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 Professional

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional Version: 1.0.0
Active as of 2023-03-29 Computable Name: PCTGFEProfessional

PCT Good Faith Estimate Professional 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 a professional 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 it 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 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: professional
... use 1..1codeclaim | preauthorization | predetermination
Required Pattern: predetermination
... patient 1..1Reference(HRex Patient Demographics)The recipient of the products and services
... insurer 1..1Reference(PCT Organization)Target
... provider 1..1Reference(PCT Organization | PCT Practitioner)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:rendering 0..*BackboneElementMembers 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: rendering
..... qualification 1..1CodeableConceptPractitioner credential or specialization - must provide a taxonomy code for the Professional case
.... careTeam:referring 0..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 S0..*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: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:claimFrequency S0..1BackboneElementClaim Frequency
..... 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: claimFrequency
..... code 1..1CodeableConceptType of information
Binding: PCT GFE Frequency Code Value Set (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:other S0..11BackboneElementPertinent 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: 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:anesthesiaRelated S0..2BackboneElementClinical 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: procedureRequiringAnesthesia
..... procedure[x] 1..1CodeableConceptSpecific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
.... procedure:other S0..24BackboneElementClinical procedures performed
... insurance
.... coverage 1..1Reference(PCT Coverage)Insurance information
.... preAuthRef 0..2stringPrior 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..50BackboneElementProduct or service provided
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... referralNumber S0..11stringReferral Number
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
.... 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
.... careTeamSequence S0..*positiveIntApplicable careTeam members
.... 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
.... location[x] 1..1CodeableConceptPlace of service or where product was supplied
Slice: Unordered, Open by type:$this
.... locationCodeableConcept 1..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
.... unitPrice 1..1MoneyFee, charge or cost per item
.... net 1..1MoneyTotal charge amount for the service line
.... detail S0..*BackboneElementDrug Identification Information
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: Claim Medical Product or Service 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:claimFrequency.coderequiredPCTGFEFrequencyVS (a valid code from PCT GFE Frequency Code System)
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
Claim.procedure.typerequiredPCTProcedureTypeVS
Claim.procedure:anesthesiaRelated.procedure[x]requiredPCTProcedureSurgicalCodes
Claim.accident.location[x].countryrequiredIso3166-1-2
Claim.item.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
Claim.item.modifierrequiredPCTGFEItemCptHcpcsVS
Claim.item.locationCodeableConceptrequiredPCTGFECMSPOS
Claim.item.detail.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
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: professional
... 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
... created Σ1..1dateTimeResource creation date
... insurer Σ1..1Reference(PCT Organization)Target
... provider Σ1..1Reference(PCT Organization | PCT Practitioner)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:rendering 0..*BackboneElementMembers 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: rendering
..... qualification 1..1CodeableConceptPractitioner credential or specialization - must provide a taxonomy code for the Professional case
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:referring 0..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 S0..*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: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:claimFrequency S0..1BackboneElementClaim Frequency
..... 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: claimFrequency
..... code 1..1CodeableConceptType of information
Binding: PCT GFE Frequency Code Value Set (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:other S0..11BackboneElementPertinent 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: 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:anesthesiaRelated S0..2BackboneElementClinical 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: procedureRequiringAnesthesia
..... procedure[x] 1..1CodeableConceptSpecific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
.... procedure:other S0..24BackboneElementClinical procedures performed
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntProcedure instance identifier
..... procedure[x] 1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConceptCodeableConcept
...... procedureReferenceReference(Procedure)
... 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..2stringPrior authorization reference number
... item 1..50BackboneElementProduct or service provided
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... referralNumber S0..11stringReferral Number
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
.... 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
.... careTeamSequence S0..*positiveIntApplicable careTeam members
.... 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] 1..1CodeableConceptPlace of service or where product was supplied
Slice: Unordered, Closed by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... location[x]:locationCodeableConcept 1..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
.... unitPrice 1..1MoneyFee, charge or cost per item
.... 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: Claim Medical Product or Service 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: professional
Claim.userequiredPattern: predetermination
Claim.priorityrequiredProcessPriorityCodes
Claim.payee.typeexampleClaim Payee Type Codes
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
Claim.careTeam:rendering.roleexamplePattern: rendering
Claim.careTeam:rendering.qualificationexampleExampleProviderQualificationCodes
Claim.careTeam:referring.roleexamplePattern: referring
Claim.supportingInfo.categoryextensiblePCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)
Claim.supportingInfo:serviceFacility.categoryexamplePattern: servicefacility
Claim.supportingInfo:claimFrequency.categoryexamplePattern: claimFrequency
Claim.supportingInfo:claimFrequency.coderequiredPCTGFEFrequencyVS (a valid code from PCT GFE Frequency Code System)
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:principal.typeexamplePattern: principal
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
Claim.diagnosis:other.typeexamplePattern: other
Claim.procedure.typerequiredPCTProcedureTypeVS
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
Claim.procedure:anesthesiaRelated.typeexamplePattern: procedureRequiringAnesthesia
Claim.procedure:anesthesiaRelated.procedure[x]requiredPCTProcedureSurgicalCodes
Claim.procedure:other.procedure[x]exampleICD-10ProcedureCodes
Claim.item.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
Claim.item.modifierrequiredPCTGFEItemCptHcpcsVS
Claim.item.location[x]exampleExampleServicePlaceCodes
Claim.item.location[x]:locationCodeableConceptrequiredPCTGFECMSPOS
Claim.item.detail.productOrServicerequiredUSClaimMedicalProductOrServiceCodes
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: professional
..... 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 Σ0..1PeriodRelevant time frame for the claim
... 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 | PCT Practitioner)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
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee S0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... 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
... referral 0..1Reference(ServiceRequest)Treatment referral
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... referralNumber 1..1stringReferral Number
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
.... 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
... facility 0..1Reference(Location)Servicing facility
... Slices for careTeam S0..*BackboneElementMembers of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... 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
..... responsible 0..1booleanIndicator of the lead practitioner
..... 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:rendering 0..*BackboneElementMembers of the care team
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... 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
..... responsible 0..1booleanIndicator of the lead practitioner
..... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


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/PCTCareTeamRole
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: rendering
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... qualification 1..1CodeableConceptPractitioner credential or specialization - must provide a taxonomy code for the Professional case
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:referring 0..1BackboneElementMembers of the care team
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... 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
..... responsible 0..1booleanIndicator of the lead practitioner
..... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


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/PCTCareTeamRole
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: referring
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for supportingInfo S0..*BackboneElementSupporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... 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)
..... code 0..1CodeableConceptType of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] 0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason 0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:serviceFacility S0..1BackboneElementService Facility
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... 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
...... 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/PCTSupportingInfoType
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: servicefacility
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code 0..1CodeableConceptType of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... 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
..... reason 0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:claimFrequency S0..1BackboneElementClaim Frequency
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... 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
...... 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/PCTSupportingInfoType
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: claimFrequency
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code 1..1