Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

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 2.0.1 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

## Change Log

Page standards status: Informative

This is a log of the significant changes that have happened to this specification since it was first released. For each release, changes are expressed with respect to the prior publication (snapshot, ballot, or official release) and are organized into the following categories:

- Breaking changes: Those that will cause instances from prior releases to no potentially no longer be conformant in the newer version of the specification. These changes are denoted in recent version history
- Substantive changes: Changes that change the expectations on conformant systems. I.e. systems will likely need to modify their code to continue complying with the guide.
- Non-substantive changes: These are changes that do not necessarily require the change of code, but may add clarification or optional features.

> NOTE: This categorization is with respect to the standard, not any particular implementation. Changes that are non-breaking from a standards perspective might still break existing implementations. Non-substantive changes might still result in a need to add or change software code. This change list is not exhaustive. Changes to formatting and layout, as well as corrections to spelling, grammar, hyperlinks, etc. are not called out here. Changes mentioned for older versions may no longer be relevant due to changes in subsequent versions.

### Changes in Version 2.0.1

- Corrected the $gfe-coordination-request operation code, output parameters, and description FHIR-53657 ⚠️ (Non-compatible change)
- Changed the CodeSystem URL in the NUBC Point of Origin ValueSet to match the official URLs in THO FHIR-55528 ⚠️ (Non-compatible change)
- Changed the CodeSystem URL in the Priority (Type) of Admission or Visit ValueSet to match the official URLs in THO FHIR-55613 ⚠️ (Non-compatible change)
- Corrected the Payer CapabilityStatement to re-add the Bundle rest resource requirements FHIR-53541
- Added the CPT IP statement to the index page FHIR-53596

### Changes in Version 2.0.0

#### Changes to GFE and AEOB Estimate Bundles

- Changed GFE Collection Bundle and the AEOB Bundle from collection bundles to document bundles and renamed the profile to Packet (GFE Packet and AEOB Packet) and added DocumentReference profiles (GFE Packet Document Reference and AEOB Packet Document Reference) to enable searching and subscriptions. This included adding the GFE Composition and AEOB Composition profiles and a way to relate estimations. Added a number of improvements in the guidance.
  - FHIR-49786 – Change the GFE Collection Bundle to be a document Bundle and add a Document reference to adequately address search and subscriptions ⚠️ (Non-compatible change)
  - FHIR-49761 – Change the AEOB Bundle to be a document Bundle and add a Document reference to adequately address search and subscriptions ⚠️ (Non-compatible change)
  - FHIR-45760 – Add information on frequency of resubmission ⚠️ (Non-compatible change)
  - FHIR-45868 – Add guidance on GFE Collection Bundle differences for coordination workflow and submission
  - FHIR-48826 – Improve wording on GFE Collection Bundle Initiating Provider/Organization slice
  - FHIR-46402 – The GFE Collection Bundle example does not have a GFE Bundle in it
  - FHIR-52301 - Change the gfe-packet and aeob-packet codes to the newly assigned LOINC codes
- Added slices to the GFE Composition and AEOB Composition profiles to provide full referenceability to all expected bundle resources from the Composition resource.
  - FHIR-51740 – Add GFE Missing Bundle entries to Composition profiles ⚠️ (Non-compatible change)
- Provide specific definition and guidance on the what is considered as a request initiation time for the specific estimate type (GFE Packet and AEOB Packet) and their referencing DocumentReference (GFE Packet Document Reference and AEOB Packet Document Reference)
  - FHIR-51554 – Add request initiation time to GFE and AEOB Composition profiles ⚠️ (Non-compatible change)
  - FHIR-51553 – AEOB DocumentReference request initiation time does not make clear what "request" event it is for
- Restrict estimate document types from being changed in the estimate Packet Compositions and DocumentReferences (GFE Composition and AEOB Composition) and their referencing DocumentReference (GFE Packet Document Reference and AEOB Packet Document Reference)
  - FHIR-49640 – Require that the Document type cannot be changed to or from the type code provided ⚠️ (Non-compatible change)

#### Searching and Subscriptions

- Add searching capabilities for the estimate documents from patients and providers by creating searchable DocumentReference profiles (GFE Packet Document Reference and AEOB Packet Document Reference) that contain or reference document bundles (GFE Packet and AEOB Packet). And added Search parameters
  - FHIR-45936 – why are is the patient system polling
  - FHIR-36316 – Please add subscriptions in addition to polling…
  - FHIR-45939 – why polling?
  - FHIR-45935 – why is the patient having to make the request
  - FHIR-51901 – Correct Search Parameter expressions and update to reflect other changes ⚠️ (Non-compatible change)
- Added estimate availability subscription capabilities for patients and providers
  - FHIR-45738 – Consider referencing the Da Vinci Notifications IG
- Added coordination task update subscriptions subscription capabilities for coordination requester and coordination contributors
  - FHIR-45894 – Consider adding more guidance on Coordination workflow notifications

#### Patient Access

- Added guidance detailing patient access and subscriptions to estimates that includes Search parameters and subscription capabilities
  - FHIR-45380 – Clarify means of sending AEOB to patient
  - FHIR-51543 – Narrative Improvement Needed for Patient Access systems
  - FHIR-44862 – Add ability for patient to receive GFEs in the event the payer cannot provide an AEOB
  - FHIR-45933 – Missing bundle resources question

