Patient Cost Transparency Implementation Guide
2.0.0 - STU 2
Patient Cost Transparency Implementation Guide
2.0.0 - STU 2
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 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
| Page standards status: Trial-use | Maturity Level: 2 |
{
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CapabilityStatement davinci-pct</b></p><a name=\"davinci-pct\"> </a><a name=\"hcdavinci-pct\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 1; Last updated: 2023-03-28 19:21:32+0000</p></div><h2 id=\"title\">Patient Cost Transparency Implementation Guide Payer Capability Statement</h2><ul><li>Implementation Guide Version: 2.0.0 </li><li>FHIR Version: 4.0.1 </li><li>Supported Formats: <strong>SHALL</strong> support <code>json</code>, <strong>SHOULD</strong> support <code>xml</code></li><li>Published on: 2023-03-28 14:21:32-0500 </li><li>Published by: HL7 International / Financial Management </li></ul><blockquote class=\"impl-note\"><p><strong>Note to Implementers: FHIR Capabilities</strong></p><p>Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.</p></blockquote><p>This CapabilityStatement imports the CapabilityStatement <a href=\"http://hl7.org/fhir/us/core/STU7/CapabilityStatement-us-core-server.html\">US Core Server CapabilityStatementversion: null7.0.0)</a></p><h2 id=\"rest\">FHIR RESTful Capabilities</h2><div class=\"panel panel-default\"><div class=\"panel-heading\"><h3 id=\"mode1\" class=\"panel-title\">Mode: <code>server</code></h3></div><div class=\"panel-body\"/></div><h3 id=\"resourcesCap1\">Capabilities by Resource/Profile</h3><h4 id=\"resourcesSummary1\">Summary</h4><p>The summary table lists the resources that are part of this configuration, and for each resource it lists:</p><ul><li>The relevant profiles (if any)</li><li>The interactions supported by each resource (<b><span class=\"bg-info\">R</span></b>ead, <b><span class=\"bg-info\">S</span></b>earch, <b><span class=\"bg-info\">U</span></b>pdate, and <b><span class=\"bg-info\">C</span></b>reate, are always shown, while <b><span class=\"bg-info\">VR</span></b>ead, <b><span class=\"bg-info\">P</span></b>atch, <b><span class=\"bg-info\">D</span></b>elete, <b><span class=\"bg-info\">H</span></b>istory on <b><span class=\"bg-info\">I</span></b>nstance, or <b><span class=\"bg-info\">H</span></b>istory on <b><span class=\"bg-info\">T</span></b>ype are only present if at least one of the resources has support for them.</li><li><span>The required, recommended, and some optional search parameters (if any). </span></li><li>The linked resources enabled for <code>_include</code></li><li>The other resources enabled for <code>_revinclude</code></li><li>The operations on the resource (if any)</li></ul><div class=\"table-responsive\"><table class=\"table table-condensed table-hover\"><thead><tr><th><b>Resource Type</b></th><th><b>Profile</b></th><th class=\"text-center\"><b title=\"GET a resource (read interaction)\">R</b></th><th class=\"text-center\"><b title=\"GET past versions of resources (vread interaction)\">V-R</b></th><th class=\"text-center\"><b title=\"GET all set of resources of the type (search interaction)\">S</b></th><th class=\"text-center\"><b title=\"PUT a new resource version (update interaction)\">U</b></th><th class=\"text-center\"><b title=\"PATCH a new resource version (patch interaction)\">P</b></th><th class=\"text-center\"><b title=\"POST a new resource (create interaction)\">C</b></th><th class=\"text-center\"><b title=\"DELETE a resource (delete interaction)\">D</b></th><th class=\"text-center\"><b title=\"GET changes to a resource (history interaction on instance)\">H-I</b></th><th class=\"text-center\"><b title=\"GET changes for all resources of the type (history interaction on type)\">H-T</b></th><th><b title=\"Required and recommended search parameters\">Searches</b></th><th><code><b>_include</b></code></th><th><code><b>_revinclude</b></code></th><th><b>Operations</b></th></tr></thead><tbody><tr><td><a href=\"#DocumentReference1-1\">DocumentReference</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-aeob-documentreference.html\">PCT AEOB Packet Document Reference</a><br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-gfe-bundle.html\">PCT GFE Bundle</a><br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-gfe-packet.html\">PCT GFE Packet</a></td><td class=\"text-center\"><span title=\"SHOULD\">Y</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"SHOULD\">Y</span></td><td class=\"text-center\"/><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"/><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span><span title=\"MAY\">y?