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

## ValueSet: PCT Financial Type Value Set

Official URL: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTFinancialTypeVS | Version: 2.0.1
Standards status: Trial-use | Maturity Level: 2 | Computable Name: PCTFinancialTypeVS
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.48.17

Financial Type codes for benefitBalance.financial.type.

References

- PCT Advanced EOB
- PCT Advanced EOB
- PCT Advanced EOB Summary
- PCT Advanced EOB Summary

Changes since version 1.1.0:

- No changes

### Logical Definition (CLD)

- Include all codes defined in `http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` version 📦2.0.1

### Expansion

Expansion performed internally based on codesystem PCT Financial Type Code System v2.0.1 (CodeSystem)

This value set contains 10 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | allowed | Allowed | The maximum amount a plan will pay for a covered health care service. May also be called "payment allowance", or "negotiated rate". |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | coinsurance | Co-Insurance | The amount the insured individual pays, as a set percentage of the cost of covered services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | copay | CoPay | A fixed amount ($20, for example) the insured individual pays for a covered health care service after the deductible is paid. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | deductible | Deductible | The amount the insured individual pays for covered health care services before the insurance plan starts to pay. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | eligible | Eligible Amount | Amount of the charge which is considered for adjudication. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | memberliability | Member Liability | The amount of the member's liability. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | noncovered | Noncovered | The portion of the cost of the service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | out-of-pocket-maximum | Out-of-Pocket Maximum | The most the insured individual has to pay for covered services in a plan year. After this amount is spent on deductibles, copayments, and coinsurance for in-network care and services, the health plan pays 100% of the costs of covered benefits. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | visit | Visit | A medical visit means diagnostic, therapeutic, or consultative services provided to a client by a healthcare professional in an outpatient setting. |  |
`http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType` | penalty | Penalty | Benefit penalty is an approach used by the insurance company to reduce their payment on a claim when the patient or medical provider does not satisfy the rules of the health plan. Benefit penalties may occur when a pre-authorization is not obtained, for example. |  |

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