#### Coordination Workflow and Tasks

- Update the gfe-retrieve operation to only support `completed` GFE Contributor Task
  - FHIR-48781 – Change the gfe-retrieve operation to only include GFE Bundles attached to GFE Contributor tasks that have a status of completed ⚠️ (Non-compatible change)
- Add ability to attach input and output parameters to the associated tasks
  - FHIR-45806 – Add Task.input and Task.output constraints ⚠️ (Non-compatible change)
  - FHIR-45859 – Question re Task Status ⚠️ (Non-compatible change)
  - FHIR-45823 – Change the automated status update requirement for the Contributor task ⚠️ (Non-compatible change)
- Added a means to link associated tasks
  - FHIR-46352 – Add a way to link previously related GFE Coordination Request Tasks
- Updates to Coordination Tasks will update associated Contributor Task.
  - FHIR-45823 – Change the automated status update requirement for the Contributor task ⚠️ (Non-compatible change)
- Updated Actor based access
  - FHIR-45943 – Can a contributor read after completion?
- Added several non-substantive capabilities to the GFE Coordination Workflow
  - FHIR-45895 – Add more guidance about out of band activities for the Coordination Workflow
- Add guidance in the workflow at a glance that a GFE requestor that also need to provide a GFE will act as a GFE Contributor
  - FHIR-45735 – GFE Coordination Requesters GFE getting to Coordination platform
- Added guidance to the GFE Overview and GFE Specification pages that a Task should not be rejected if more information is required
  - FHIR-45893 – Add Guidance stating that a contributor task should not be rejected if more info is required
- Added guidance for cancelling and replacing of GFE contributor tasks
  - FHIR-45858 – Coordinating Requestor Capabilities to Amend Tasks
  - FHIR-45892 – Add guidance regarding the updating of tasks
  - FHIR-45857 – GFE Coordinator Capabilities
- Add guidance to Full GFE Coordination: End-to-End Workflow that if the contributor declines the task, `Task.status` shall be changed to rejected and the reason for the rejection should be placed in Task.statusReason.
  - FHIR-45942 – is a rejection reason provided?

#### Coverage Related

- Updated the PCT Coverage profile to enable the expression of self-pay or uninsured patient.
  - FHIR-45855 – Create a self-pay/uninsured Coverage profile and make Coverage required for the information bundle ⚠️ (Non-compatible change)
  - FHIR-51648 – Create a single Coverage profile for both insured and self/pay/uninsured ⚠️ (Non-compatible change)
  - FHIR-49752 – Coverage extension for kind valueset is not showing
- Removed duplicative requirement for multiple references to the payer organization (removed Claim.insurer reference in the Good Faith Estimate Professional and Good Faith Estimate Institutional profiles.
  - FHIR-51649 – Remove Duplicative Insurer requirement from GFE (keep Coverage payer)

#### Moved several CodeSystems and ValueSets to the HL7 Terminology IG.

- Moved the CodeSystem PCTSubjectToMedicalMgmtReasonCS to the THO Medical Management Type
  - FHIR-35549 – Defining URL should be anchored in THO not hl7.org/fhir.13
- Moved the CodeSystem and ValueSet PCTDiagnosisType to the THO Diagnosis Type CodeSystem and Diagnosis Type ValueSet
  - FHIR-35540 – Defining URL should be anchored in THO not hl7.org/fhir.4 for CodeSystem-PCTDiagnosisType.html ⚠️ (Non-compatible change)
- Removed the PCTOrgIdentifierCS from the IG and added codes to the to THO identifierType CodeSystem
  - FHIR-35545 – Defining URL should be anchored in THO not hl7.org/fhir.9 for CodeSystem-PCTOrgIdentifierTypeCS.html ⚠️ (Non-compatible change)
  - FHIR-51601 – Remove the PCTIdentifierType Code system and move to THO ⚠️ (Non-compatible change)
  - FHIR-45860 – Add a means to identify bundle purpose ⚠️ (Non-compatible change)
  - FHIR-51075 – Remove INTER identifier type code from the PCT IG ⚠️ (Non-compatible change)
- Removed the Codesystem PCTCareTeamRole and adopted the codes in Claim Care Team Role Codes
  - FHIR-35538 – Defining URL should be anchored in THO not hl7.org/fhir.2 for CodeSystem-PCTCareTeamRole.html ⚠️ (Non-compatible change)
- Remove the PCTAEOBTypeVS ValueSet and change binding of PCT Advanced EOB `ExplanationOfBenefit.type` to THO Claim Type Codes
  - FHIR-45819 – Consider anchoring the valuesets in THO (terminology.hl7.org). 3

#### Support US Core 7.0.0 and 6.1.0

- Added support and alignment to use Core 7.0.0 and US Core 6.1.0
  - FHIR-45836 – Add support for US Core 6.1 ⚠️ (Non-compatible change)
  - FHIR-46187 – NAIC Code Number Identifier system not registered in THO ⚠️ (Non-compatible change)
  - FHIR-36638 – Patient Profile state can either be US state or out of US subdivision code.
    - Changed to US Core profile and removed the extension

