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

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0 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

ValueSet: PCT Total Value Set

Official URL: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTTotal Version: 2.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTTotal
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.48.34

Copyright/Legal: This Valueset is not copyrighted.

Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values defined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the Network Status.

References

Changes since version 1.1.0:

  • New Content

    • Logical Definition (CLD)

    This value set includes codes based on the following rules:

     

    Expansion

    This value set contains 12 concepts

    SystemCodeDisplay (en)JSONXML
    http://terminology.hl7.org/CodeSystem/adjudication  submittedSubmitted Amount
    http://terminology.hl7.org/CodeSystem/adjudication  copayCoPay
    http://terminology.hl7.org/CodeSystem/adjudication  eligibleEligible Amount
    http://terminology.hl7.org/CodeSystem/adjudication  deductibleDeductible
    http://terminology.hl7.org/CodeSystem/adjudication  benefitBenefit Amount
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication  coinsuranceCo-insurance
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication  noncoveredNoncovered
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication  memberliabilityMember liability
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication  discountDiscount
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS  innetworkIn Network
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS  outofnetworkOut Of Network
    http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS  negotiatedNegotiated Service or Product

    Explanation of the columns that may appear on this page:

    Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
    System The source of the definition of the code (when the value set draws in codes defined elsewhere)
    Code The code (used as the code in the resource instance)
    Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
    Definition An explanation of the meaning of the concept
    Comments Additional notes about how to use the code