Patient Cost Transparency Implementation Guide
1.0.0 - STU 1 United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International - Financial Management Work Group. This is not an authorized publication; it is the continuous build for version 1.0.0). 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: 1.0.0
Active as of 2023-03-29 Computable Name: PCTGFEInstitutional

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 0..*ClaimClaim, Pre-determination or Pre-authorization
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeSubmitter 1..1Reference()The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter
... gfeServiceLinkingInfo S0..1(Complex)GFE Service Linking Information.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
... gfeDisclaimer S0..*stringDisclaimers the patient should be made aware of regarding the providers estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... Slices for identifier 1..*IdentifierBusiness Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:PLAC 1..1IdentifierProvider Assigned Identifier for GFE Claim
..... type 1..1CodeableConceptDescription of identifier
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
....... display1..1stringRepresentation defined by the system
Fixed Value: Placer Identifier
..... system S0..1uriThe namespace for the identifier value
..... value 1..1stringThe value that is unique
.... identifier:INTER 0..*IdentifierIntermediary System Identifier
..... type 1..1CodeableConceptDescription of identifier
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: INTER
....... display1..1stringRepresentation defined by the system
Fixed Value: Intermediary System Identifier
... type 1..1CodeableConceptCategory or discipline
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: institutional
... use 1..1codeclaim | preauthorization | predetermination
Required Pattern: predetermination
... patient 1..1Reference(HRex Patient Demographics)The recipient of the products and services
... billablePeriod S0..1PeriodRelevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
... insurer 1..1Reference(PCT Organization)Target
... provider 1..1Reference(PCT Organization)Billing provider - party responsible for the GFE
.... extension 1..*ExtensionExtension
.... providerTaxonomy 1..1CodeableConceptProvider 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 S0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
... priority 1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (required)
... payee S0..1BackboneElementRecipient of benefits payable
.... party 0..1Reference(PCT Practitioner | PCT Organization)Recipient reference
... referral
.... extension 1..*ExtensionExtension
.... referralNumber 1..1stringReferral Number
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
... Slices for careTeam S0..*BackboneElementMembers of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... provider 1..1Reference(PCT Practitioner | PCT Organization)Practitioner or organization
..... role 1..1CodeableConceptFunction within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S0..1BackboneElementMembers of the care team
..... provider 1..1Reference(PCT Practitioner)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1CodeableConceptPractitioner credential or specialization
.... careTeam:operating S0..2BackboneElementMembers of the care team
..... provider 1..1Reference(PCT Practitioner)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S0..1BackboneElementMembers of the care team
..... provider 1..1Reference(PCT Practitioner)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S0..1BackboneElementMembers of the care team
..... role 0..1CodeableConceptFunction within the team
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: referring
... Slices for supportingInfo S1..*BackboneElementSupporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:All Slices Content/Rules for all slices
..... category 1..1CodeableConceptClassification of the supplied information
Binding: PCT Supporting Info Type Value Set (extensible)
.... supportingInfo:typeOfBill 1..1BackboneElementSupporting information
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: typeofbill
..... code 1..1CodeableConceptType of information
Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
.... supportingInfo:serviceFacility S0..1BackboneElementService Facility
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: servicefacility
..... value[x] 1..1Reference(Resource)Data to be provided
Slice: Unordered, Open by type:$this
..... valueReference 1..1Reference(PCT Organization)Data to be provided
.... supportingInfo:drg 0..1BackboneElementSupporting information
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: drg
..... code 0..1CodeableConceptType of information
Binding: US Claim DRG Codes (required)
.... supportingInfo:pointoforigin 0..1BackboneElementSupporting information
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: pointoforigin
..... code 0..1CodeableConceptType of information
Binding: NUBC Point Of Origin (required)
.... supportingInfo:admtype 0..1BackboneElementSupporting information
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admtype
..... code 0..1CodeableConceptType of information
Binding: NUBC Priority (Type) of Admission or Visit (required)
... Slices for diagnosis S1..*BackboneElementPertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... type S0..*CodeableConceptTiming or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1BackboneElementPertinent diagnosis information
..... sequence 1..1positiveIntDiagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S0..1BackboneElementPertinent diagnosis information
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S0..3BackboneElementPertinent diagnosis information
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S0..12BackboneElementPertinent diagnosis information
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S0..24BackboneElementPertinent diagnosis information
..... diagnosis[x] S1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S0..*BackboneElementClinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type S0..*CodeableConceptCategory of Procedure