#### Updates to Estimate Element Requirements and Guidance

- Add an additional Process Note Class of `conditional` to the code system and value set to the Process Note Class Extension valueCodeableConcept binding
  - FHIR-46228 – How should we represent the conditional aspects of an estimate?
- Add requirement for PCT Advanced EOB `ExplanationOfBenefit.benefitBalance.category.text` as MS
  - FHIR-42828 – Add requirement for EoB.benefitBalance Category text ⚠️ (Non-compatible change)
- Add the Remaining Benefit Extension to the Advanced EOB Summary profile
  - FHIR-50082 – Add remaining extension to Summary ExplanationOfBenefit.benefitBalance.financial
- Added guidance to several entries to the Advanced EOB Notes on Fields and Summary Advanced EOB Notes on Fieldsto improve guidance for elements
  - FHIR-51541 – Review bullet on AEOB Profile: Notes on Fields: .total.amount
  - FHIR-42706 – Add description for benefit balance
  - FHIR-38769 – Add Operational requirement that there is a 1 to 1 relationship between a GFE and an AEOB
  - FHIR-51619 – Add Notes to AEOB Summary Profile regarding Totals
  - FHIR-46227 – Add guidance for AEOBs with examples for Prior Auth, Out of Network,
- Added the ability to indicate an estimate request is for a scheduled or non-scheduled service and the time of the request to the GFE Composition
  - FHIR-45759 – Add 'shopping vs scheduled service' flag ⚠️ (Non-compatible change)
- Update the GFE Service Linking Information Extension to address several needs for linking separately submitted GFEs
  - FHIR-34959 – gfeServiceLinkingInfo Comments ⚠️ (Non-compatible change)
- Require member liability and eligible slices to the `ExplanationOfBenefit.total` element in the Advanced EOB and Advanced EOB Summary profiles.
  - FHIR-51542 – Require Total Member Liability and Total Eligible on the AEOB Summary ⚠️ (Non-compatible change)
- Require CPT Consumer Friendly Descriptor in the Good Faith Estimate Institutional, Good Faith Estimate Professional, and Advanced EOB profiles where a CPT code is used.
  - FHIR-45909 – require use of CPT friendly descriptors ⚠️ (Non-compatible change)
- Removed the CountrySubdivisionCode From the PCT Organization `address` element.
  - FHIR-51747 – Remove CountrySubdivisionCode extension ⚠️ (Non-compatible change)
- Change Claim Frequency code binding from an IG defined CodeSystem to the NUBC Uniform Billing Type ValueSet in the Good Faith Estimate Professional profile
  - FHIR-51072 – Remove Claim Frequency Supporting Info slice from Professional GFE Profile ⚠️ (Non-compatible change)
- Remove the requirement to always include the diagnosis code in the Good Faith Estimate Professional profile.
  - FHIR-45178 – Diagnosis is required but not always known
  - FHIR-46091 – Add guidance regarding the inclusion of Diagnosis codes in GFEs
- Removed NPI as an identifier type in PCT Organization and PCT Practitioner
  - FHIR-50457 – NPI isn't a valid identifier type ⚠️ (Non-compatible change)
- Updated the description for the Advanced EOB and Advanced EOB Summary profiles `ExplanationOfBenefit.total:negotiated`
  - FHIR-51544 – Update definition for the ExplanationOfBenefit.total:negotiated
- Added guidance to the estimation Profiles (Good Faith Estimate Institutional, Good Faith Estimate Professional, and GFE Summary, Advanced EOB and Advanced EOB Summary ) for including additional information for medical management
  - FHIR-45862 – Add guidance about where to place medical management/prior auth and other contextual info

#### Updates to Request and Submission Workflow and Operations

- Create a gfe-coordination-request operation
  - FHIR-45737 – May support individual resource posting seems incongruent with should statement for Requestor. ⚠️ (Non-compatible change)
- Updates to the GFE Submission workflow to allow for early error response in the Full GFE Coordination: End-to-End Workflow and AEOB Response
  - FHIR-49778 – Update gfe-submit operation workflow to support providing error status as early in the process as possible ⚠️ (Non-compatible change)
  - FHIR-45856 – Error Messages
  - FHIR-45938 – work quetsion regarding AEOB with errors
  - FHIR-45937 – Error information should be actionable
- Added guidance that the AEOB should be made available to the submitting provider
  - FHIR-45901 – require that the AEOB be returned to the provider
- Note that the Coordination Workflow is an option, not a requirement, for submission of the GFE Packet in the Overview and GFE Submit Workflow sections of the index page and Business Actors of the Use Cases page
  - FHIR-45928 – Do not presume convening provider model for insured patients
  - FHIR-45853 – Purpose of IG
  - FHIR-45851 – Clarification regarding convening provider
  - FHIR-45854 – Issue with information flow between business actors
- Change the GFE Task operation to be resource ID based
  - FHIR-48357 – Change Retrieve GFE Collection Bundle Operation from a global operation to a Task instance operation ⚠️ (Non-compatible change)
- Update to the correct term (GFE Packet and GFE Bundle) in numerous places in the IG
  - FHIR-45381 - Some instances of bundle should be collection bundle

#### General Narrative Requirements and Guidance for Submissions to Payers

- Added guidance on addressing submissions that relate to a previous submission.
  - FHIR-51746 – Add Guidance to the AEOB request for a relatesTo document that has already been processed.
- Added requirements and guidance for collation of multiple GFE Bundles
  - FHIR-51078 – Add more narrative guidance on the two means to collate GFE Bundles ⚠️ (Non-compatible change)

