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

CodeSystem: PCT Document Types

Official URL: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse Version: 2.0.0-draft
Standards status: Trial-use Computable Name: PCTDocumentTypeTemporaryTrialUse
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.16.23

Copyright/Legal: This CodeSystem is not copyrighted.

Defining codes for types and categories of documents and collections used for Patient Cost Transparency estimates. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as LOINC, which will result in a code system url change and possibly modified codes and definitions.

This Code system is referenced in the content logical definition of the following value sets:

  • This CodeSystem is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Changes since version 1.1.0:

  • New Content

    • This case-sensitive code system http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse defines the following codes:

    CodeDisplayDefinition
    gfe-packet GFE Packet A Good Faith Estimate (GFE) Packet providing a notification of reasonably expected charges and billing codes for a scheduled or requested item or service. This document type bundle may contain one or more individual GFE (Claim) resources.
    gfe-bundle GFE Bundle A Good Faith Estimate (GFE) Bundle GFE Bundle that contains all resources for a Good faith estimate submitted by a single GFE contributing provider. Organizations for both the provider and payer MAY be included. This single contributing provider GFE Bundle may be included in a set of GFE bundles from other providers in a GFE Packet that can then be made available to the patient or sent to a payer for insurance estimation.
    gfe-information-bundle GFE Information Bundle A Good Faith Estimate (GFE) Informational Bundle that contains the information necessary for GFE contributors to create their estimates. This bundle may for all GFE Contributors or specific to a single contributor and may include, but is not limited to, the Patient Resource, request resources (such as ServiceRequest, MedicationRequest, and DeviceRequest), Service location information, Coverage and Payer Organization resources (if applicable).
    aeob-packet AEOB Packet An Advanced Explanation of Benefit (AEOB) Packet providing a notification of reasonably expected charges and billing codes provided by a payer according to the member benefits in relation a Good Faith Estimate (GFE) supplied by one or more providers for a given period of service. AEOBs need to include which providers are expected to provide treatment, the network status of providers, good faith estimates of cost, cost-sharing and progress towards meeting deductibles and out-of-pocket maximums, as well as whether a service is subject to medical management and relevant disclaimers of estimates; for example, the disclaimer might state that the information provided in the notification is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) and is subject to change.
    estimate Estimation Packet An estimate of healthcare services, products, costs and/or benefits.
    pct-gfe-packet PCT GFE Packet Patient Cost Transparency (PCT) Good Faith Estimate (GFE) Packet bundle that contains GFE Bundles from GFE contributors.
    pct-aeob-packet PCT AEOB Packet Patient Cost Transparency (PCT) Advanced Explanation of Benefit (AEOB) Packet PCT AEOB Packet that contains product and service estimations provided by a payer based on a provider submitted Good Faith Estimate (GFE) and a members coverage and benefits.