Patient Cost Transparency Implementation Guide
2.0.0 - STU 2 United States of America flag

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 2.0.0 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

NameWorkflow PatternFiveWs Pattern MappingHL7 v2 MappingRIM Mappingdoco
.. 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]

doco Documentation for this format