#### Updates to the CapabilityStatements

- Updated the Coordination Platform CapabilityStatement, Coordination Requester CapabilityStatement, GFE Provider CapabilityStatement, and Payer CapabilityStatement
  - FHIR-51684 – Add CapabilityStatements & requirements for the GFE & AEOB DocumentReference profiles, searching, and notification ⚠️ (Non-compatible change)
  - FHIR-52528 - Add CapabilityStatement requirements for providers that create GFEs for patients
- Add a requirement in the Formal Specifications page CapabilityStatement Requirements that servers conforming to the IG indicate the the version (e.g. STU1 or STU2) of the profile being supporting in `CapabilityStatement.instantiates`
  - FHIR-45861 – Add guidance for implementers to detect the difference between STU1 and STU2 usage ⚠️ (Non-compatible change)

#### Other Changes

- Added a Section About Data Retention and Access
  - FHIR-45941 – Coordination Platform question
- Create a means to better distinguish Bundles
  - FHIR-45860 – Add a means to identify bundle purpose ⚠️ (Non-compatible change)
- Remove the unused PCT Endpoint extension
  - FHIR-51692 – Remove the orphaned PCTEndpoint extension ⚠️ (Non-compatible change)
- Clarified the relation of the role of the convening and submitting providers
  - FHIR-45852 – Misapplication of convening provider requirement
- Removed term definition for terms already defined in CodeSystem from the Terms and Concepts section
  - FHIR-45373 – Glossary could include a few related terms
- Added requirements and guidance for adjudication
  - FHIR-45377 – Clarify scope of adjudication

### High Level Changes 2.0.0-ballot

This ballot version includes a new use case addressing the need to coordinate GFE collection among providers and makes some modifications to the existing GFE Submit workflow:

- Added the GFE Coordination Workflow Overview and Specification pages.
- Created the following profiles in support of the GFE Collection workflow:
  - GFE Collection Bundle - This collection of GFE Bundles from GFE contributors that can then be made available to the patient or sent to a payer for insurance estimation.
  - GFE Coordination Bundle - Contains necessary resources for GFE to request GFEs from one or multiple GFE contributing providers.
  - GFE Coordination Task - Used to organize a GFE across providers for a single period of care for which all GFE Contributor Task resources will be linked.
  - GFE Contributor Task - Used by a GFE coordinator to assign a GFE contributor task to a specific provider and may include information specific to that patient’s expected service.
  - GFE Information Bundle - Contains the information necessary for GFE contributors to create their estimates.
  - GFE Missing Bundle - Used to indicate when a GFE Contributor task request was made, but no GFE Bundle was submitted.
  - GFE ServiceRequest - Includes details about a service for which a GFE is being requested.
  - GFE MedicationRequest - Includes details about a medication for which a GFE is being requested.
  - GFE DeviceRequest - Includes details about a device for which a GFE is being requested.
  - PCT Service Location - Provides information where the service is to be performed or the item delivered.
- Created the following CapabilityStatements identifying requirements of the GFE Coordination workflow actors:
  - Coordination Platform Capability Statement
  - Coordination Requester Capability Statement
  - GFE Contributor Capability Statement
- Created CodeSystems and ValueSets in support of the GFE Coordination workflow
- Created the Retrieve GFE Collection Bundle (GFE-Retrieve) operation to support the collection of GFE Bundles contributed through the GFE Coordination workflow.
- Updated the GFE Submit operation to take a GFE Collection Bundle instead of the GFE Bundle (which is now contained in the GFE Collection Bundle)
- Added the AEOB Summary and GFE Summary profiles and requirements for their presence in the AEOB Bundle and GFE Bundle respectively
- Assign a standard status to all artifacts and pages.
- Small presentation and example changes.

