Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional | Version: 2.0.0-ballot | |||
| Standards status: Trial-use | Maturity Level: 2 | Computable Name: PCTGFEProfessional | ||
| Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.14 | ||||
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.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim |
Claim | |||
  Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
   gfeServiceLinkingInfo |
S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
| providerEventMethodology |
S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
 gfeDisclaimer |
S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer |
 Slices for identifier |
1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type | |
 identifier:PLAC |
1..1 | Identifier | Provider Assigned Identifier for GFE Claim | |
   type |
1..1 | CodeableConcept | Description of identifier Required Pattern: At least the following | |
   coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
  system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC | |
 display |
1..1 | string | Representation defined by the system Fixed Value: Placer Identifier | |
 system |
S | 0..1 | uri | The namespace for the identifier value |
 value |
1..1 | string | The value that is unique | |
 identifier:INTER |
0..* | Identifier | Intermediary System Identifier | |
 type |
1..1 | CodeableConcept | Description of identifier Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: INTER | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Intermediary System Identifier | |
| type |
1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| use |
1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination | |
 patient |
1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | |
| insurer |
S | 0..1 | Reference(PCT Organization) | Required if insured estimate |
| provider |
1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | |
| extension |
1..* | Extension | Extension | |
| Slices for extension |
Content/Rules for all slices | |||
| providerTaxonomy |
1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible) | |
| Slices for extension |
Content/Rules for all slices | |||
| consentForBalanceBilling |
S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling |
| priority |
1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) | |
| payee |
S | 0..1 | BackboneElement | Recipient of benefits payable |
| party |
0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
| referral |
||||
| extension |
1..* | Extension | Extension | |
| Slices for extension |
Content/Rules for all slices | |||
| referralNumber |
1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber | |
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
| careTeam:All Slices |
Content/Rules for all slices | |||
| provider |
1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | |
| role |
1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) | |
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) | |
| careTeam:rendering |
0..* | BackboneElement | Members of the care team | |
| role |
0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
| qualification |
1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case | |
| careTeam:referring |
0..1 | BackboneElement | Members of the care team | |
| role |
0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
| supportingInfo:All Slices |
Content/Rules for all slices | |||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) | |
| supportingInfo:serviceFacility |
S | 0..1 | BackboneElement | Service Facility |
| category |
1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |
| Slices for value[x] |
1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this | |
| value[x]:valueReference |
1..1 | Reference(PCT Organization) | Data to be provided | |
| supportingInfo:claimFrequency |
S | 0..1 | BackboneElement | Claim Frequency |
| category |
1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: claimFrequency | |
| code |
1..1 | CodeableConcept | Type of information Binding: PCT GFE Frequency Code Value Set (required) | |
| Slices for diagnosis |
S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type |
| diagnosis:All Slices |
Content/Rules for all slices | |||
| type |
S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: PCT Diagnosis Type Value Set (required) |
| diagnosis:principal |
1..1 | BackboneElement | Pertinent diagnosis information | |
| sequence |
1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1 | |
 diagnosis[x] |
1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) | |
| type |
1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: principal | |
| diagnosis:other |
S | 0..11 | BackboneElement | Pertinent diagnosis information |
| diagnosis[x] |
1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) | |
| type |
1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| Slices for procedure |
S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type |
| procedure:All Slices |
Content/Rules for all slices | |||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| serviceDescription |
1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription | |
| type |
S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) |
| procedure:anesthesiaRelated |
S | 0..2 | BackboneElement | Clinical procedures performed |
| Slices for extension |
Content/Rules for all slices | |||
| serviceDescription |
1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription | |
| type |
1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia | |
| procedure[x] |
1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) | |
| procedure:other |
S | 0..24 | BackboneElement | Clinical procedures performed |
| insurance |
||||
| coverage |
1..1 | Reference(PCT Coverage) | Insurance information | |
| Slices for extension |
Content/Rules for all slices | |||
| dataAbsentReason |
S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) |
| preAuthRef |
0..2 | string | Prior authorization reference number | |
| accident |
||||
| location[x] |
0..1 | Address | Where the event occurred | |
| country |
0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required) | |
| item |
1..50 | BackboneElement | Product or service provided | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber |
S | 0..11 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| gfeBillingProviderLineItemCtrlNum |
S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum |
| serviceDescription |
1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription | |
| ProviderEventMethodology |
S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| careTeamSequence |
