PCT GFE Packet - Patient Cost Transparency Implementation Guide v2.0.0-draft

Patient Cost Transparency Implementation Guide
2.0.0-draft - STU 2 - Draft United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-draft built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

Resource Profile: PCT GFE Packet

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-packet		Version: 2.0.0-draft
Standards status: Trial-use	Maturity Level: 1	Computable Name: PCTGFEPacket
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.61

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

Usages:

Examples for this Profile: Bundle/PCT-GFE-Packet-Inst-1 and Bundle/PCT-GFE-Packet-Prof-1
CapabilityStatements using this Profile: Patient Cost Transparency Implementation Guide Coordination Platform Capability Statement, Patient Cost Transparency Implementation Guide Coordination Requester Capability Statement and Patient Cost Transparency Implementation Guide Payer Capability Statement

Changes since version 1.1.0:

New Content

Formal Views of Profile Content

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

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Bundle	C	0..*	Bundle	Contains a collection of resources Constraints: bdl-1, bdl-2, bdl-3, bdl-4, bdl-7, bdl-9, bdl-10, bdl-11, bdl-12, pct-gfe-packet-1, pct-gfe-packet-2
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
identifier	Σ	1..1	Identifier	Persistent identifier for the bundle
type	Σ	1..1	code	document \| message \| transaction \| transaction-response \| batch \| batch-response \| history \| searchset \| collection Binding: BundleType (required): Indicates the purpose of a bundle - how it is intended to be used. Fixed Value: document
timestamp	Σ	1..1	instant	When the bundle was assembled
Slices for entry	ΣC	2..*	BackboneElement	Entry in the bundle - will have a resource or information Slice: Unordered, Open by type:resource Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
entry:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
entry:composition	SΣC	1..1	BackboneElement	SHALL have a PCTGFEComposition resource Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource		1..1	PCTGFEComposition	A set of resources composed into a single coherent clinical statement with clinical attestation
entry:patient	ΣC	1..2	BackboneElement	SHALL have the patient subject of care and may have a separate subscriber Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource		1..1	HRexPatientDemographics	Information about an individual or animal receiving health care services
entry:coverage	SΣC	0..1	BackboneElement	MAY have one Coverage. SHALL be present submitted to a payer in the $gfe-submit operation. Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource		1..1	PCTCoverage	Insurance or medical plan or a payment agreement
entry:organization	SΣC	0..2	BackboneElement	SHALL have an initiating provider or initiating organization, but not both. May also have a payer organization. Payer Organization SHALL be present when being submitted to a payer in the $gfe-submit operation. Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource		1..1	PCTOrganization	A grouping of people or organizations with a common purpose
entry:practitioner	SΣC	0..1	BackboneElement	SHALL have a initiating provider or initiating organization, but not both. Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource		1..1	PCTPractitioner	A person with a formal responsibility in the provisioning of healthcare or related services
entry:gfe-bundle	SΣC	0..*	BackboneElement	MAY include GFE contributor specific GFE bundle and MAY include bundle(s) with information about a unfulfilled GFE request Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource		1..1	PCTGFEBundle, PCTGFEMissingBundle	Contains a collection of resources
entry:attachment	SΣC	0..*	BackboneElement	MAY have attachments as DocumentReference resource(s) Constraints: bdl-5, bdl-8 This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
fullUrl	Σ	1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
resource	Σ	1..1	DocumentReference	A resource in the bundle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Bundle.type	required	Fixed Value: document `http://hl7.org/fhir/ValueSet/bundle-type\|4.0.1` From the FHIR Standard
Bundle.entry.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:composition.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:patient.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:coverage.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:organization.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:practitioner.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:gfe-bundle.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard
Bundle.entry:attachment.request.method	required	HTTPVerb `http://hl7.org/fhir/ValueSet/http-verb\|4.0.1` From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
bdl-1	error	Bundle	total only when a search or history : total.empty() or (type = 'searchset') or (type = 'history')
bdl-2	error	Bundle	entry.search only when a search : entry.search.empty() or (type = 'searchset')
bdl-3	error	Bundle	entry.request mandatory for batch/transaction/history, otherwise prohibited : entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
bdl-4	error	Bundle	entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited : entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
bdl-5	error	Bundle.entry, Bundle.entry:composition, Bundle.entry:patient, Bundle.entry:coverage, Bundle.entry:organization, Bundle.entry:practitioner, Bundle.entry:gfe-bundle, Bundle.entry:attachment	must be a resource unless there's a request or response : resource.exists() or request.exists() or response.exists()
bdl-7	error	Bundle	FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles) : (type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
bdl-8	error	Bundle.entry, Bundle.entry:composition, Bundle.entry:patient, Bundle.entry:coverage, Bundle.entry:organization, Bundle.entry:practitioner, Bundle.entry:gfe-bundle, Bundle.entry:attachment	fullUrl cannot be a version specific reference : fullUrl.contains('/_history/').not()
bdl-9	error	Bundle	A document must have an identifier with a system and a value : type = 'document' implies (identifier.system.exists() and identifier.value.exists())
bdl-10	error	Bundle	A document must have a date : type = 'document' implies (timestamp.hasValue())
bdl-11	error	Bundle	A document must have a Composition as the first resource : type = 'document' implies entry.first().resource.is(Composition)
bdl-12	error	Bundle	A message must have a MessageHeader as the first resource : type = 'message' implies entry.first().resource.is(MessageHeader)
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
pct-gfe-packet-1	error	Bundle	SHALL have a initiating provider or initiating organization, but not both. : Bundle.entry.resource.ofType(Practitioner).exists() or Bundle.entry.resource.ofType(Organization).exists()
pct-gfe-packet-2	error	Bundle	All references resources SHALL be contained within the Bundle : Bundle.entry.resource.descendants().reference.where($this.startsWith('#').not()).all((%resource.entry.fullUrl.join('\|')&'\|').contains(($this&'\|')))