#### Detailed Changes 2.0.0-ballot (JIRA Change Requests)

Key | Resolution | Summary
--- | --- | ---
FHIR-42832 | Persuasive with Modification | Add slices to the Advanced ExplanationOfBenefit total
FHIR-42707 | Persuasive with Modification | GFE submit operation should describe the wrapping batch-response bundle
FHIR-42785 | Persuasive with Modification | Add "negotiated" code to Network status CodeSystem and adjudication and item.adjudication bound ValueSet
FHIR-43705 | Persuasive | Improve description of OperationOutcome OUT param in $gfe-submit
FHIR-44952 | Persuasive | Relax insurance/coverage requirements on GFE Bundle and GFE claim profiles
FHIR-44955 | Persuasive | Add CDT codes to GFE Claim codes ValueSet bindings
FHIR-44971 | Persuasive | Create an operation to retrieve a GFE Collection Bundle for a task
FHIR-44993 | Persuasive | Create CapabilityStatements for GFE Request workflow
FHIR-45001 | Persuasive | Pre-adopt Coverage.kind into PCT Coverage profile and add declaration
FHIR-45037 | Persuasive | Add proposed service location to GFE information request bundle
FHIR-45053 | Persuasive | Remove GFE Submitter from Claim resource Profiles
FHIR-45055 | Persuasive with Modification | Add a GFE Coordination Workflow to the IG
FHIR-45151 | Persuasive | Add an STU note on all draft pages (narrative & profile) about it being draft
FHIR-45152 | Persuasive | Change the home page STU Note text
FHIR-44951 | Not Persuasive with Modification | Change the GFE Bundle to be contributor specific and add a GFE Collection Bundle
FHIR-45054 | Persuasive with Modification | Create a GFE Coordination Bundle for submitting a GFE Coordination request
FHIR-45061 | Persuasive | Section 3.3 US Core currently resolves to US Core 6.1 in two places. It should actually NOT point to US Core 6.1.0, but US Core 3.1.1
FHIR-45060 | Persuasive | The header for section 3.2.1 reads FHIR Version, but the link reads FHIR R4 US Core and points to US Core 6.1 instead of the FHIR R4 Specification.
FHIR-43329 | Persuasive | Correct Example fullURL to use the right resource base
FHIR-44859 | Persuasive | Correct the spelling of the word definition
FHIR-44691 | Persuasive | Correct typo in index page regarding future IG
FHIR-44970 | Persuasive | Add a GFE Request Information Bundle and related profiles
FHIR-44954 | Persuasive | Create Coordinating Request Task and Contributing Provider Request Task Profiles
FHIR-44778 | Persuasive | Create an GFE Summary Profile to add to the GFE Bundle
FHIR-42827 | Persuasive | Create an AEOB Summary Profile to add to the AEOB Bundle
FHIR-43330 | Persuasive with Modification | Correct invariant expressions where a coding is checked

### High Level Changes 1.1.0

This STU Update includes a number of changes addressing some critical and minor fixes including:

- Set max occurrences for slice discriminator element 'type' to one of the Good Faith Estimate profiles.
- Corrected Advanced Explanation Of Benefit Profile benefit payment status and adjustment reason adjudication slices to the correct Value Set binding.
- Corrected Advanced Explanation Of Benefit Profile benefitBalance.financial element types and added remaining amount extension.
- Corrected numerous FHIRPath expressions for SearchParameter and Invariants.
- Assign context to all of the extensions
- Small presentation and example changes.

#### Detailed Changes 1.1.0 (JIRA Change Requests)

Key | Resolution | Summary
--- | --- | ---
FHIR-40526 | Accepted Technical Correction | Fixed Value CodeableConcept discriminator elements should have a max Cardinality of 1
FHIR-40812 | Persuasive | Change AEOB adjudication[adjustmentreason] binding to adjustment reason codes
FHIR-42786 | Persuasive with Modification | Correct Adjudication reason ValueSet binding for network status adjudication category slices
FHIR-41490 | Accepted Technical Correction | Update link for Asynchronous Interaction Request Pattern to point to R5 instead of CI
FHIR-42825 | Persuasive with Modification | Add extension for benefit balance remaining amount
FHIR-42910 | Persuasive | Change constraint in ExplanationOfBenefit.benefitBalance.financial allowed[x] and used[x]
FHIR-43065 | Accepted Technical Correction | Correct Date Of Service SearchParameter expression
FHIR-43111 | Persuasive | Correct Invariant issues identified in the IG Publisher
FHIR-43077 | Persuasive | Assign context to all of the extensions
FHIR-43330 | Persuasive with Modification | Assign context to all of the extensions
FHIR-43329 | Persuasive | Correct Example fullURL to use the right resource base

### High Level Changes 1.0.0

There were many changes to all the profiles, value sets, etc. since the last ballot. The details are listed in the section below. High level changes since the ballot are:

- The polling mechanism changed form polling based on Bundle.identifier to using the asynchronous response pattern.
- Updated workflow diagrams on the Use Cases page.
- Most code systems have been moved to the HL7 terminology page, and their code system URLs changed as a result.
- Harmonized with CARIN blue button EOB where possible to reduce implementation barriers
- Added Must Support definition, and updated elements to align with MS definition, and removed MS from elements where the minimum cardinality is 1 since these are required anyway
- Updates to the AEOB profile to provide guidance and improve alignment with requirements for patient AEOBs including benefit period, benefit balance, adjudication and supporting info elements