Binding: PCT Procedure Type Value Set (required)
.... procedure:principal S0..1BackboneElementPrincipal clinical procedure performed
..... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... sequence 1..1positiveIntProcedure instance identifier
Required Pattern: 1
..... type 1..1CodeableConceptCategory of Procedure
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1CodeableConceptSpecific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S0..24BackboneElementClinical procedures performed
..... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type 1..1CodeableConceptCategory of Procedure
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1CodeableConceptSpecific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance
.... coverage 1..1Reference(PCT Coverage)Insurance information
.... preAuthRef 0..1stringPrior authorization reference number
... accident
.... location[x] 0..1AddressWhere the event occurred
..... country 0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
Binding: Iso3166-1-2 (required)
... item 1..999BackboneElementProduct or service provided
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... gfeBillingProviderLineItemCtrlNum S0..1IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
.... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
.... ProviderEventMethodology S0..1stringProvider Event Methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
.... revenue 1..1CodeableConceptRevenue or cost center code - must provide a value for the Institutional case
Binding: PCT GFE NUBC Revenue Value Set (required)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: Claim Medical Product or Service Value Set (required)
.... modifier S0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... serviced[x] S1..1date, PeriodThis is the planned or estimated date(s)s of service
.... locationCodeableConcept S0..1CodeableConceptPlace of service or where product was supplied
Binding: PCT GFE CMS Place of Service Value Set (required)
.... quantity 1..1SimpleQuantityCount of products or services
.... net 1..1MoneyTotal charge amount for the service line
.... detail S0..*BackboneElementDrug Identification Information
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: PCT GFE Item NDC Value Set (required)
..... quantity S0..1SimpleQuantityCount of products or services
... total 1..1MoneyTotal GFE Charges Submitted

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Claim.priorityrequiredProcessPriorityCodes
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
Claim.supportingInfo.categoryextensiblePCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)
Claim.supportingInfo:typeOfBill.coderequiredPCTGFETypeOfBillVS
Claim.supportingInfo:drg.coderequiredUSClaimDRGCodes
Claim.supportingInfo:pointoforigin.coderequiredAHANUBCPointOfOriginVS
Claim.supportingInfo:admtype.coderequiredAHANUBCPriorityTypeOfAdmissionOrVisitVS (a valid code from http://terminology.hl7.org/CodeSystem/AHANUBCPriorityTypeOfAdmitOrVisit)
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
Claim.procedure.typerequiredPCTProcedureTypeVS
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
Claim.accident.location[x].countryrequiredIso3166-1-2
Claim.item.revenuerequiredPCTGFEItemRevenueVS
Claim.item.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
Claim.item.modifierrequiredPCTGFEItemCptHcpcsVS
Claim.item.locationCodeableConceptrequiredPCTGFECMSPOS
Claim.item.detail.productOrServicerequiredPCTGFEItemNDCVS
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, Pre-determination or Pre-authorization
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeSubmitter 1..1Reference()The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter
... providerEventMethodology S0..1stringProvider event collection methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
... gfeDisclaimer S0..*stringDisclaimers the patient should be made aware of regarding the providers estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier 1..*IdentifierBusiness Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:PLAC 1..1IdentifierProvider Assigned Identifier for GFE Claim
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription 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
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
....... display1..1stringRepresentation defined by the system
Fixed Value: Placer Identifier
..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
.... identifier:INTER 0..*IdentifierIntermediary System Identifier
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription 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
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: INTER
....... display1..1stringRepresentation defined by the system
Fixed Value: Intermediary System Identifier
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: institutional
... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ1..1Reference(HRex Patient Demographics)The recipient of the products and services
... billablePeriod SΣ0..1PeriodRelevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
... created Σ1..1dateTimeResource creation date
... insurer Σ1..1Reference(PCT Organization)Target
... provider Σ1..1Reference(PCT Organization)Billing provider - party responsible for the GFE
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... providerTaxonomy 1..1CodeableConceptProvider 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 S0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
... priority Σ1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (required)
... payee S0..1BackboneElementRecipient of benefits payable
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1Reference(PCT Practitioner | PCT Organization)Recipient reference
... Slices for careTeam S0..*BackboneElementMembers of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntOrder of care team
..... provider 1..1Reference(PCT Practitioner | PCT Organization)Practitioner or organization
..... role 1..1CodeableConceptFunction within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S0..1BackboneElementMembers of the care team
