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

## Resource Profile: PCTAdvancedEOB - Mappings

Page standards status: Trial-use | Maturity Level: 2

Mappings for the davinci-pct-aeob resource profile.

#### Mappings to Structures in this Implementation Guide

No Mappings Found

#### Mappings to other Structures

No Mappings Found

#### Other Mappings

Name | Workflow Pattern | FiveWs Pattern Mapping | HL7 v2 Mapping | RIM Mapping
--- | --- | --- | --- | ---
ExplanationOfBenefit | Event |  |  | Entity. Role or Act
id |  |  |  |
meta |  |  |  |
implicitRules |  |  |  |
language |  |  |  |
text |  |  |  | Act.text?
contained |  |  |  | N/A
Slices for extension |  |  |  |
extension:gfeReference |  |  |  |
extension:serviceDescription |  |  |  |
extension:outOfNetworkProviderInfo |  |  |  |
modifierExtension |  |  |  | N/A
Slices for identifier | Event.identifier | FiveWs.identifier |  |
identifier:uniqueclaimid | Event.identifier | FiveWs.identifier |  |
id |  |  |  | n/a
extension |  |  |  | n/a
use |  |  | N/A | Role.code or implied by context
type |  |  | CX.5 | Role.code or implied by context
system |  |  | CX.4 / EI-2-4 | II.root or Role.id.root
value |  |  | CX.1 / EI.1 | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period |  |  | CX.7 + CX.8 | Role.effectiveTime or implied by context
assigner |  |  | CX.4 / (CX.4 CX.9 CX.10) | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
status | Event.status | FiveWs.status |  |
type | Event.code | FiveWs.class |  |
subType |  | FiveWs.class |  |
use |  | FiveWs.class |  |
patient | Event.subject | FiveWs.subject |  |
billablePeriod |  | FiveWs.done[x] |  |
created | Event.occurrence[x] | FiveWs.recorded |  |
enterer | Event.performer.agent | FiveWs.author |  |
insurer | Event.performer.agent | FiveWs.author |  |
provider |  | FiveWs.source |  |
priority |  |  | Request.priority |
fundsReserveRequested |  |  |  |
fundsReserve |  |  |  |
related |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
claim |  |  |  |
relationship |  |  |  |
reference |  |  |  |
prescription |  |  |  |
originalPrescription |  |  |  |
payee |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
type |  |  |  |
party |  |  |  |
referral |  | FiveWs.cause |  |
facility | Event.performer.location | FiveWs.where[x] |  |
claim |  | FiveWs.why[x] |  |
id |  |  |  | n/a
extension |  |  |  | n/a
reference |  |  |  | N/A
type |  |  |  | N/A
identifier |  |  |  | .identifier
id |  |  |  | n/a
extension |  |  |  | n/a
use |  |  | N/A | Role.code or implied by context
type |  |  | CX.5 | Role.code or implied by context
system |  |  | CX.4 / EI-2-4 | II.root or Role.id.root
value |  |  | CX.1 / EI.1 | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period |  |  | CX.7 + CX.8 | Role.effectiveTime or implied by context
assigner |  |  | CX.4 / (CX.4 CX.9 CX.10) | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
display |  |  |  | N/A
claimResponse |  |  |  |
outcome |  |  |  |
disposition |  |  |  |
preAuthRef |  |  |  |
preAuthRefPeriod |  |  |  |
careTeam |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
sequence |  |  |  |
provider |  | FiveWs.actor |  |
responsible |  |  |  |
role |  |  |  |
qualification |  |  |  |
supportingInfo |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
sequence |  |  |  |
category |  |  |  |
code |  |  |  |
timing[x] |  |  |  |
value[x] |  |  |  |
reason |  |  |  |
diagnosis |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
sequence |  |  |  |
diagnosis[x] |  |  |  |
type |  |  |  |
onAdmission |  |  |  |
packageCode |  |  |  |
procedure |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
sequence |  |  |  |
type |  |  |  |
date |  |  |  |
procedure[x] |  |  |  |
udi |  |  |  |
precedence |  |  |  |
insurance |  |  | Coverage |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
focal |  |  |  |
coverage |  |  |  |
preAuthRef |  |  |  |
accident |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
date |  |  |  |
type |  |  |  |
location[x] |  |  |  |
item |  |  |  |
id |  |  |  | n/a
Slices for extension |  |  |  |
extension:serviceDescription |  |  |  |
modifierExtension |  |  |  | N/A
sequence |  |  |  |
careTeamSequence |  |  |  |
diagnosisSequence |  |  |  |
procedureSequence |  |  |  |
informationSequence |  |  |  |
revenue |  |  |  |
category |  |  |  |
productOrService |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
coding |  |  | C*E.1-8 C*E.10-22 | union(. ./translation)
text |  |  | C*E.9. But note many systems use C*E.2 for this | ./originalText[mediaType/code="text/plain"]/data
modifier |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
coding |  |  | C*E.1-8 C*E.10-22 | union(. ./translation)
text |  |  | C*E.9. But note many systems use C*E.2 for this | ./originalText[mediaType/code="text/plain"]/data
programCode |  |  |  |
serviced[x] |  | FiveWs.done[x] |  |
location[x] |  | FiveWs.where[x] |  |
quantity |  |  |  |
unitPrice |  |  |  |
factor |  |  |  |
net |  |  |  |
udi |  |  |  |
bodySite |  |  |  |
subSite |  |  |  |
