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

## Example Claim: PCT-GFE-Summary-MRI

Page standards status: Informative

Profile: PCT Good Faith Estimate Summary

status: Active

type: Estimate Summary

use: Predetermination

patient: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)

billablePeriod: 2021-10-31 --> (ongoing)

created: 2021-10-05

insurer: Organization Umbrella Insurance Company

provider: ?rref?

priority: Normal

### Diagnoses

- | Sequence | Diagnosis[x] | Type | PackageCode
* | 1 | Unspecified focal traumatic brain injury | Principal Diagnosis | Head trauma - concussion

### Insurances

- | Sequence | Focal | Coverage
* | 1 | true | Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01

### Totals

- | Value | Currency
* | 200 | United States dollar