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntOrder of care team
..... provider 1..1Reference(PCT Practitioner)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:operating S0..2BackboneElementMembers of the care team
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntOrder of care team
..... provider 1..1Reference(PCT Practitioner)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S0..1BackboneElementMembers of the care team
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntOrder of care team
..... provider 1..1Reference(PCT Practitioner)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S0..1BackboneElementMembers of the care team
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntOrder of care team
..... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
..... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: referring
... Slices for supportingInfo S1..*BackboneElementSupporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntInformation instance identifier
..... category 1..1CodeableConceptClassification of the supplied information
Binding: PCT Supporting Info Type Value Set (extensible)
.... supportingInfo:typeOfBill 1..1BackboneElementSupporting information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntInformation instance identifier
..... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: typeofbill
..... code 1..1CodeableConceptType of information
Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
.... supportingInfo:serviceFacility S0..1BackboneElementService Facility
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntInformation instance identifier
..... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: servicefacility
..... Slices for value[x] 1..1Reference(Resource)Data to be provided
Slice: Unordered, Closed by type:$this
...... value[x]:valueReference 1..1Reference(PCT Organization)Data to be provided
.... supportingInfo:drg 0..1BackboneElementSupporting information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntInformation instance identifier
..... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: drg
..... code 0..1CodeableConceptType of information
Binding: US Claim DRG Codes (required)
.... supportingInfo:pointoforigin 0..1BackboneElementSupporting information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntInformation instance identifier
..... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: pointoforigin
..... code 0..1CodeableConceptType of information
Binding: NUBC Point Of Origin (required)
.... supportingInfo:admtype 0..1BackboneElementSupporting information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntInformation instance identifier
..... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admtype
..... code 0..1CodeableConceptType of information
Binding: NUBC Priority (Type) of Admission or Visit (required)
... Slices for diagnosis S1..*BackboneElementPertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntDiagnosis instance identifier
..... diagnosis[x] 1..1Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConceptCodeableConcept
...... diagnosisReferenceReference(Condition)
..... type S0..*CodeableConceptTiming or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1BackboneElementPertinent diagnosis information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntDiagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S0..1BackboneElementPertinent diagnosis information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntDiagnosis instance identifier
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S0..3BackboneElementPertinent diagnosis information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntDiagnosis instance identifier
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S0..12BackboneElementPertinent diagnosis information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntDiagnosis instance identifier
..... diagnosis[x] 1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S0..24BackboneElementPertinent diagnosis information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntDiagnosis instance identifier
..... diagnosis[x] S1..1CodeableConceptNature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S0..*BackboneElementClinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntProcedure instance identifier
..... type S0..*CodeableConceptCategory of Procedure
Binding: PCT Procedure Type Value Set (required)
..... procedure[x] 1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConceptCodeableConcept
...... procedureReferenceReference(Procedure)
.... procedure:principal S0..1BackboneElementPrincipal clinical procedure performed
..... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntProcedure instance identifier
Required Pattern: 1
..... type 1..1CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1CodeableConceptSpecific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S0..24BackboneElementClinical procedures performed
..... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntProcedure instance identifier
..... type 1..1CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1CodeableConceptSpecific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance Σ1..*BackboneElementPatient insurance information
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal Σ1..1booleanCoverage to be used for adjudication
.... coverage Σ1..1Reference(PCT Coverage)Insurance information
.... preAuthRef 0..1stringPrior authorization reference number
... item 1..999BackboneElementProduct or service provided
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... gfeBillingProviderLineItemCtrlNum S0..1IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
.... serviceDescription 1..1stringService Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
.... ProviderEventMethodology S0..1stringProvider Event Methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntItem instance identifier
.... revenue 1..1CodeableConceptRevenue or cost center code - must provide a value for the Institutional case