#### Detailed Changes 1.0.0 (JIRA Change Requests)

Key | Resolution | Summary
--- | --- | ---
FHIR-35228 | Persuasive | PCT GFE Institutional .item, remove .item estimated DOS extension
FHIR-34692 | Persuasive | Institutional profile - modify mapping of charge amount
FHIR-34816 | Persuasive | Professional profile - modify mapping of charge amount
FHIR-34928 | Persuasive with Modification | US Core Reference
FHIR-34934 | Persuasive with Modification | Terms and concepts - Charge Master Description
FHIR-34935 | Persuasive with Modification | Terms and concepts - Collection of Services
FHIR-34938 | Persuasive | Systems Update
FHIR-35207 | Persuasive with Modification | Disclaimer wording is awkward in MRI scenario
FHIR-35234 | Persuasive | Remove section 4.4 Testing requirements
FHIR-34925 | Persuasive | In the Coverage profile, remove Must Support from costToBeneficiary
FHIR-34919 | Persuasive | Modify AEOB profile to add Practitioner
FHIR-34915 | Persuasive with Modification | Require pattern for AEOB profile claim.use; add MS to claim.status
FHIR-34904 | Persuasive | AEOB profile - remove expirationDate
FHIR-34661 | Persuasive | Remove Must Support from Institutional.facility
FHIR-34505 | Persuasive | Clarify wording for Claim Resource in GFE Bundle Resource
FHIR-35236 | Persuasive | Remove inherited invariants from profile pages
FHIR-34969 | Persuasive with Modification | stronger language in P&S section
FHIR-34936 | Persuasive | Terms and concepts - De-identified Minimum Negotiated Rate
FHIR-36025 | Persuasive | PCT AEOB Profile - Add PractitionerRole to provider
FHIR-34933 | Persuasive | Terms and concepts updates - Consolidated Appropriations Act
FHIR-34976 | Persuasive with Modification | change SHOULD to SHALL
FHIR-34931 | Persuasive with Modification | Terms and concepts updates - Advanced EOB
FHIR-34939 | Persuasive | Downloads
FHIR-35230 | Persuasive | PCT GFE Professional - remove procedure:other slice
FHIR-35274 | Persuasive | Security and Privacy section mentioning X12
FHIR-34791 | Persuasive with Modification | Require pattern for professional profile claim.use; add MS to claim.status
FHIR-35357 | Persuasive | Move downloads to its own page with a menu link
FHIR-35344 | Persuasive | Add link to GFE Submit operation in referenced Overview text
FHIR-35340 | Persuasive | Include link to HRex IG in overview
FHIR-35264 | Persuasive | Add link to GFE Submit operation
FHIR-35266 | Persuasive | Define AEOB on first use on page
FHIR-34927 | Persuasive with Modification | Update Example
FHIR-35200 | Persuasive | All diagrams should have an identifier to make it easy to reference.
FHIR-35170 | Persuasive with Modification | Add definition of GFE
FHIR-34691 | Persuasive with Modification | Institutional profile - remove location extension
FHIR-34995 | Persuasive | Clarify a single PCT GFE Bundle SHALL only contain gfe for a single patient
FHIR-34942 | Persuasive | GFE Professional Claim .accident, constrain to locationAddress, add binding to country code
FHIR-34941 | Persuasive | PCT GFE Institutional - .accident, constrain to locationAddress and add binding for country code
FHIR-35102 | Persuasive with Modification | edit definition of Changemaster
FHIR-34650 | Persuasive with Modification | Require pattern for institutional profile claim.use; add MS to claim.status
FHIR-34980 | Persuasive | Patient Profile - remove employeeID
FHIR-34794 | Persuasive with Modification | Define Servicing Facility reference resource as an organization, not a location
FHIR-34984 | Persuasive with Modification | Remove PractitionerRole Profile
FHIR-34906 | Persuasive with Modification | PCT GFE Institutional supportingInfo:typeOfBill .code
FHIR-34983 | Persuasive | Remove the Location Profile
FHIR-35147 | Persuasive | Remove Code Systems defined for testing purposes
FHIR-36640 | Persuasive | Define Institutional Servicing Facility reference resource as an organization, not a location
FHIR-35256 | Persuasive with Modification | More guidance is required for the AEOB Out of network provider info
FHIR-35208 | Persuasive | Provide link to the CAA No Surprises legislation
FHIR-35219 | Persuasive | PCT GFE Institutional - .careTeam:attending - PCT Practitioner only
FHIR-34953 | Persuasive | Payer Intermediary and FHIR-X12 Translators
FHIR-34787 | Persuasive | Move Security section to own page as a Menu item
FHIR-34810 | Persuasive with Modification | Professional Profile: Difference between the Provider Event Methodology and the Provider GFE Grouper Methodology
FHIR-34809 | Persuasive with Modification | Professional Profile - remove location extension
FHIR-37632 | Not Persuasive with Modification | Make AEOB .benefitPeriod cardinality 1..1
FHIR-37636 | Persuasive | Add markdown datatype to disclaimer extension
FHIR-36200 | Persuasive with Modification | AEOB - Add a String Element to contain the Description of the Provided Service
FHIR-37625 | Persuasive with Modification | Change AEOB element short description and comments on ExplanationOfBenefit.created
FHIR-34811 | Not Persuasive with Modification | Change GFE Billing Provider Line Item Control Number to item.sequence
FHIR-34946 | Persuasive with Modification | use of the term "near real time"
FHIR-35097 | Persuasive with Modification | Could payers reasonably produce an AEOB in 5 minutes?
FHIR-34892 | Persuasive with Modification | Change terminology for 'Submitting Provider' to 'Convening Provider'
FHIR-35233 | Persuasive | Fixed display values should not generally be required