S | 0..* | positiveInt | Applicable careTeam members |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required) | |
| modifier |
S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required) |
| serviced[x] |
S | 1..1 | date, Period | This is the planned or estimated date(s)s of service |
| location[x] |
1..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required) | |
| quantity |
1..1 | SimpleQuantity | Count of products or services | |
| unitPrice |
1..1 | Money | Fee, charge or cost per item | |
| net |
1..1 | Money | Total charge amount for the service line | |
| detail |
S | 0..* | BackboneElement | Drug Identification Information |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required) | |
| quantity |
S | 0..1 | SimpleQuantity | Count of products or services |
| total |
1..1 | Money | Total GFE Charges Submitted | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Claim.priority | required | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | |
| Claim.careTeam.role | required | PCTCareTeamRoleVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVSfrom this IG | |
| Claim.careTeam.qualification | required | USCoreProviderRoleNucchttp://hl7.org/fhir/us/core/ValueSet/us-core-provider-role | |
| Claim.supportingInfo.category | extensible | PCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVSfrom this IG | |
| Claim.supportingInfo:claimFrequency.code | required | PCTGFEFrequencyVS (a valid code from PCT GFE Frequency Code System)http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEFrequencyVSfrom this IG | |
| Claim.diagnosis.type | required | PCTDiagnosisTypeVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVSfrom this IG | |
| Claim.diagnosis:principal.diagnosis[x] | required | PCTDiagnosticCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodesfrom this IG | |
| Claim.diagnosis:other.diagnosis[x] | required | PCTDiagnosticCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodesfrom this IG | |
| Claim.procedure.type | required | PCTProcedureTypeVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVSfrom this IG | |
| Claim.procedure:anesthesiaRelated.procedure[x] | required | PCTProcedureSurgicalCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodesfrom this IG | |
| Claim.accident.location[x].country | required | Iso3166-1-2http://hl7.org/fhir/ValueSet/iso3166-1-2from the FHIR Standard | |
| Claim.item.productOrService | required | USClaimMedicalProductOrServiceCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodesfrom this IG | |
| Claim.item.modifier | required | PCTGFEItemCptHcpcsVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVSfrom this IG | |
| Claim.item.location[x] | required | PCTGFECMSPOShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOSfrom this IG | |
| Claim.item.detail.productOrService | required | USClaimMedicalProductOrServiceCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodesfrom this IG |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
 implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| gfeServiceLinkingInfo |
S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
| providerEventMethodology |
S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| gfeDisclaimer |
S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| Slices for identifier |
1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type | |
| identifier:PLAC |
1..1 | Identifier | Provider Assigned Identifier for GFE Claim | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Placer Identifier | |
| system |
SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 |
| identifier:INTER |
0..* | Identifier | Intermediary System Identifier | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: INTER | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Intermediary System Identifier | |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| use |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination |
| patient |
Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services |
| created |
Σ | 1..1 | dateTime | Resource creation date |
| insurer |
SΣ | 0..1 | Reference(PCT Organization) | Required if insured estimate |
| provider |
Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| providerTaxonomy |
1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible) | |
| consentForBalanceBilling |
S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling |
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) |
| payee |
S | 0..1 | BackboneElement | Recipient of benefits payable |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type |
1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |
| party |
0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
| careTeam:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Order of care team | |
| provider |
1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | |
| role |
1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) | |
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) | |
| careTeam:rendering |
0..* | BackboneElement | Members of the care team | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Order of care team | |
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| role |
0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
| qualification |
1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |
| careTeam:referring |
0..1 | BackboneElement | Members of the care team | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Order of care team | |
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| role |
0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
| supportingInfo:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Information instance identifier | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) | |
| supportingInfo:serviceFacility |
S | 0..1 | BackboneElement | Service Facility |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Information instance identifier | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |
| Slices for value[x] |
1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this | |
| value[x]:valueReference |
1..1 | Reference(PCT Organization) | Data to be provided | |
| supportingInfo:claimFrequency |
S | 0..1 | BackboneElement | Claim Frequency |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Information instance identifier | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: claimFrequency | |
| code |
1..1 | CodeableConcept | Type of information Binding: PCT GFE Frequency Code Value Set (required) | |
| Slices for diagnosis |
S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type |
| diagnosis:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Diagnosis instance identifier | |
