Patient Cost Transparency Implementation Guide Payer Capability Statement

Patient Cost Transparency Implementation Guide
2.0.0-draft - STU 2 - Draft United States of America flag

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-draft 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

CapabilityStatement: Patient Cost Transparency Implementation Guide Payer Capability Statement

Official URL: http://hl7.org/fhir/us/davinci-pct/CapabilityStatement/davinci-pct				Version: 2.0.0-draft
Standards status: Trial-use				Computable Name: PatientCostTransparencyCapabilityStatement
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.13.1
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

Payer capability statement for the Da Vinci Patient Cost Transparency Implementation Guide

Raw OpenAPI-Swagger Definition file | Download

Title:Patient Cost Transparency Implementation Guide Payer Capability Statement
Implementation Guide Version: 2.0.0-draft
FHIR Version: 4.0.1
Intended Use: Requirements
Supported Formats: SHALL support json; SHOULD support xml;
Published: 2023-03-28 14:21:32-0500
Published by: HL7 International / Financial Management
Status: Active
Copyright:
Used by permission of HL7 International, all rights reserved Creative Commons License

Description:

Payer capability statement for the Da Vinci Patient Cost Transparency Implementation Guide

Support and Requirements for Other Artifacts

Imports other capabilities:

US Core Server CapabilityStatement

Jump to:

REST Server

FHIR Server RESTful Capabilities

System-wide Server Capabilities

Summary of Resource/Profile Capabilities

♦ = SHALL expectation; ⋄ = SHOULD expectation; ▿ = MAY expectation;

Resource Type Supported Interactions Supported Profiles Supported Searches Supported _includes Supported _revincludes Supported Operations

Bundle create^▿, search-type^♦, read^♦, vread^▿, update^▿, patch^▿, delete^▿, history-instance^▿, history-type^▿, PCT AEOB Packet, PCT GFE Bundle, PCT GFE Packet, estimate-initiation-time^♦, estimate-service^♦, estimate-condition^♦, linking-identifier^♦, planned-period^♦, $GFESubmit^♦

ExplanationOfBenefit create^▿, search-type^♦, read^♦, vread^▿, update^▿, patch^▿, delete^▿, history-instance^▿, history-type^▿, PCT Advanced EOB^♦,

Coverage create^▿, search-type^♦, read^♦, vread^▿, update^▿, patch^▿, delete^▿, history-instance^▿, history-type^▿, PCT Coverage^♦,

Claim create^▿, search-type^♦, read^♦, vread^▿, update^▿, patch^▿, delete^▿, history-instance^▿, history-type^▿, PCT Good Faith Estimate Professional, PCT Good Faith Estimate Institutional,

Organization create^▿, search-type^♦, read^♦, vread^▿, update^▿, patch^▿, delete^▿, history-instance^▿, history-type^▿, PCT Organization^♦,

Practitioner create^▿, search-type^♦, read^♦, vread^▿, update^▿, patch^▿, delete^▿, history-instance^▿, history-type^▿, PCT Practitioner^♦,

RESTful Server Capabilities by Resource/Profile:

Bundle

Conformance Expectation:

Supported Profiles:

SHALL support PCT AEOB Packet

SHOULD support PCT GFE Bundle

SHOULD support PCT GFE Packet

Bundle Interaction Summary:

SHALL support search-type, read,

MAY support create, vread, update, patch, delete, history-instance, history-type,

Modify Criteria:

A Server MAY be capable of a create interaction creating a Bundle resource using: POST [base]/Bundle/[id]{?_format=[mime-type]}

A Server MAY be capable of updating a existing Bundle resource using: PUT [base]/Bundle/[id]{?_format=[mime-type]}

A Server MAY be capable of patching an existing Bundle resource using: PATCH [base]/Bundle/[id]{?_format=[mime-type]}

A Server MAY be capable of deleting a Bundle resource using: DELETE [base]//[id]

Fetch and Search Criteria:

A Server SHALL be capable of a search-type interaction returning Bundle resources matching a search query using: GET [base]/Bundle/[id]{?[parameters]{&_format=[mime-type]}}

A Server SHALL be capable of a read interaction returning a Bundle resource using: GET [base]/Bundle/[id]

A Server MAY be capable of a vread interaction returning a Bundle resource using: GET [base]/Bundle/[id]/_history/vid

