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

Resource Profile: PCT Good Faith Estimate Institutional

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTGFEInstitutional
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.12

PCT Good Faith Estimate Institutional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for an institutional GFE submission.

Notes on Fields

  • The estimated service date, when available at the header level, is placed in Claim.billablePeriod. If the estimated date of service is available at the line level is placed in Claim.item.serviced[x].

Examples of .providerEventMethodology usage examples below:

Example 1 – A provider is offering both a surgical and a drug therapy-based option to the patient. The provider can add text such as "Surgical care option" and "Drug therapy option" to the Good Faith Estimate (GFE) so that the patient could easily understand the options without having to understand different CPT codes.
    Example 2 – A provider added services to a previously submitted GFE. They would be able to add "Added physical therapist on Sep 18, ignore estimates submitted on Sep 17".

Usage:

Formal Views of Profile Content

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

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim Claim
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
... providerEventMethodology S 0..1 string Provider event collection methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
... Slices for identifier 1..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PLAC
....... display 1..1 string Representation defined by the system
Fixed Value: Placer Identifier
..... system S 0..1 uri The namespace for the identifier value
..... value 1..1 string The value that is unique
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... type 1..1 CodeableConcept Category or discipline
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
... use 1..1 code claim | preauthorization | predetermination
Required Pattern: predetermination
... patient 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod S 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
... insurer S 0..1 Reference(PCT Organization) Required if insured estimate
... provider 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
.... extension 1..* Extension Extension
.... providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
Binding: US Core Provider Role (NUCC) (extensible)
.... consentForBalanceBilling S 0..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
... priority 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... payee S 0..1 BackboneElement Recipient of benefits payable
.... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
... referral
.... extension 1..* Extension Extension
.... referralNumber 1..1 string Referral Number
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
... Slices for supportingInfo S 1..* BackboneElement Supporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:All Slices Content/Rules for all slices
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: PCT Supporting Info Type Value Set (extensible)
.... supportingInfo:typeOfBill 1..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: typeofbill
..... code 1..1 CodeableConcept Type of information
Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
.... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: servicefacility
..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
.... supportingInfo:drg 0..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drg
..... code 0..1 CodeableConcept Type of information
Binding: US Claim DRG Codes (required)
.... supportingInfo:pointoforigin 0..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pointoforigin
..... code 0..1 CodeableConcept Type of information
Binding: NUBC Point Of Origin (required)
.... supportingInfo:admtype 0..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admtype
..... code 0..1 CodeableConcept Type of information
Binding: NUBC Priority (Type) of Admission or Visit (required)
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type 1..1 CodeableConcept Category of Procedure
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance
.... coverage 1..1 Reference(PCT Coverage) Insurance information
..... dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.

.... preAuthRef 0..1 string Prior authorization reference number
... accident
.... location[x] 0..1 Address Where the event occurred
..... country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
Binding: Iso3166-1-2 (required)
... item 1..999 BackboneElement Product or service provided
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
.... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
.... ProviderEventMethodology S 0..1 string Provider Event Methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
.... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
Binding: PCT GFE NUBC Revenue Value Set (required)
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Claim Medical Product or Service Value Set (required)
.... modifier S 0..4 CodeableConcept Product or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... serviced[x] S 1..1 date, Period This is the planned or estimated date(s)s of service
.... Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
Slice: Unordered, Open by type:$this
..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
Binding: PCT GFE CMS Place of Service Value Set (required)
.... quantity 1..1 SimpleQuantity Count of products or services
.... net 1..1 Money Total charge amount for the service line
.... detail S 0..* BackboneElement Drug Identification Information
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PCT GFE Item NDC Value Set (required)
..... quantity S 0..1 SimpleQuantity Count of products or services
... total 1..1 Money Total GFE Charges Submitted

