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

Resource Profile: PCT GFE Document Bundle

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-document-bundle Version: 2.0.0-draft
Standards status: Trial-use Maturity Level: 1 Computable Name: PCTGFEDocumentBundle
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.58

PCT GFE Document Bundle that contains GFE Bundles from GFE contributors. This collection of GFE Bundles from GFE contributors that can then be made available to the patient or sent to a payer for insurance estimation. The scope of this guide does not include coordination of benefits or more than one coverage. This does not serve as a replacement for eligibility, prior authorization or other financial and administrative use cases.

Usage:

Changes since version 1.1.0:

  • New Content
  • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Bundle C 0..* Bundle Contains a collection of resources
    bdl-1: total only when a search or history
    bdl-2: entry.search only when a search
    bdl-3: entry.request mandatory for batch/transaction/history, otherwise prohibited
    bdl-4: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
    bdl-7: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
    bdl-9: A document must have an identifier with a system and a value
    bdl-10: A document must have a date
    bdl-11: A document must have a Composition as the first resource
    bdl-12: A message must have a MessageHeader as the first resource
    pct-gfe-document-bundle-1: SHALL have a initiating provider or initiating organization, but not both.
    pct-gfe-document-bundle-2: All references resources SHALL be contained within the Bundle
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... identifier Σ 1..1 Identifier Persistent identifier for the bundle
    ele-1: All FHIR elements must have a @value or children
    ... type Σ 1..1 code document | message | transaction | transaction-response | batch | batch-response | history | searchset | collection
    Binding: BundleType (required): Indicates the purpose of a bundle - how it is intended to be used.


    ele-1: All FHIR elements must have a @value or children
    Fixed Value: document
    ... timestamp Σ 1..1 instant When the bundle was assembled
    ele-1: All FHIR elements must have a @value or children
    ... Slices for entry ΣC 2..* BackboneElement Entry in the bundle - will have a resource or information
    Slice: Unordered, Open by type:resource
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    .... entry:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    .... entry:composition SΣC 1..1 BackboneElement SHALL have a PCTGFEComposition resource
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource 1..1 PCTGFEComposition A set of resources composed into a single coherent clinical statement with clinical attestation
    .... entry:patient ΣC 1..2 BackboneElement SHALL have the patient subject of care and may have a separate subscriber
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource 1..1 HRexPatientDemographics Information about an individual or animal receiving health care services
    .... entry:coverage SΣC 0..1 BackboneElement MAY have one Coverage. SHALL be present submitted to a payer in the $gfe-submit operation.
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource 1..1 PCTCoverage Insurance or medical plan or a payment agreement
    .... entry:organization SΣC 0..2 BackboneElement SHALL have an initiating provider or initiating organization, but not both. May also have a payer organization. Payer Organization SHALL be present when being submitted to a payer in the $gfe-submit operation.
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource 1..1 PCTOrganization A grouping of people or organizations with a common purpose
    .... entry:practitioner SΣC 0..1 BackboneElement SHALL have a initiating provider or initiating organization, but not both.
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource 1..1 PCTPractitioner A person with a formal responsibility in the provisioning of healthcare or related services
    .... entry:gfe-bundle SΣC 0..* BackboneElement MAY include GFE contributor specific GFE bundle and MAY include bundle(s) with information about a unfulfilled GFE request
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource 1..1 PCTGFEBundle, PCTGFEMissingBundle Contains a collection of resources
    .... entry:attachment SΣC 0..* BackboneElement MAY have attachments as DocumentReference resource(s)
    bdl-5: must be a resource unless there's a request or response
    bdl-8: fullUrl cannot be a version specific reference
    ele-1: All FHIR elements must have a @value or children
    This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... fullUrl Σ 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID)
    ele-1: All FHIR elements must have a @value or children
    ..... resource Σ 1..1 DocumentReference A resource in the bundle

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Bundle.typerequiredFixed Value: document
    http://hl7.org/fhir/ValueSet/bundle-type|4.0.1
    from the FHIR Standard
    Bundle.entry.request.methodrequiredHTTPVerb
    http://hl7.org/fhir/ValueSet/http-verb|4.0.1
    from the FHIR Standard
    Bundle.entry:attachment.request.methodrequiredHTTPVerb
    http://hl7.org/fhir/ValueSet/http-verb|4.0.1
    from the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    pct-gfe-document-bundle-1errorBundleSHALL have a initiating provider or initiating organization, but not both.
    : Bundle.entry.resource.ofType(Practitioner).exists() or Bundle.entry.resource.ofType(Organization).exists()
    pct-gfe-document-bundle-2errorBundleAll references resources SHALL be contained within the Bundle
    : Bundle.entry.resource.descendants().reference.where($this.startsWith('#').not()).all((%resource.entry.fullUrl.join('|')&'|').contains(($this&'|')))

     

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