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

## Extension: Subject To Medical Management

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt | Version: 2.0.1
Standards status: Trial-use | Maturity Level: 2 | Computable Name: SubjectToMedicalMgmt
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.47

This extension is used to provide a reason to explain how the estimate may change subject to medical management.

Context of Use

This extension may be used on the following element(s)

- Element ID: `ExplanationOfBenefit.adjudication`
- Element ID: `ExplanationOfBenefit.item.adjudication`

Usage info

Usages:

- Use this Extension: PCT Advanced EOB
- Examples for this Extension: Bundle/PCT-AEOB-Packet-1 and ExplanationOfBenefit/PCT-AEOB-1

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

- The data elements list has changed

### Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

- Differential Table
- Snapshot Table
- Statistics/References
- All

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Subject To Medical Management
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"
Slices for value[x] |  | 1..1 |  | The estimate may change subject to medical management with this reason Slice: Unordered, Open by type:$this
valueString |  |  | string |
valueCodeableConcept |  |  | CodeableConcept |
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: Medical Management Type (extensible)
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Subject To Medical Management
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"
Slices for value[x] |  | 1..1 |  | The estimate may change subject to medical management with this reason Slice: Unordered, Open by type:$this
valueString |  |  | string |
valueCodeableConcept |  |  | CodeableConcept |
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: Medical Management Type (extensible)
Documentation for this format

This structure is derived from Extension

Summary

Simple Extension with the type string, CodeableConcept: This extension is used to provide a reason to explain how the estimate may change subject to medical management.

Maturity: 2

Differential View

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Subject To Medical Management
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"
Slices for value[x] |  | 1..1 |  | The estimate may change subject to medical management with this reason Slice: Unordered, Open by type:$this
valueString |  |  | string |
valueCodeableConcept |  |  | CodeableConcept |
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: Medical Management Type (extensible)
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Subject To Medical Management
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"
Slices for value[x] |  | 1..1 |  | The estimate may change subject to medical management with this reason Slice: Unordered, Open by type:$this
valueString |  |  | string |
valueCodeableConcept |  |  | CodeableConcept |
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: Medical Management Type (extensible)
Documentation for this format

This structure is derived from Extension

Summary

Simple Extension with the type string, CodeableConcept: This extension is used to provide a reason to explain how the estimate may change subject to medical management.

Maturity: 2

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x]:valueCodeableConcept | Base | extensible | Medical Management Type | 📦1.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`