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
Generated Narrative: Bundle PCT-GFE-Collection-Bundle-2
Bundle PCT-GFE-Collection-Bundle-2 of type collection
Entry 1 - fullUrl = http://example.org/fhir/Patient/patient1001
Resource Patient:
Eve Betterhalf female, DoB: 1955-07-23 (
http://example.com/identifiers/patient
/1001)
Marital Status: unmarried Contact Details:
- ph: 781-949-4949(MOBILE)
- 222 Burlington Road, Bedford MA 01730
Language: English (United States) (preferred)
Entry 2 - fullUrl = http://example.org/fhir/Coverage/coverage1001
Resource Coverage:
Resource Coverage "coverage1001"
Profile: PCT Coverage
Extension Definition for Coverage.kind for Version 5.0: insurance
status: active
subscriberId: PFP123450000
beneficiary: Patient/patient1001 " BETTERHALF"
relationship: Self (SubscriberPolicyholder Relationship Codes#self)
period: 2021-01-01 --> 2022-01-01
payor: Organization/org1001 "Umbrella Insurance Company"
Classes
Type Value Name Plan (Coverage Class Codes#plan) Premim Family Plus Premim Family Plus Plan CostToBeneficiaries
Type Value[x] Copay Percentage (Coverage Copay Type Codes#copaypct) 20
Entry 3 - fullUrl = http://example.org/fhir/Practitioner/Submitter-Practitioner-1
Resource Practitioner:
Generated Narrative: Practitioner Submitter-Practitioner-1
identifier: National provider identifier/6456789016, Electronic Transmitter Identification Number/ETIN-20020001
active: true
name: Nora Ologist
telecom: ph: 860-547-3301(Work), csender@GFEServiceHelp.com
Entry 4 - fullUrl = http://example.org/fhir/Organization/org1001
Resource Organization:
Resource Organization "org1001"
Profile: PCT Organization
identifier: Electronic Transmitter Identification Number/ETIN-3200002
active: true
type: Payer (Organization type#pay)
name: Umbrella Insurance Company
telecom: ph: 860-547-5001(WORK)
address: 680 Asylum Street Hartford CT 06155 US
Entry 5 - fullUrl = http://example.org/fhir/Bundle/PCT-GFE-Bundle-Prof-1
Resource Bundle:
Generated Narrative: Bundle PCT-GFE-Bundle-Prof-1
Bundle PCT-GFE-Bundle-Prof-1 of type collection
Entry 1 - fullUrl = http://example.org/fhir/Claim/PCT-GFE-Summary-MRI
Resource Claim:
Generated Narrative: Claim PCT-GFE-Summary-MRI
status: Active
type: Estimate Summary
use: Predetermination
patient: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)
billablePeriod: 2021-10-31 --> (ongoing)
created: 2021-10-05
insurer: Organization Umbrella Insurance Company
provider: ??
priority: Normal
Diagnoses
Sequence Diagnosis[x] Type 1 Unspecified focal traumatic brain injury Principal Diagnosis Insurances
Totals
Value Currency 200 USD Entry 2 - fullUrl = http://example.org/fhir/Claim/PCT-GFE-Professional-MRI
Resource Claim:
Generated Narrative: Claim PCT-GFE-Professional-MRI
identifier: Placer Identifier/GFEProviderAssignedID0002
status: Active
type: Professional
use: Predetermination
patient: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)
created: 2021-10-05
insurer: Organization Umbrella Insurance Company
provider: Practitioner Nora Ologist
priority: Normal
Payees
Type Provider referral: Referral Number
Diagnoses
Sequence Diagnosis[x] Type 1 Unspecified focal traumatic brain injury Principal Diagnosis Insurances
item
sequence: 1
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: 2021-10-31
location: Inpatient Hospital
quantity: 1
UnitPrices
Value Currency 200 USD Nets
Value Currency 200 USD Totals
Value Currency 200 USD Entry 3 - fullUrl = http://example.org/fhir/Practitioner/Submitter-Practitioner-1
Resource Practitioner:
Generated Narrative: Practitioner Submitter-Practitioner-1
identifier: National provider identifier/6456789016, Electronic Transmitter Identification Number/ETIN-20020001
active: true