</span></td><td>category, status, doc-status, type, date, patient, estimate-initiation-time, estimate-service, estimate-condition, linking-identifier, planned-period, author, relatesto</td><td/><td/><td><code>$GFESubmit</code></td></tr><tr><td><a href=\"#ExplanationOfBenefit1-2\">ExplanationOfBenefit</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-aeob.html\">PCT Advanced EOB</a></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td/><td/><td/><td/></tr><tr><td><a href=\"#Coverage1-3\">Coverage</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-coverage.html\">PCT Coverage</a></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td/><td/><td/><td/></tr><tr><td><a href=\"#Claim1-4\">Claim</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-gfe-professional.html\">PCT Good Faith Estimate Professional</a><br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-gfe-institutional.html\">PCT Good Faith Estimate Institutional</a></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td/><td/><td/><td/></tr><tr><td><a href=\"#Organization1-5\">Organization</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-organization.html\">PCT Organization</a></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td/><td/><td/><td/></tr><tr><td><a href=\"#Practitioner1-6\">Practitioner</a></td><td>Supported Profiles<br/>\u00a0\u00a0<a href=\"StructureDefinition-davinci-pct-practitioner.html\">PCT Practitioner</a></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"SHALL\"><b>Y</b></span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td class=\"text-center\"><span title=\"MAY\">y?</span></td><td/><td/><td/><td/></tr></tbody></table></div><hr/><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"DocumentReference1-1\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHOULD </span>DocumentReference</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/documentreference.html\">DocumentReference</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHOULD</strong> support <code>search-type</code>, <code>read</code>.</li><li><strong>MAY</strong> support <code>vread</code>, <code>history-instance</code>, <code>history-type</code>, <code>patch</code>, <code>delete</code>, <code>history-instance</code>, <code>history-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-davinci-pct-aeob-documentreference.html\">PCT AEOB Packet Document Reference</a><br/><a href=\"StructureDefinition-davinci-pct-gfe-bundle.html\">PCT GFE Bundle</a><br/><a href=\"StructureDefinition-davinci-pct-gfe-packet.html\">PCT GFE Packet</a></p></div></div><p/><div class=\"row\"><div class=\"col-lg-7\"><span class=\"lead\">Search Parameters</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">category</a></td><td><code>token</code></td><td><div><p>Categorization of document.</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">status</a></td><td><code>token</code></td><td><div><p>current | superseded | entered-in-error</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"SearchParameter-DocumentReference-doc-status.html\">doc-status</a></td><td><code>token</code></td><td><div><p>preliminary | final | amended | entered-in-error</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">type</a></td><td><code>token</code></td><td><div><p>Kind of document</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">date</a></td><td><code>date</code></td><td><div><p>Kind of document</p>\n</div></td></tr><tr><td><b>SHALL</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">patient</a></td><td><code>reference</code></td><td><div><p>Who/what is the subject of the document</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-packet-request-initiation-time.html\">estimate-initiation-time</a></td><td><code>date</code></td><td><div><p>Instant from which the request originating request was being initiated.</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-packet-procedure-or-service.html\">estimate-service</a></td><td><code>token</code></td><td><div><p>Significant Procedures and/or products involved in an estimate in the packet.</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-packet-condition.html\">estimate-condition</a></td><td><code>token</code></td><td><div><p>Significant condition involved in an estimate in the packet.</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-packet-linking-identifier.html\">linking-identifier</a></td><td><code>token</code></td><td><div><p>An identifier assigned to a particular service or series of services to enabling linking.</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"SearchParameter-packet-PlannedPeriodOfService.html\">planned-period</a></td><td><code>date</code></td><td><div><p>Planned date(s) of a particular admission/service or a series of admissions/services.</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">author</a></td><td><code>reference</code></td><td><div><p>All involved authoring parties, including payer all Good Faith Estimate (GFE) providers.</p>\n</div></td></tr><tr><td><b>SHOULD</b></td><td><a href=\"http://hl7.org/fhir/R4/documentreference.html#search\">relatesto</a></td><td><code>reference</code></td><td><div><p>Target of the relationship.