A Server MAY be capable of a history-instance interaction returning a history of a Bundle using: GET [base]/Bundle/[id]/_history{?[parameters]&_format=[mime-type]}

A Server MAY be capable of a history-type interaction returning the history of Bundle resources using: GET [base]/Bundle/_history{?[parameters]&_format=[mime-type]}

Search Parameter Summary:

Conformance Parameter Type Example

SHALL estimate-initiation-time Date/DateTime GET [base]/Bundle?estimate-initiation-time=[dateTime]

SHALL estimate-service Token GET [base]/Bundle?estimate-service=[system]|[code]

SHALL estimate-condition Token GET [base]/Bundle?estimate-condition=[system]|[code]

SHALL linking-identifier Token GET [base]/Bundle?linking-identifier=[system]|[code]

SHALL planned-period Date/DateTime GET [base]/Bundle?planned-period=[dateTime]

Search Parameter Requirements (When Used Alone or in Combination):

estimate-initiation-time (Date/DateTime):
Instant from which the request originating request was being initiated.

estimate-service (Token):
Significant Procedures and/or products involved in an estimate in the packet.

estimate-condition (Token):
Significant condition involved in an estimate in the packet.

linking-identifier (Token):
An identifier assigned to a particular service or series of services to enabling linking.

planned-period (Date/DateTime):
Planned date(s) of a particular admission/service or a series of admissions/services.

ExplanationOfBenefit

Conformance Expectation:

Supported Profiles:

SHALL support PCT Advanced EOB

Modify Criteria:

A Server MAY be capable of a create interaction creating a ExplanationOfBenefit resource using: POST [base]/ExplanationOfBenefit/[id]{?_format=[mime-type]}

A Server MAY be capable of updating a existing ExplanationOfBenefit resource using: PUT [base]/ExplanationOfBenefit/[id]{?_format=[mime-type]}

A Server MAY be capable of patching an existing ExplanationOfBenefit resource using: PATCH [base]/ExplanationOfBenefit/[id]{?_format=[mime-type]}

A Server MAY be capable of deleting a ExplanationOfBenefit resource using: DELETE [base]//[id]

Fetch and Search Criteria:

A Server SHALL be capable of a search-type interaction returning ExplanationOfBenefit resources matching a search query using: GET [base]/ExplanationOfBenefit/[id]{?[parameters]{&_format=[mime-type]}}

A Server SHALL be capable of a read interaction returning a ExplanationOfBenefit resource using: GET [base]/ExplanationOfBenefit/[id]

A Server MAY be capable of a vread interaction returning a ExplanationOfBenefit resource using: GET [base]/ExplanationOfBenefit/[id]/_history/vid

A Server MAY be capable of a history-instance interaction returning a history of a ExplanationOfBenefit using: GET [base]/ExplanationOfBenefit/[id]/_history{?[parameters]&_format=[mime-type]}

A Server MAY be capable of a history-type interaction returning the history of ExplanationOfBenefit resources using: GET [base]/ExplanationOfBenefit/_history{?[parameters]&_format=[mime-type]}

Coverage

Conformance Expectation:

Supported Profiles:

SHALL support PCT Coverage

Modify Criteria:

A Server MAY be capable of a create interaction creating a Coverage resource using: POST [base]/Coverage/[id]{?_format=[mime-type]}

A Server MAY be capable of updating a existing Coverage resource using: PUT [base]/Coverage/[id]{?_format=[mime-type]}

A Server MAY be capable of patching an existing Coverage resource using: PATCH [base]/Coverage/[id]{?_format=[mime-type]}

A Server MAY be capable of deleting a Coverage resource using: DELETE [base]//[id]

Fetch and Search Criteria:

A Server SHALL be capable of a search-type interaction returning Coverage resources matching a search query using: GET [base]/Coverage/[id]{?[parameters]{&_format=[mime-type]}}

A Server SHALL be capable of a read interaction returning a Coverage resource using: GET [base]/Coverage/[id]

A Server MAY be capable of a vread interaction returning a Coverage resource using: GET [base]/Coverage/[id]/_history/vid

A Server MAY be capable of a history-instance interaction returning a history of a Coverage using: GET [base]/Coverage/[id]/_history{?[parameters]&_format=[mime-type]}

