierExtensionN/A
   payee
      idn/a
      extensionn/a
      modifierExtensionN/A
   claim
      idn/a
      extensionn/a
      referenceN/A
      typeN/A
      identifier.identifier
         idn/a
         extensionn/a
         useRole.code or implied by context
         typeRole.code or implied by context
         systemII.root or Role.id.root
         valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
         periodRole.effectiveTime or implied by context
         assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
      displayN/A
   careTeam
      idn/a
      extensionn/a
      modifierExtensionN/A
   supportingInfo
      idn/a
      extensionn/a
      modifierExtensionN/A
   diagnosis
      idn/a
      extensionn/a
      modifierExtensionN/A
   procedure
      idn/a
      extensionn/a
      modifierExtensionN/A
   insurance
      idn/a
      extensionn/a
      modifierExtensionN/A
   accident
      idn/a
      extensionn/a
      modifierExtensionN/A
   item
      idn/a
      modifierExtensionN/A
      adjudication
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (medicalmanagement)
         idn/a
         modifierExtensionN/A
      adjudication (benefitpaymentstatus)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (adjustmentreason)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (submitted)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (memberliability)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (eligible)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (benefit)
         idn/a
         extensionn/a
         modifierExtensionN/A
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A
   addItem
      idn/a
      extensionn/a
      modifierExtensionN/A
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A
   adjudication
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (medicalmanagement)
      idn/a
      modifierExtensionN/A
   adjudication (billingnetworkstatus)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (renderingnetworkstatus)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (benefitpaymentstatus)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (adjustmentreason)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (submitted)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (memberliability)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (eligible)
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (benefit)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (submitted)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (memberliability)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (innetwork)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (outofnetwork)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (noncovered)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (negotiated)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (eligible)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total (benefit)
      idn/a
      extensionn/a
      modifierExtensionN/A
   payment
      idn/a
      extensionn/a
      modifierExtensionN/A
   processNote
      idn/a
      modifierExtensionN/A
   benefitBalance
      idn/a
      extensionn/a
      modifierExtensionN/A
      financial
         idn/a
         modifierExtensionN/A