</p>\n</div></td></tr></tbody></table></div><div class=\"col-lg-5\">\u00a0</div></div><div class=\"row\"><div class=\"col-12\"><span class=\"lead\">Extended Operations</span><table class=\"table table-condensed table-hover\"><thead><tr><th>Conformance</th><th>Operation</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href=\"OperationDefinition-GFE-submit.html\">$GFESubmit</a></td><td><div><p>This operation is used by an entity to submit one or multiple GFEs as a Bundle containing the GFE(s) and other referenced resources for processing. The only input parameter is the single Bundle resource with one or multiple GFE(s) - each of which is based on the Claim resource (along with other referenced resources). The only output is a url for subsequent polling per <a href=\"https://hl7.org/fhir/R5/async-bundle.html\">async pattern</a>. If after polling the response is complete, then the result will either be a single Bundle with the AEOB - which is based on the ExplanationOfBenefit resource, (and other referenced resources) or an OperationOutcome resource indicating the AEOB will be sent directly to the patient.</p>\n</div></td></tr></tbody></table></div></div></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"ExplanationOfBenefit1-2\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHOULD </span>ExplanationOfBenefit</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/explanationofbenefit.html\">ExplanationOfBenefit</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>search-type</code>, <code>read</code>.</li><li><strong>MAY</strong> support <code>create</code>, <code>vread</code>, <code>update</code>, <code>patch</code>, <code>delete</code>, <code>history-instance</code>, <code>history-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-davinci-pct-aeob.html\">PCT Advanced EOB</a></p></div></div><p/></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"Coverage1-3\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHOULD </span>Coverage</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/coverage.html\">Coverage</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>search-type</code>, <code>read</code>.</li><li><strong>MAY</strong> support <code>create</code>, <code>vread</code>, <code>update</code>, <code>patch</code>, <code>delete</code>, <code>history-instance</code>, <code>history-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-davinci-pct-coverage.html\">PCT Coverage</a></p></div></div><p/></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"Claim1-4\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHOULD </span>Claim</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/claim.html\">Claim</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>search-type</code>, <code>read</code>.</li><li><strong>MAY</strong> support <code>create</code>, <code>vread</code>, <code>update</code>, <code>patch</code>, <code>delete</code>, <code>history-instance</code>, <code>history-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-davinci-pct-gfe-professional.html\">PCT Good Faith Estimate Professional</a><br/><a href=\"StructureDefinition-davinci-pct-gfe-institutional.html\">PCT Good Faith Estimate Institutional</a></p></div></div><p/></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"Organization1-5\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHOULD </span>Organization</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/organization.html\">Organization</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>search-type</code>, <code>read</code>.</li><li><strong>MAY</strong> support <code>create</code>, <code>vread</code>, <code>update</code>, <code>patch</code>, <code>delete</code>, <code>history-instance</code>, <code>history-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-davinci-pct-organization.html\">PCT Organization</a></p></div></div><p/></div></div></div><div class=\"panel panel-default\"><div class=\"panel-heading\"><h4 id=\"Practitioner1-6\" class=\"panel-title\"><span style=\"float: right;\">Resource Conformance: SHOULD </span>Practitioner</h4></div><div class=\"panel-body\"><div class=\"container\"><div class=\"row\"><div class=\"col-lg-4\"><span class=\"lead\">Core FHIR Resource</span><br/><a href=\"http://hl7.org/fhir/R4/practitioner.html\">Practitioner</a></div><div class=\"col-lg-4\"><span class=\"lead\">Reference Policy</span><br/></div><div class=\"col-lg-4\"><span class=\"lead\">Interaction summary</span><br/><ul><li><strong>SHALL</strong> support <code>search-type</code>, <code>read</code>.</li><li><strong>MAY</strong> support <code>create</code>, <code>vread</code>, <code>update</code>, <code>patch</code>, <code>delete</code>, <code>history-instance</code>, <code>history-type</code>.</li></ul></div></div><p/><div class=\"row\"><div class=\"col-6\"><span class=\"lead\">Supported Profiles</span><p><a href=\"StructureDefinition-davinci-pct-practitioner.html\">PCT Practitioner</a></p></div></div><p/></div></div></div></div>"
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