FHIR-35145 | Not Persuasive with Modification | Practitioner Profile - add NUCC Value Set to .qualification
FHIR-34943 | Persuasive with Modification | Remove the Taxonomy extension from Organization
FHIR-35262 | Persuasive | Change the use of payor to payer
FHIR-35265 | Persuasive | Add EOB.use to explanation of predetermination
FHIR-35268 | Persuasive | Correct wording on example regarding occurence of resource
FHIR-36647 | Persuasive | Add missing '$' to FSH alias reference.
FHIR-34956 | Not Persuasive with Modification | Out of Network Info
FHIR-34792 | Persuasive | Modify .provider Reference Resource
FHIR-34900 | Persuasive with Modification | PCT Practitioner - Add explicit identifier slice for Tax ID
FHIR-35103 | Persuasive | rewrite in third person
FHIR-35263 | Persuasive | Update the the finally published version of HRex
FHIR-36198 | Persuasive | PCT Coverage - check to ensure is based on HRex - Missing Group Slice in IG
FHIR-37653 | Persuasive | Align PCT Coverage with HRex 1.0.0 Coverage
FHIR-35326 | Persuasive with Modification | Update Overview to better reflect the workflow
FHIR-34951 | Persuasive with Modification | Stronger language as to why Provider SHOULD also receive AEOB
FHIR-34954 | Persuasive with Modification | Overview Flow
FHIR-34947 | Persuasive with Modification | should state the close relationship between GFEs/AEOBs and X12 claims/ERAs
FHIR-35328 | Persuasive | Change overview language regarding X12
FHIR-35322 | Persuasive with Modification | Institutional profile - supportingInfo:typeOfBill update
FHIR-35240 | Not Persuasive with Modification | Remove Organization.identfier ccn as MS element
FHIR-34944 | Not Persuasive with Modification | In the Organization profile, update the ccn identifier description
FHIR-34979 | Persuasive with Modification | Organization Profile - add payer id and NAIC identifiers
FHIR-34937 | Persuasive | References to CAA
FHIR-34924 | Persuasive with Modification | Reference to X12
FHIR-35104 | Persuasive with Modification | Advanced EOB Response to Provider(s) Must Be Optional
FHIR-35056 | Not Persuasive with Modification | Revise PCT Organization Type Code System
FHIR-34982 | Not Persuasive with Modification | Practitioner Profile - update the ccn identifier description
FHIR-34922 | Persuasive | In the Coverage profile, define slices for .class
FHIR-35014 | Persuasive with Modification | GFE Submitter Must be Uniform Across All GFEs within a Bundle
FHIR-35379 | Persuasive | Add invariant requiring only a single GFE submitter
FHIR-34687 | Not Persuasive with Modification | Institutional Profile - add estimated admission period
FHIR-34666 | Persuasive with Modification | Define DRG as .supportingInfo on Institutional Profile
FHIR-35330 | Persuasive | Correct overview wording using IG name
FHIR-35202 | Persuasive | "Must Support" is not defined in this IG and it has to be since it is applied to several of the Resources
FHIR-34945 | Persuasive with Modification | Organization Profile - delete tin identifier
FHIR-38766 | Persuasive | Remove MS from AEOB.item.revenue
FHIR-35237 | Persuasive | FHIR US Core 3.1 is required for providers/payers to support adjacent ONC/CMS regulation
FHIR-38125 | Persuasive | Remove Must Support from PreAuthRef
FHIR-35294 | Not Persuasive with Modification | Coverage Profile - modify .subscriber Reference resource
FHIR-34990 | Not Persuasive with Modification | Define RelatedPerson Profile
FHIR-35216 | Persuasive with Modification | AEOB Item links to GFE
FHIR-34920 | Persuasive | On the AEOB profile, remove requirement for net; add requirement for adjudication
FHIR-37934 | Persuasive | Make type of bill on institutional supportinginfo cardinality 1..1
FHIR-35108 | Persuasive with Modification | which x12 specifications?
FHIR-36761 | Persuasive | Institutional GFE - Chg procedure:primary to procedure:principal, modify definition
FHIR-35243 | Not Persuasive with Modification | Add relatedPerson to Subscriber reference types
FHIR-35217 | Not Persuasive with Modification | Updating / Cancelling AEOB Request
FHIR-37516 | Persuasive with Modification | Change careTeam:rendering slice on Institutional GFE to only be a Human (not Organization)
FHIR-35095 | Persuasive | Utilize Distinct FHIR Profiles for Professional and Institutional Claims
FHIR-38126 | Persuasive | Add Disclaimer extension to GFEs
FHIR-34948 | Persuasive | Make a stronger case as to why FHIR is the best
FHIR-35254 | Not Persuasive with Modification | compoundDrugLinkingNum needs more guidance
FHIR-34905 | Persuasive with Modification | PCT GFE Professional - Create identifier slices rather than extensions
FHIR-35246 | Persuasive with Modification | Create slices on identifier instead of creating extensions
FHIR-35258 | Persuasive with Modification | Require type and subtype in AEOB
FHIR-34903 | Persuasive with Modification | PCT GFE Institutional - Identifiers. Add slices to .identifier rather than creating extensions
FHIR-35319 | Persuasive with Modification | Institutional Profile - define Point of Origin, Admission Type and Discharge Status
FHIR-37720 | Persuasive with Modification | Add the extension gfeProviderAssignedIdentifier to the AEOB Profile. (at the header level)
FHIR-34897 | Not Persuasive with Modification | PCT Practitioner - remove endpoint extension add slice on contact
FHIR-36193 | Not Persuasive with Modification | Plan or Coverage Entity Name and GFE Plan or Coverage Payer Name appear to be the same
FHIR-34901 | Persuasive with Modification | Institutional profile - define careTeamSequence