This structure is derived from Bundle

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Bundle	C	0..*	Bundle	Contains a collection of resources Constraints: pct-gfe-packet-1, pct-gfe-packet-2
identifier		1..1	Identifier	Persistent identifier for the bundle
type		1..1	code	document \| message \| transaction \| transaction-response \| batch \| batch-response \| history \| searchset \| collection Fixed Value: document
timestamp		1..1	instant	When the bundle was assembled
Slices for entry		2..*	BackboneElement	Entry in the bundle - will have a resource or information Slice: Unordered, Open by type:resource
entry:All Slices				Content/Rules for all slices
fullUrl		1..1	uri	URI for resource (Absolute URL server address or URI for UUID/OID)
search		0..0
request		0..0
response		0..0
entry:composition	S	1..1	BackboneElement	SHALL have a PCTGFEComposition resource
resource		1..1	PCTGFEComposition	A set of resources composed into a single coherent clinical statement with clinical attestation
entry:patient		1..2	BackboneElement	SHALL have the patient subject of care and may have a separate subscriber
resource		1..1	HRexPatientDemographics	Information about an individual or animal receiving health care services
entry:coverage	S	0..1	BackboneElement	MAY have one Coverage. SHALL be present submitted to a payer in the $gfe-submit operation.
resource		1..1	PCTCoverage	Insurance or medical plan or a payment agreement
entry:organization	S	0..2	BackboneElement	SHALL have an initiating provider or initiating organization, but not both. May also have a payer organization. Payer Organization SHALL be present when being submitted to a payer in the $gfe-submit operation.
resource		1..1	PCTOrganization	A grouping of people or organizations with a common purpose
entry:practitioner	S	0..1	BackboneElement	SHALL have a initiating provider or initiating organization, but not both.
resource		1..1	PCTPractitioner	A person with a formal responsibility in the provisioning of healthcare or related services
entry:gfe-bundle	S	0..*	BackboneElement	MAY include GFE contributor specific GFE bundle and MAY include bundle(s) with information about a unfulfilled GFE request
resource		1..1	PCTGFEBundle, PCTGFEMissingBundle	Contains a collection of resources
entry:attachment	S	0..*	BackboneElement	MAY have attachments as DocumentReference resource(s)
resource		1..1	DocumentReference	A resource in the bundle
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
pct-gfe-packet-1	error	Bundle	SHALL have a initiating provider or initiating organization, but not both. : Bundle.entry.resource.ofType(Practitioner).exists() or Bundle.entry.resource.ofType(Organization).exists()
pct-gfe-packet-2	error	Bundle	All references resources SHALL be contained within the Bundle : Bundle.entry.resource.descendants().reference.where($this.startsWith('#').not()).all((%resource.entry.fullUrl.join('\|')&'\|').contains(($this&'\|')))