Binding: PCT GFE NUBC Revenue Value Set (required)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: Claim Medical Product or Service Value Set (required)
.... modifier S0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... serviced[x] S1..1This is the planned or estimated date(s)s of service
..... servicedDatedate
..... servicedPeriodPeriod
.... Slices for location[x] 0..1Place of service or where product was supplied
Slice: Unordered, Open by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
..... location[x]:locationCodeableConcept S0..1CodeableConceptPlace of service or where product was supplied
Binding: PCT GFE CMS Place of Service Value Set (required)
.... quantity 1..1SimpleQuantityCount of products or services
.... net 1..1MoneyTotal charge amount for the service line
.... detail S0..*BackboneElementDrug Identification Information
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntItem instance identifier
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: PCT GFE Item NDC Value Set (required)
..... quantity S0..1SimpleQuantityCount of products or services
... total 1..1MoneyTotal GFE Charges Submitted

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Claim.identifier:PLAC.userequiredIdentifierUse
Claim.identifier:PLAC.typeextensiblePattern: PLAC("Placer Identifier")
Claim.identifier:INTER.userequiredIdentifierUse
Claim.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
Claim.statusrequiredFinancialResourceStatusCodes
Claim.typeextensiblePattern: institutional
Claim.userequiredPattern: predetermination
Claim.priorityrequiredProcessPriorityCodes
Claim.payee.typeexampleClaim Payee Type Codes
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
Claim.careTeam:attending.roleexamplePattern: attending
Claim.careTeam:attending.qualificationexampleExampleProviderQualificationCodes
Claim.careTeam:operating.roleexamplePattern: operating
Claim.careTeam:rendering.roleexamplePattern: rendering
Claim.careTeam:referring.roleexamplePattern: referring
Claim.supportingInfo.categoryextensiblePCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)
Claim.supportingInfo:typeOfBill.categoryexamplePattern: typeofbill
Claim.supportingInfo:typeOfBill.coderequiredPCTGFETypeOfBillVS
Claim.supportingInfo:serviceFacility.categoryexamplePattern: servicefacility
Claim.supportingInfo:drg.categoryexamplePattern: drg
Claim.supportingInfo:drg.coderequiredUSClaimDRGCodes
Claim.supportingInfo:pointoforigin.categoryexamplePattern: pointoforigin
Claim.supportingInfo:pointoforigin.coderequiredAHANUBCPointOfOriginVS
Claim.supportingInfo:admtype.categoryexamplePattern: admtype
Claim.supportingInfo:admtype.coderequiredAHANUBCPriorityTypeOfAdmissionOrVisitVS (a valid code from http://terminology.hl7.org/CodeSystem/AHANUBCPriorityTypeOfAdmitOrVisit)
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:principal.typeexamplePattern: principal
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:admitting.typeexamplePattern: admitting
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:patientReasonForVisit.typeexamplePattern: patientReasonForVisit
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:externalcauseofinjury.typeexamplePattern: externalCauseOfInjury
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:other.typeexamplePattern: other
Claim.procedure.typerequiredPCTProcedureTypeVS
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
Claim.procedure:principal.typeexamplePattern: principal
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
Claim.procedure:other.typeexamplePattern: other
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
Claim.item.revenuerequiredPCTGFEItemRevenueVS
Claim.item.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
Claim.item.modifierrequiredPCTGFEItemCptHcpcsVS
Claim.item.location[x]exampleExampleServicePlaceCodes
Claim.item.location[x]:locationCodeableConceptrequiredPCTGFECMSPOS
Claim.item.detail.productOrServicerequiredPCTGFEItemNDCVS
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, Pre-determination or Pre-authorization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeSubmitter 1..1Reference()The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter
... gfeServiceLinkingInfo S0..1(Complex)GFE Service Linking Information.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
... providerEventMethodology S0..1stringProvider event collection methodology
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
... gfeDisclaimer S0..*stringDisclaimers the patient should be made aware of regarding the providers estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier 1..*IdentifierBusiness Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:PLAC 1..1IdentifierProvider Assigned Identifier for GFE Claim
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription 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
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: PLAC
....... display1..1stringRepresentation defined by the system
Fixed Value: Placer Identifier
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:INTER 0..*IdentifierIntermediary System Identifier
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription 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
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: INTER
....... display1..1stringRepresentation defined by the system
Fixed Value: Intermediary System Identifier
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: institutional
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ1..1Reference(HRex Patient Demographics)The recipient of the products and services
... billablePeriod SΣ0..1PeriodRelevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
... created Σ1..1dateTimeResource creation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ1..1Reference(PCT Organization)Target
... provider Σ1..1Reference(PCT Organization)Billing provider - party responsible for the GFE
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... providerTaxonomy 1..1CodeableConceptProvider 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 S0..1booleanExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... priority Σ1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
....