name: Nora Ologist
telecom: ph: 860-547-3301(Work), csender@GFEServiceHelp.com
Entry 4 - fullUrl = http://example.org/fhir/Organization/org1001
Resource Organization:
Resource Organization "org1001"
Profile: PCT Organization
identifier: Electronic Transmitter Identification Number/ETIN-3200002
active: true
type: Payer (Organization type#pay)
name: Umbrella Insurance Company
telecom: ph: 860-547-5001(WORK)
address: 680 Asylum Street Hartford CT 06155 US
Entry 5 - fullUrl = http://example.org/fhir/Patient/patient1001
Resource Patient:
Eve Betterhalf female, DoB: 1955-07-23 (
http://example.com/identifiers/patient
/1001)
Marital Status: unmarried Contact Details:
- ph: 781-949-4949(MOBILE)
- 222 Burlington Road, Bedford MA 01730
Language: English (United States) (preferred) Entry 6 - fullUrl = http://example.org/fhir/Coverage/coverage1001
Resource Coverage:
Resource Coverage "coverage1001"
Profile: PCT Coverage
Extension Definition for Coverage.kind for Version 5.0: insurance
status: active
subscriberId: PFP123450000
beneficiary: Patient/patient1001 " BETTERHALF"
relationship: Self (SubscriberPolicyholder Relationship Codes#self)
period: 2021-01-01 --> 2022-01-01
payor: Organization/org1001 "Umbrella Insurance Company"
Classes
Type Value Name Plan (Coverage Class Codes#plan) Premim Family Plus Premim Family Plus Plan CostToBeneficiaries
Type Value[x] Copay Percentage (Coverage Copay Type Codes#copaypct) 20
Entry 6 - fullUrl = http://example.org/fhir/Bundle/PCT-GFE-Missing-Bundle-1
Resource Bundle:
Generated Narrative: Bundle PCT-GFE-Missing-Bundle-1
Bundle PCT-GFE-Missing-Bundle-1 of type collection
Entry 1 - fullUrl = http://example.org/fhir/Organization/org1002
Resource Organization:
Resource Organization "org1002"
Profile: PCT Organization
identifier: National provider identifier/1234568095, Tax ID number/TAX-3211001
active: true
type: Healthcare Provider (Organization type#prov)
name: Boston Radiology Center
telecom: ph: 781-232-3200(WORK)
address: 32 Fruit Street Boston MA 02114 US
Entry 2 - fullUrl = http://example.org/fhir/Patient/patient1001
Resource Patient:
Eve Betterhalf female, DoB: 1955-07-23 (
http://example.com/identifiers/patient
/1001)
Marital Status: unmarried Contact Details:
- ph: 781-949-4949(MOBILE)
- 222 Burlington Road, Bedford MA 01730
Language: English (United States) (preferred) Entry 3 - fullUrl = http://example.org/fhir/Coverage/coverage1001
Resource Coverage:
Resource Coverage "coverage1001"
Profile: PCT Coverage
Extension Definition for Coverage.kind for Version 5.0: insurance
status: active
subscriberId: PFP123450000
beneficiary: Patient/patient1001 " BETTERHALF"
relationship: Self (SubscriberPolicyholder Relationship Codes#self)
period: 2021-01-01 --> 2022-01-01
payor: Organization/org1001 "Umbrella Insurance Company"
Classes
Type Value Name Plan (Coverage Class Codes#plan) Premim Family Plus Premim Family Plus Plan CostToBeneficiaries
Type Value[x] Copay Percentage (Coverage Copay Type Codes#copaypct) 20 Entry 4 - fullUrl = http://example.org/fhir/Organization/org1001
Resource Organization:
Resource Organization "org1001"
Profile: PCT Organization
identifier: Electronic Transmitter Identification Number/ETIN-3200002
active: true
type: Payer (Organization type#pay)
name: Umbrella Insurance Company
telecom: ph: 860-547-5001(WORK)
address: 680 Asylum Street Hartford CT 06155 US
Entry 5 - fullUrl = http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1
Resource DeviceRequest:
Resource DeviceRequest "PCT-DeviceRequest-1"
Profile: PCT GFE DeviceRequest
status: active
intent: proposal
code: KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (HCPCSReleaseCodeSets#L1820)
subject: Patient/patient1001 " BETTERHALF"