Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot 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-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 ExplanationOfBenefit: PCT-AEOB-Summary-1

Page standards status: Informative

Generated Narrative: ExplanationOfBenefit

Resource ExplanationOfBenefit "PCT-AEOB-Summary-1"

Profile: PCT Advanced EOB Summary

Service Description: Example service

In Network Provider Options Link: http://example.com/out-of-network.html

status: active

type: Estimate Summary (PCT Estimate Type Code System#estimate-summary)

use: predetermination

patient: Patient/patient1001 " BETTERHALF"

billablePeriod: 2022-01-01 --> 2022-01-01

created: 2021-10-12

insurer: Organization/org1001 "Umbrella Insurance Company"

provider: ??

outcome: complete

Insurances

-FocalCoverage
*trueCoverage/coverage1001

total

category: Submitted Amount (Adjudication Value Codes#submitted)

Amounts

-ValueCurrency
*200USD

ProcessNotes

-ExtensionText
*processNote disclaimer text

benefitPeriod: 2022-01-01 --> 2022-01-01

benefitBalance

category: Medical Care (X12 Service Type Codes#1)

unit: Individual (Unit Type Codes#individual)

term: Annual (Benefit Term Codes#annual)

Financials

-ExtensionTypeAllowed[x]Used[x]
*Allowed (PCT Financial Type Code System#allowed)$1.00 (USD)$1.00 (USD)