encounter |  |  |  |
noteNumber |  |  |  |
Slices for adjudication |  |  |  |
adjudication:All Slices |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:medicalmanagement |  |  |  |
id |  |  |  | n/a
Slices for extension |  |  |  |
extension:subjectToMedicalMgmt |  |  |  |
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:benefitpaymentstatus |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:adjustmentreason |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:submitted |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:memberliability |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:eligible |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:benefit |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
detail |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
sequence |  |  |  |
revenue |  |  |  |
category |  |  |  |
productOrService |  |  |  |
modifier |  |  |  |
programCode |  |  |  |
quantity |  |  |  |
unitPrice |  |  |  |
factor |  |  |  |
net |  |  |  |
udi |  |  |  |
noteNumber |  |  |  |
adjudication |  |  |  |
subDetail |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
sequence |  |  |  |
revenue |  |  |  |
category |  |  |  |
productOrService |  |  |  |
modifier |  |  |  |
programCode |  |  |  |
quantity |  |  |  |
unitPrice |  |  |  |
factor |  |  |  |
net |  |  |  |
udi |  |  |  |
noteNumber |  |  |  |
adjudication |  |  |  |
addItem |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
itemSequence |  |  |  |
detailSequence |  |  |  |
subDetailSequence |  |  |  |
provider |  | FiveWs.source |  |
productOrService |  |  |  |
modifier |  |  |  |
programCode |  |  |  |
serviced[x] |  | FiveWs.done[x] |  |
location[x] |  | FiveWs.where[x] |  |
quantity |  |  |  |
unitPrice |  |  |  |
factor |  |  |  |
net |  |  |  |
bodySite |  |  |  |
subSite |  |  |  |
noteNumber |  |  |  |
adjudication |  |  |  |
detail |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
productOrService |  |  |  |
modifier |  |  |  |
quantity |  |  |  |
unitPrice |  |  |  |
factor |  |  |  |
net |  |  |  |
noteNumber |  |  |  |
adjudication |  |  |  |
subDetail |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
productOrService |  |  |  |
modifier |  |  |  |
quantity |  |  |  |
unitPrice |  |  |  |
factor |  |  |  |
net |  |  |  |
noteNumber |  |  |  |
adjudication |  |  |  |
Slices for adjudication |  |  |  |
adjudication:All Slices |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:medicalmanagement |  |  |  |
id |  |  |  | n/a
Slices for extension |  |  |  |
extension:subjectToMedicalMgmt |  |  |  |
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:billingnetworkstatus |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:renderingnetworkstatus |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:benefitpaymentstatus |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:adjustmentreason |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:submitted |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:memberliability |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:eligible |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
adjudication:benefit |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
reason |  |  |  |
amount |  |  |  |
value |  |  |  |
Slices for total |  |  |  |
total:All Slices |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:submitted |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:memberliability |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:eligible |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:innetwork |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:outofnetwork |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:noncovered |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:negotiated |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
total:benefit |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
amount |  |  |  |
payment |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
type |  |  |  |
adjustment |  |  |  |
adjustmentReason |  |  |  |
date |  |  |  |
amount |  |  |  |
identifier |  |  |  |
formCode |  |  |  |
form |  |  |  |
processNote |  |  |  |
id |  |  |  | n/a
Slices for extension |  |  |  |
extension:processNoteClass |  |  |  |
modifierExtension |  |  |  | N/A
number |  |  |  |
type |  |  |  |
text |  |  |  |
language |  |  |  |
benefitPeriod |  |  |  |
benefitBalance |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
modifierExtension |  |  |  | N/A
category |  |  |  |
id |  |  |  | n/a
extension |  |  |  | n/a
coding |  |  | C*E.1-8 C*E.10-22 | union(. ./translation)
text |  |  | C*E.9. But note many systems use C*E.2 for this | ./originalText[mediaType/code="text/plain"]/data
excluded |  |  |  |
name |  |  |  |
description |  |  |  |
network |  |  |  |
unit |  |  |  |
term |  |  |  |
financial |  |  |  |
id |  |  |  | n/a
Slices for extension |  |  |  |
extension:remaining |  |  |  |
modifierExtension |  |  |  | N/A
type |  |  |  |
allowed[x] |  |  |  |
used[x] |  |  |  |
Documentation for this format