FHIR-34955 | Persuasive with Modification | Network status in advanced EOB profile
FHIR-35069 | Persuasive with Modification | Professional profile - update careTeam
FHIR-35057 | Persuasive with Modification | Institutional profile - add diagnosis slice, add invariants
FHIR-35249 | Persuasive with Modification | More clearly define the purpose and constraints of ProviderEventMethodology
FHIR-35273 | Persuasive | Provide means to declare an in or out of network/coverage status for AEOB
FHIR-35272 | Persuasive with Modification | Provide a means to specify a denial reason in AEOB
FHIR-35222 | Persuasive with Modification | PCT GFE Institutional - Claim.CareTeam:operating - PCT Practitioner, fix NUCC
FHIR-35261 | Persuasive | Make Conformance statement verbs in bold format
FHIR-38644 | Persuasive with Modification | Add provider descriptions for patients to both encounter and claim level
FHIR-37581 | Persuasive with Modification | Add clarifying comment to processNote with best practice for patient information
FHIR-38840 | Persuasive with Modification | Allow GFE Submitter to be Practitioner in Institutional GFE
FHIR-35088 | Persuasive with Modification | Institutional and Professional profiles - NDC mapping and Value Set
FHIR-39416 | Persuasive with Modification | Remove disclaimer extension from AEOB and update processNote description and cardinality
FHIR-35453 | Persuasive | Harmonize Profiles with the CARIN BB IG
FHIR-34913 | Persuasive | Harmonize CARIN BB and PCT FHIR data element mapping and Value Sets
FHIR-35238 | Persuasive | Include a CapabilityStatement
FHIR-38842 | Persuasive with Modification | Patient should be able to search EOBs, not get Bundles
FHIR-35063 | Persuasive with Modification | polling mechanism in question
FHIR-34974 | Persuasive with Modification | need to better explain the need for all the workflow steps
FHIR-35271 | Persuasive with Modification | AEOB Query should take a different approach
FHIR-34789 | Persuasive | Rewrite to make easier to understand the API
FHIR-34997 | Persuasive with Modification | Change who gets authentication done in AEOB request from payer
FHIR-34914 | Persuasive with Modification | Response to gfe-submit is unclear
FHIR-34952 | Persuasive with Modification | Process Flow Revisions
FHIR-34940 | Persuasive with Modification | Process for Sharing Advanced EOBs with Providers
FHIR-34533 | Persuasive with Modification | Is return type form GFE Submit Appropriate?
FHIR-35124 | Persuasive with Modification | Use of the FHIR API for Advanced AOBs to Member Must Be Optional
FHIR-35199 | Persuasive with Modification | Diagram in Overview seems to imply that the Patient could only get a response from an Intermediary
FHIR-39463 | Persuasive | Remove MS from AEOB.priority
FHIR-39465 | Persuasive | Make AEOB.insurance.coverage MS
FHIR-35143 | Persuasive with Modification | Professional profile - modify requirement for careTeam.qualification
FHIR-35140 | Persuasive with Modification | Institutional profile - modify requirement for careTeam.qualification
FHIR-38771 | Persuasive with Modification | Add note in overview that this IG does not address eligibility, prior authorization, or coordination of benefits
FHIR-34964 | Persuasive with Modification | provider web portal?
FHIR-38127 | Persuasive | GFE profiles need to require item.net
FHIR-35250 | Not Persuasive with Modification | Use Claim.billablePeriod instead of creating a new extension
FHIR-34785 | Persuasive with Modification | simplify menu navigation
FHIR-37963 | Persuasive | Redesign subjectToMedicalMgmt extension to support CodeableConcept and string
FHIR-34786 | Persuasive with Modification | Simplify or Replace figures with tables
FHIR-35051 | Persuasive with Modification | Modify GFE and AEOB Bundle Graphics
FHIR-39415 | Persuasive with Modification | Add service description to AEOB header
FHIR-34532 | Persuasive | Need example of return from gfe-submit
FHIR-34963 | Persuasive with Modification | GFE and AEOB Bundle Graphics
FHIR-39397 | Persuasive | Add clarity for the operation outcome when server doesn't include AEOB
FHIR-34962 | Persuasive | GFE and AEOB Bundle Graphics
FHIR-39346 | Persuasive | Add a slice on AEOB.identifier for unique claim id to align with CARIN, but clarify in the description that it is the payer's claim id.
FHIR-34961 | Persuasive with Modification | Detailed Requirements Summary
FHIR-35269 | Persuasive with Modification | Specify OperationOutcome requirements for common outcomes
FHIR-39379 | Persuasive with Modification | Make date of service required and add search parameter
FHIR-38770 | Persuasive | Add Operational requirement that the GFE linked in the AEOB is an exact copy of the provider submitted GFE Bundle
FHIR-38120 | Persuasive | Add an Operational requirement about GFE stored as is as originally received and not updated.
FHIR-38738 | Persuasive with Modification | Define assumptions about what payers must verify in the GFE
FHIR-39380 | Persuasive | Guiding principle for repeating items in GFE in AEOB
FHIR-38122 | Persuasive | Specify more details on the scope of the IG regarding coordination of benefits and other use cases
FHIR-35260 | Persuasive with Modification | Add slice requirements for AEOB adjudication categories
FHIR-38835 | Persuasive | Consider GFE Value to Indicate if Member Has Agreed to Balance Billing
FHIR-35378 | Persuasive with Modification | Add entry slices on Bundles for expected and required resource types
FHIR-34930 | Persuasive | Add Relationship Diagram

### Version 0.1.0

Initial ballot version