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

Example Bundle: PCT-GFE-Collection-Bundle-2

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

-TypeValueName
*Plan (Coverage Class Codes#plan)Premim Family PlusPremim Family Plus Plan

CostToBeneficiaries

-TypeValue[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

-SequenceDiagnosis[x]Type
*1Unspecified focal traumatic brain injuryPrincipal Diagnosis

Insurances

-SequenceFocalCoverage
*1trueCoverage: extension = No display for Extension ,No display for Extension ; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01

Totals

-ValueCurrency
*200USD

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

-SequenceDiagnosis[x]Type
*1Unspecified focal traumatic brain injuryPrincipal Diagnosis

Insurances

-SequenceFocalCoverage
*1trueCoverage: 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

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

-ValueCurrency
*200USD

Nets

-ValueCurrency
*200USD

Totals

-ValueCurrency
*200USD

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

-TypeValueName
*Plan (Coverage Class Codes#plan)Premim Family PlusPremim Family Plus Plan

CostToBeneficiaries

-TypeValue[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

-TypeValueName
*Plan (Coverage Class Codes#plan)Premim Family PlusPremim Family Plus Plan

CostToBeneficiaries

-TypeValue[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"