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

## CapabilityStatement: Patient Cost Transparency Implementation Guide Payer Capability Statement

Official URL: http://hl7.org/fhir/us/davinci-pct/CapabilityStatement/davinci-pct | Version: 2.0.1
Standards status: Trial-use | Maturity Level: 2 | Computable Name: PatientCostTransparencyCapabilityStatement
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.13.1
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

Payer capability statement for the Da Vinci Patient Cost Transparency Implementation Guide

Raw OpenAPI-Swagger Definition file | Download

version: 1; Last updated: 2023-03-28 19:21:32+0000

## Patient Cost Transparency Implementation Guide Payer Capability Statement

- Implementation Guide Version: 2.0.1
- FHIR Version: 4.0.1
- Supported Formats: SHALL support `json`, SHOULD support `xml`
- Published on: 2023-03-28 14:21:32-0500
- Published by: HL7 International / Financial Management

> Note to Implementers: FHIR Capabilities

> Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.

This CapabilityStatement imports the CapabilityStatement US Core Server CapabilityStatementversion: 7.0.0)

## FHIR RESTful Capabilities

### Mode: `server`

### Capabilities by Resource/Profile

#### Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

- The relevant profiles (if any)
- The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
- The required, recommended, and some optional search parameters (if any).
- The linked resources enabled for `_include`
- The other resources enabled for `_revinclude`
- The operations on the resource (if any)

Resource Type | Profile | R | V-R | S | U | P | C | D | H-I | H-T | Searches | `_include` | `_revinclude` | Operations
--- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | ---
Bundle | Supported Profiles PCT AEOB Packet PCT GFE Bundle PCT GFE Packet | Y | y? | Y | y? | y? | y? | y? | y? | y? |  |  |  | `$GFESubmit`
ExplanationOfBenefit | Supported Profiles PCT Advanced EOB | Y | y? | Y | y? | y? | y? | y? | y? | y? |  |  |  |
Coverage | Supported Profiles PCT Coverage | Y | y? | Y | y? | y? | y? | y? | y? | y? |  |  |  |
Claim | Supported Profiles PCT Good Faith Estimate Professional PCT Good Faith Estimate Institutional | Y | y? | Y | y? | y? | y? | y? | y? | y? |  |  |  |
Organization | Supported Profiles PCT Organization | Y | y? | Y | y? | y? | y? | y? | y? | y? |  |  |  |
Practitioner | Supported Profiles PCT Practitioner | Y | y? | Y | y? | y? | y? | y? | y? | y? |  |  |  |
DocumentReference | Supported Profiles PCT AEOB Packet Document Reference PCT GFE Bundle PCT GFE Packet | Y | y? | Y |  |  |  |  | y? | y? | category, status, doc-status, type, date, patient, estimate-initiation-time, estimate-service, estimate-condition, linking-identifier, planned-period, author, relatesto |  |  |

#### Resource Conformance: SHALLBundle

Core FHIR Resource
Bundle
Reference Policy
Interaction summary

- SHALL support `search-type`, `read`.
- MAY support `create`, `vread`, `update`, `patch`, `delete`, `history-instance`, `history-type`.

Supported Profiles

PCT AEOB Packet
PCT GFE Bundle
PCT GFE Packet

Extended Operations

Conformance | Operation | Documentation
--- | --- | ---
SHALL | $GFESubmit | This operation is used by an entity to submit one or multiple GFEs as a Bundle containing the GFE(s) and other referenced resources for processing. The only input parameter is the single Bundle resource with one or multiple GFE(s) - each of which is based on the Claim resource (along with other referenced resources). The only output is a url for subsequent polling per async pattern. If after polling the response is complete, then the result will either be a single Bundle with the AEOB - which is based on the ExplanationOfBenefit resource, (and other referenced resources) or an OperationOutcome resource indicating the AEOB will be sent directly to the patient.

#### Resource Conformance: SHOULDExplanationOfBenefit

Core FHIR Resource
ExplanationOfBenefit
Reference Policy
Interaction summary

- SHALL support `search-type`, `read`.
- MAY support `create`, `vread`, `update`, `patch`, `delete`, `history-instance`, `history-type`.

Supported Profiles

PCT Advanced EOB

#### Resource Conformance: SHOULDCoverage

Core FHIR Resource
Coverage
Reference Policy
Interaction summary

- SHALL support `search-type`, `read`.
- MAY support `create`, `vread`, `update`, `patch`, `delete`, `history-instance`, `history-type`.

Supported Profiles

PCT Coverage

#### Resource Conformance: SHOULDClaim

Core FHIR Resource
Claim
Reference Policy
Interaction summary

- SHALL support `search-type`, `read`.
- MAY support `create`, `vread`, `update`, `patch`, `delete`, `history-instance`, `history-type`.

Supported Profiles

PCT Good Faith Estimate Professional
PCT Good Faith Estimate Institutional

#### Resource Conformance: SHOULDOrganization

Core FHIR Resource
Organization
Reference Policy
Interaction summary

- SHALL support `search-type`, `read`.
- MAY support `create`, `vread`, `update`, `patch`, `delete`, `history-instance`, `history-type`.

Supported Profiles

PCT Organization

#### Resource Conformance: SHOULDPractitioner

Core FHIR Resource
Practitioner
Reference Policy
Interaction summary

- SHALL support `search-type`, `read`.
- MAY support `create`, `vread`, `update`, `patch`, `delete`, `history-instance`, `history-type`.

Supported Profiles

PCT Practitioner

#### Resource Conformance: SHOULDDocumentReference

Core FHIR Resource
DocumentReference
Reference Policy
Interaction summary

- SHOULD support `search-type`, `read`.
- MAY support `vread`, `history-instance`, `history-type`.

Supported Profiles

PCT AEOB Packet Document Reference
PCT GFE Bundle
PCT GFE Packet

Search Parameters

Conformance | Parameter | Type | Documentation
--- | --- | --- | ---
SHALL | category | `token` | Categorization of document.
SHALL | status | `token` | current | superseded | entered-in-error
SHALL | doc-status | `token` | preliminary | final | amended | entered-in-error
SHALL | type | `token` | Kind of document
SHALL | date | `date` | Kind of document
SHALL | patient | `reference` | Who/what is the subject of the document
SHOULD | estimate-initiation-time | `date` | Instant from which the request originating request was being initiated.
SHOULD | estimate-service | `token` | Significant Procedures and/or products involved in an estimate in the packet.
SHOULD | estimate-condition | `token` | Significant condition involved in an estimate in the packet.
SHOULD | linking-identifier | `token` | An identifier assigned to a particular service or series of services to enabling linking.
SHOULD | planned-period | `date` | Planned date(s) of a particular admission/service or a series of admissions/services.
SHOULD | author | `reference` | All involved authoring parties, including payer all Good Faith Estimate (GFE) providers.
SHOULD | relatesto | `reference` | Target of the relationship.