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: PCTAdvancedEOBSummary - Mappings

Page standards status: Trial-use Maturity Level: 1

Mappings for the davinci-pct-aeob-summary resource profile.

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

PCTAdvancedEOBSummary
ExplanationOfBenefitEvent
   identifierEvent.identifier
   identifier (INTER)Event.identifier
   statusEvent.status
   typeEvent.code
   patientEvent.subject
   createdEvent.occurrence[x]
   insurerEvent.performer.agent

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

PCTAdvancedEOBSummary
ExplanationOfBenefit
   identifierFiveWs.identifier
   identifier (INTER)FiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   useFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   billablePeriodFiveWs.done[x]
   createdFiveWs.recorded
   insurerFiveWs.author
   providerFiveWs.source
   careTeam
      providerFiveWs.actor

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

PCTAdvancedEOBSummary
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)
   priorityRequest.priority
   insuranceCoverage

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

PCTAdvancedEOBSummary
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
   provider
      idn/a
      extension
      extension (dataAbsentReason)ANY.nullFlavor
         idn/a
         urlN/A
         value[x]N/A
   related
      idn/a
      extensionn/a
      modifierExtensionN/A
   careTeam
      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
   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
   processNote
      idn/a
      modifierExtensionN/A
   benefitBalance
      idn/a
      extensionn/a
      modifierExtensionN/A
      financial
         idn/a
         extensionn/a
         modifierExtensionN/A