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.supportingInfo.categoryextensiblePCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS
from this IG
Claim.supportingInfo:typeOfBill.coderequiredPCTGFETypeOfBillVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFETypeOfBillVS
from this IG
Claim.supportingInfo:drg.coderequiredUSClaimDRGCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimDRGCodes
from this IG
Claim.supportingInfo:pointoforigin.coderequiredAHANUBCPointOfOriginVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPointOfOriginVS
from this IG
Claim.supportingInfo:admtype.coderequiredAHANUBCPriorityTypeOfAdmissionOrVisitVS (a valid code from http://terminology.hl7.org/CodeSystem/AHANUBCPriorityTypeOfAdmitOrVisit)
http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisitVS
from this IG
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.accident.location[x].countryrequiredIso3166-1-2
http://hl7.org/fhir/ValueSet/iso3166-1-2
from the FHIR Standard
Claim.item.revenuerequiredPCTGFEItemRevenueVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS
from this IG
Claim.item.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
from this IG
Claim.item.modifierrequiredPCTGFEItemCptHcpcsVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS
from this IG
Claim.item.location[x]:locationCodeableConceptrequiredPCTGFECMSPOS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS
from this IG
Claim.item.detail.productOrServicerequiredPCTGFEItemNDCVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemNDCVS
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 1..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PLAC
....... display 1..1 string Representation defined by the system
Fixed Value: Placer Identifier
..... system SΣ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
... created Σ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(PCT Organization) Required if insured estimate
... provider Σ 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
Binding: US Core Provider Role (NUCC) (extensible)
.... consentForBalanceBilling S 0..1 boolean Extension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... payee S 0..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
... Slices for supportingInfo S 1..* BackboneElement Supporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: PCT Supporting Info Type Value Set (extensible)
.... supportingInfo:typeOfBill 1..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: typeofbill
..... code 1..1 CodeableConcept Type of information
Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
.... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: servicefacility
..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
Slice: Unordered, Closed by type:$this
...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
.... supportingInfo:drg 0..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: drg
..... code 0..1 CodeableConcept Type of information
Binding: US Claim DRG Codes (required)
.... supportingInfo:pointoforigin 0..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pointoforigin
..... code 0..1 CodeableConcept Type of information
Binding: NUBC Point Of Origin (required)
.... supportingInfo:admtype 0..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admtype
..... code 0..1 CodeableConcept Type of information
Binding: NUBC Priority (Type) of Admission or Visit (required)
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
..... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConcept CodeableConcept
...... procedureReference Reference(Procedure)
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
..... dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


.... preAuthRef 0..1 string Prior authorization reference number
... item 1..999 BackboneElement Product or service provided
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
.... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
.... ProviderEventMethodology S 0..1 string Provider Event Methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
Binding: PCT GFE NUBC Revenue Value Set (required)
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Claim Medical Product or Service Value Set (required)
.... modifier S 0..4 CodeableConcept Product or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... serviced[x] S 1..1 This is the planned or estimated date(s)s of service
..... servicedDate date
..... servicedPeriod Period
.... Slices for location[x] 0..1 Place of service or where product was supplied
Slice: Unordered, Open by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
Binding: PCT GFE CMS Place of Service Value Set (required)
.... quantity 1..1 SimpleQuantity Count of products or services
.... net 1..1 Money Total charge amount for the service line
.... detail S 0..* BackboneElement Drug Identification Information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PCT GFE Item NDC Value Set (required)
..... quantity S 0..1 SimpleQuantity Count of products or services
... total 1..1 Money Total GFE Charges Submitted

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.identifier:PLAC.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Claim.identifier:PLAC.typeextensiblePattern: PLAC("Placer Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Claim.identifier:INTER.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Claim.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: institutional
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.userequiredPattern: predetermination
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.roleexamplePattern: attending
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:attending.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:operating.roleexamplePattern: operating
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:rendering.roleexamplePattern: rendering
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:referring.roleexamplePattern: referring
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.supportingInfo.categoryextensiblePCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS
from this IG
Claim.supportingInfo:typeOfBill.categoryexamplePattern: typeofbill
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:typeOfBill.coderequiredPCTGFETypeOfBillVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFETypeOfBillVS
from this IG
Claim.supportingInfo:serviceFacility.categoryexamplePattern: servicefacility
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:drg.categoryexamplePattern: drg
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:drg.coderequiredUSClaimDRGCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimDRGCodes
from this IG
Claim.supportingInfo:pointoforigin.categoryexamplePattern: pointoforigin
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:pointoforigin.coderequiredAHANUBCPointOfOriginVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPointOfOriginVS
from this IG
Claim.supportingInfo:admtype.categoryexamplePattern: admtype
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:admtype.coderequiredAHANUBCPriorityTypeOfAdmissionOrVisitVS (a valid code from http://terminology.hl7.org/CodeSystem/AHANUBCPriorityTypeOfAdmitOrVisit)
http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisitVS
from this IG
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.typeexamplePattern: admitting
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.typeexamplePattern: patientReasonForVisit
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.typeexamplePattern: externalCauseOfInjury
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.procedure:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.item.revenuerequiredPCTGFEItemRevenueVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS
from this IG
Claim.item.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
from this IG
Claim.item.modifierrequiredPCTGFEItemCptHcpcsVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS
from this IG
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.location[x]:locationCodeableConceptrequiredPCTGFECMSPOS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS
from this IG
Claim.item.detail.productOrServicerequiredPCTGFEItemNDCVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemNDCVS
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
... providerEventMethodology S 0..1 string Provider event collection methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 1..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PLAC
....... display 1..1 string Representation defined by the system
Fixed Value: Placer Identifier
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: institutional
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
... created Σ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(