A Server MAY be capable of a history-type interaction returning the history of Coverage resources using: GET [base]/Coverage/_history{?[parameters]&_format=[mime-type]}

Claim

Conformance Expectation:

Supported Profiles:

SHALL support PCT Good Faith Estimate Professional

SHALL support PCT Good Faith Estimate Institutional

Modify Criteria:

A Server MAY be capable of a create interaction creating a Claim resource using: POST [base]/Claim/[id]{?_format=[mime-type]}

A Server MAY be capable of updating a existing Claim resource using: PUT [base]/Claim/[id]{?_format=[mime-type]}

A Server MAY be capable of patching an existing Claim resource using: PATCH [base]/Claim/[id]{?_format=[mime-type]}

A Server MAY be capable of deleting a Claim resource using: DELETE [base]//[id]

Fetch and Search Criteria:

A Server SHALL be capable of a search-type interaction returning Claim resources matching a search query using: GET [base]/Claim/[id]{?[parameters]{&_format=[mime-type]}}

A Server SHALL be capable of a read interaction returning a Claim resource using: GET [base]/Claim/[id]

A Server MAY be capable of a vread interaction returning a Claim resource using: GET [base]/Claim/[id]/_history/vid

A Server MAY be capable of a history-instance interaction returning a history of a Claim using: GET [base]/Claim/[id]/_history{?[parameters]&_format=[mime-type]}

A Server MAY be capable of a history-type interaction returning the history of Claim resources using: GET [base]/Claim/_history{?[parameters]&_format=[mime-type]}

Organization

Conformance Expectation:

Supported Profiles:

SHALL support PCT Organization

Modify Criteria:

A Server MAY be capable of a create interaction creating a Organization resource using: POST [base]/Organization/[id]{?_format=[mime-type]}

A Server MAY be capable of updating a existing Organization resource using: PUT [base]/Organization/[id]{?_format=[mime-type]}

A Server MAY be capable of patching an existing Organization resource using: PATCH [base]/Organization/[id]{?_format=[mime-type]}

A Server MAY be capable of deleting a Organization resource using: DELETE [base]//[id]

Fetch and Search Criteria:

A Server SHALL be capable of a search-type interaction returning Organization resources matching a search query using: GET [base]/Organization/[id]{?[parameters]{&_format=[mime-type]}}

A Server SHALL be capable of a read interaction returning a Organization resource using: GET [base]/Organization/[id]

A Server MAY be capable of a vread interaction returning a Organization resource using: GET [base]/Organization/[id]/_history/vid

A Server MAY be capable of a history-instance interaction returning a history of a Organization using: GET [base]/Organization/[id]/_history{?[parameters]&_format=[mime-type]}

A Server MAY be capable of a history-type interaction returning the history of Organization resources using: GET [base]/Organization/_history{?[parameters]&_format=[mime-type]}

Practitioner

Conformance Expectation:

Supported Profiles:

SHALL support PCT Practitioner

Modify Criteria:

A Server MAY be capable of a create interaction creating a Practitioner resource using: POST [base]/Practitioner/[id]{?_format=[mime-type]}

A Server MAY be capable of updating a existing Practitioner resource using: PUT [base]/Practitioner/[id]{?_format=[mime-type]}

A Server MAY be capable of patching an existing Practitioner resource using: PATCH [base]/Practitioner/[id]{?_format=[mime-type]}

A Server MAY be capable of deleting a Practitioner resource using: DELETE [base]//[id]

Fetch and Search Criteria:

A Server SHALL be capable of a search-type interaction returning Practitioner resources matching a search query using: GET [base]/Practitioner/[id]{?[parameters]{&_format=[mime-type]}}

A Server SHALL be capable of a read interaction returning a Practitioner resource using: GET [base]/Practitioner/[id]

A Server MAY be capable of a vread interaction returning a Practitioner resource using: GET [base]/Practitioner/[id]/_history/vid

A Server MAY be capable of a history-instance interaction returning a history of a Practitioner using: GET [base]/Practitioner/[id]/_history{?[parameters]&_format=[mime-type]}

A Server MAY be capable of a history-type interaction returning the history of Practitioner resources using: GET [base]/Practitioner/_history{?[parameters]&_format=[mime-type]}