 diagnosis[x] |
1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||
| diagnosisCodeableConcept |
CodeableConcept | |||
| diagnosisReference |
Reference(Condition) | |||
| type |
S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: PCT Diagnosis Type Value Set (required) |
| diagnosis:principal |
1..1 | BackboneElement | Pertinent diagnosis information | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1 | |
| diagnosis[x] |
1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) | |
| type |
1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: principal | |
| diagnosis:other |
S | 0..11 | BackboneElement | Pertinent diagnosis information |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Diagnosis instance identifier | |
| diagnosis[x] |
1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) | |
| type |
1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| Slices for procedure |
S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type |
| procedure:All Slices |
Content/Rules for all slices | |||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| serviceDescription |
1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Procedure instance identifier | |
| type |
S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) |
| procedure[x] |
1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||
| procedureCodeableConcept |
CodeableConcept | |||
| procedureReference |
Reference(Procedure) | |||
| procedure:anesthesiaRelated |
S | 0..2 | BackboneElement | Clinical procedures performed |
| Slices for extension |
Content/Rules for all slices | |||
| serviceDescription |
1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Procedure instance identifier | |
| type |
1..1 | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia | |
| procedure[x] |
1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) | |
| procedure:other |
S | 0..24 | BackboneElement | Clinical procedures performed |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Procedure instance identifier | |
| procedure[x] |
1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||
| procedureCodeableConcept |
CodeableConcept | |||
| procedureReference |
Reference(Procedure) | |||
| insurance |
Σ | 1..* | BackboneElement | Patient insurance information |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
Σ | 1..1 | positiveInt | Insurance instance identifier |
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
| coverage |
Σ | 1..1 | Reference(PCT Coverage) | Insurance information |
| Slices for extension |
Content/Rules for all slices | |||
| dataAbsentReason |
S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) |
| preAuthRef |
0..2 | string | Prior authorization reference number | |
| item |
1..50 | BackboneElement | Product or service provided | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber |
S | 0..11 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| gfeBillingProviderLineItemCtrlNum |
S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum |
| serviceDescription |
1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription | |
| ProviderEventMethodology |
S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Item instance identifier | |
| careTeamSequence |
S | 0..* | positiveInt | Applicable careTeam members |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required) | |
| modifier |
S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required) |
| serviced[x] |
S | 1..1 | This is the planned or estimated date(s)s of service | |
| servicedDate |
date | |||
| servicedPeriod |
Period | |||
| location[x] |
1..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required) | |
| quantity |
1..1 | SimpleQuantity | Count of products or services | |
| unitPrice |
1..1 | Money | Fee, charge or cost per item | |
| net |
1..1 | Money | Total charge amount for the service line | |
| detail |
S | 0..* | BackboneElement | Drug Identification Information |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Item instance identifier | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required) | |
| quantity |
S | 0..1 | SimpleQuantity | Count of products or services |
| total |
1..1 | Money | Total GFE Charges Submitted | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| Claim.identifier:PLAC.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| Claim.identifier:PLAC.type | extensible | Pattern: PLAC("Placer Identifier")http://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | |
| Claim.identifier:INTER.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1from the FHIR Standard | |
| Claim.identifier:INTER.type | extensible | Pattern: INTER("Intermediary System Identifier")http://hl7.org/fhir/ValueSet/identifier-typefrom the FHIR Standard | |
| Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | |
| Claim.type | extensible | Pattern: professionalhttp://hl7.org/fhir/ValueSet/claim-typefrom the FHIR Standard | |
| Claim.use | required | Pattern: predeterminationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1from the FHIR Standard | |
| Claim.priority | required | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | |
| Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypefrom the FHIR Standard | |
| Claim.careTeam.role | required | PCTCareTeamRoleVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVSfrom this IG | |
| Claim.careTeam.qualification | required | USCoreProviderRoleNucchttp://hl7.org/fhir/us/core/ValueSet/us-core-provider-role | |
| Claim.careTeam:rendering.role | example | Pattern: renderinghttp://hl7.org/fhir/ValueSet/claim-careteamrolefrom the FHIR Standard | |
| Claim.careTeam:rendering.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationfrom the FHIR Standard | |
| Claim.careTeam:referring.role | example | Pattern: referringhttp://hl7.org/fhir/ValueSet/claim-careteamrolefrom the FHIR Standard | |
| Claim.supportingInfo.category | extensible | PCTSupportingInfoTypeVS (a valid code from PCT GFE Supporting Info Type Code System)http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVSfrom this IG | |
| Claim.supportingInfo:serviceFacility.category | example | Pattern: servicefacilityhttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.supportingInfo:claimFrequency.category | example | Pattern: claimFrequencyhttp://hl7.org/fhir/ValueSet/claim-informationcategoryfrom the FHIR Standard | |
| Claim.supportingInfo:claimFrequency.code | required | PCTGFEFrequencyVS (a valid code from PCT GFE Frequency Code System)http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEFrequencyVSfrom this IG | |
| Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10from the FHIR Standard | |
| Claim.diagnosis.type | required | PCTDiagnosisTypeVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVSfrom this IG | |
| Claim.diagnosis:principal.diagnosis[x] | required | PCTDiagnosticCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodesfrom this IG | |
| Claim.diagnosis:principal.type | example | Pattern: principalhttp://hl7.org/fhir/ValueSet/ex-diagnosistypefrom the FHIR Standard | |
| Claim.diagnosis:other.diagnosis[x] | required | PCTDiagnosticCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodesfrom this IG | |
| Claim.diagnosis:other.type | example | Pattern: otherhttp://hl7.org/fhir/ValueSet/ex-diagnosistypefrom the FHIR Standard | |
| Claim.procedure.type | required | PCTProcedureTypeVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVSfrom this IG | |
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-proceduresfrom the FHIR Standard | |
| Claim.procedure:anesthesiaRelated.type | example | Pattern: procedureRequiringAnesthesiahttp://hl7.org/fhir/ValueSet/ex-procedure-typefrom the FHIR Standard | |
| Claim.procedure:anesthesiaRelated.procedure[x] | required | PCTProcedureSurgicalCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodesfrom this IG | |
| Claim.procedure:other.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-proceduresfrom the FHIR Standard | |
| Claim.item.productOrService | required | USClaimMedicalProductOrServiceCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodesfrom this IG | |
| Claim.item.modifier | required | PCTGFEItemCptHcpcsVShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVSfrom this IG | |
| Claim.item.location[x] | required | PCTGFECMSPOShttp://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOSfrom this IG | |
| Claim.item.detail.productOrService | required | USClaimMedicalProductOrServiceCodeshttp://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodesfrom this IG |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| gfeServiceLinkingInfo |
S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo | ||||
| providerEventMethodology |
S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology | ||||
| gfeDisclaimer |
S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| Slices for identifier |
1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type | |||||
| identifier:PLAC |
1..1 | Identifier | Provider Assigned Identifier for GFE Claim | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Placer Identifier | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| system |
SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| identifier:INTER |
0..* | Identifier | Intermediary System Identifier | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: INTER | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Intermediary System Identifier | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| system |
Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value |
Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| subType |
0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
| use |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | ||||
| patient |
Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | ||||
| billablePeriod |
Σ | 0..1 | Period | Relevant time frame for the claim | ||||
| created |
Σ | 1..1 | dateTime | Resource creation date | ||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
| insurer |
SΣ | 0..1 | Reference(PCT Organization) | Required if insured estimate | ||||
| provider |
Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| providerTaxonomy |
1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible) | |||||
| consentForBalanceBilling |
S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling | ||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) | ||||
| fundsReserve |
0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| related |
0..* | BackboneElement | Prior or corollary claims | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| claim |
0..1 | Reference(Claim) | Reference to the related claim | |||||
| relationship |
0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
| reference |
0..1 | Identifier | File or case reference | |||||
| prescription |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
| originalPrescription |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
| payee |
S | 0..1 | BackboneElement | Recipient of benefits payable | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| party |
0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |||||
| referral |
0..1 | Reference(ServiceRequest) | Treatment referral | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| referralNumber |
1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| facility |
0..1 | Reference(Location) | Servicing facility | |||||
| Slices for careTeam |
S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role | ||||
| careTeam:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) | |||||
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) | |||||
| careTeam:rendering |
0..* | BackboneElement | Members of the care team | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| qualification |
1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||
| careTeam:referring |
0..1 | BackboneElement | Members of the care team | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Order of care team | |||||
| provider |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible |
0..1 | boolean | Indicator of the lead practitioner | |||||
| role |
0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| qualification |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||
| Slices for supportingInfo |
S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | ||||
| supportingInfo:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] |
0..1 | When it occurred | ||||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| value[x] |
0..1 | Data to be provided | ||||||
| valueBoolean |
boolean | |||||||
| valueString |
string | |||||||
| valueQuantity |
Quantity | |||||||
| valueAttachment |
Attachment | |||||||
| valueReference |
Reference(Resource) | |||||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:serviceFacility |
S | 0..1 | BackboneElement | Service Facility | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] |
0..1 | When it occurred | ||||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| Slices for value[x] |
1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this | |||||
| Slices for value[x] |
Content/Rules for all slices | |||||||
| value[x]:valueReference |
1..1 | Reference(PCT Organization) | Data to be provided | |||||
| reason |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||