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 2.0.2 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
Mappings for the davinci-pct-aeob-summary resource profile.
| Name | Workflow Pattern | FiveWs Pattern Mapping | HL7 v2 Mapping | RIM Mapping |
|---|
  ExplanationOfBenefit |
Event |
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  ExplanationOfBenefit / id |
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 ExplanationOfBenefit / meta |
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| ExplanationOfBenefit / implicitRules |
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| ExplanationOfBenefit / language |
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| ExplanationOfBenefit / text |
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Act.text? |
| ExplanationOfBenefit / contained |
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N/A |
 ExplanationOfBenefit / Slices for extension |
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   ExplanationOfBenefit / Slices for extension / extension:serviceDescription |
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 ExplanationOfBenefit / Slices for extension / extension:outOfNetworkProviderInfo |
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 ExplanationOfBenefit / modifierExtension |
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N/A |
| ExplanationOfBenefit / identifier |
Event.identifier |
FiveWs.identifier |
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| ExplanationOfBenefit / status |
Event.status |
FiveWs.status |
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| ExplanationOfBenefit / type |
Event.code |
FiveWs.class |
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| ExplanationOfBenefit / subType |
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FiveWs.class |
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| ExplanationOfBenefit / use |
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FiveWs.class |
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 ExplanationOfBenefit / patient |
Event.subject |
FiveWs.subject |
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| ExplanationOfBenefit / billablePeriod |
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FiveWs.done[x] |
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| ExplanationOfBenefit / created |
Event.occurrence[x] |
FiveWs.recorded |
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| ExplanationOfBenefit / enterer |
Event.performer.agent |
FiveWs.author |
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| ExplanationOfBenefit / insurer |
Event.performer.agent |
FiveWs.author |
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| ExplanationOfBenefit / provider |
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FiveWs.source |
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| ExplanationOfBenefit / provider / id |
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n/a |
| ExplanationOfBenefit / provider / Slices for extension |
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| ExplanationOfBenefit / provider / Slices for extension / extension:dataAbsentReason |
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ANY.nullFlavor |
  ExplanationOfBenefit / provider / Slices for extension / extension:dataAbsentReason / id |
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n/a |
| ExplanationOfBenefit / provider / Slices for extension / extension:dataAbsentReason / extension |
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| ExplanationOfBenefit / provider / Slices for extension / extension:dataAbsentReason / url |
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N/A |
 ExplanationOfBenefit / provider / Slices for extension / extension:dataAbsentReason / value[x] |
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N/A |
| ExplanationOfBenefit / provider / reference |
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N/A |
| ExplanationOfBenefit / provider / type |
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N/A |
| ExplanationOfBenefit / provider / identifier |
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.identifier |
 ExplanationOfBenefit / provider / display |
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N/A |
| ExplanationOfBenefit / priority |
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Request.priority |
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| ExplanationOfBenefit / fundsReserveRequested |
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| ExplanationOfBenefit / fundsReserve |
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| ExplanationOfBenefit / related |
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| ExplanationOfBenefit / related / id |
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n/a |
| ExplanationOfBenefit / related / extension |
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n/a |
| ExplanationOfBenefit / related / modifierExtension |
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N/A |
| ExplanationOfBenefit / related / claim |
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| ExplanationOfBenefit / related / relationship |
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| ExplanationOfBenefit / related / reference |
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| ExplanationOfBenefit / prescription |
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| ExplanationOfBenefit / originalPrescription |
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| ExplanationOfBenefit / payee |
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| ExplanationOfBenefit / referral |
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FiveWs.cause |
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| ExplanationOfBenefit / facility |
Event.performer.location |
FiveWs.where[x] |
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| ExplanationOfBenefit / claim |
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FiveWs.why[x] |
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| ExplanationOfBenefit / claimResponse |
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| ExplanationOfBenefit / outcome |
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| ExplanationOfBenefit / disposition |
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| ExplanationOfBenefit / preAuthRef |
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| ExplanationOfBenefit / preAuthRefPeriod |
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| ExplanationOfBenefit / careTeam |
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| ExplanationOfBenefit / careTeam / id |
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n/a |
| ExplanationOfBenefit / careTeam / extension |
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n/a |
| ExplanationOfBenefit / careTeam / modifierExtension |
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N/A |
| ExplanationOfBenefit / careTeam / sequence |
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| ExplanationOfBenefit / careTeam / provider |
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FiveWs.actor |
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| ExplanationOfBenefit / careTeam / responsible |
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| ExplanationOfBenefit / careTeam / role |
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| ExplanationOfBenefit / careTeam / qualification |
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| ExplanationOfBenefit / supportingInfo |
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| ExplanationOfBenefit / diagnosis |
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| ExplanationOfBenefit / diagnosis / id |
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n/a |
| ExplanationOfBenefit / diagnosis / extension |
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n/a |
| ExplanationOfBenefit / diagnosis / modifierExtension |
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N/A |
| ExplanationOfBenefit / diagnosis / sequence |
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 ExplanationOfBenefit / diagnosis / diagnosis[x] |
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| ExplanationOfBenefit / diagnosis / type |
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| ExplanationOfBenefit / diagnosis / onAdmission |
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| ExplanationOfBenefit / diagnosis / packageCode |
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| ExplanationOfBenefit / procedure |
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| ExplanationOfBenefit / procedure / id |
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n/a |
| ExplanationOfBenefit / procedure / extension |
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n/a |
| ExplanationOfBenefit / procedure / modifierExtension |
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N/A |
| ExplanationOfBenefit / procedure / sequence |
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| ExplanationOfBenefit / procedure / type |
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| ExplanationOfBenefit / procedure / date |
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| ExplanationOfBenefit / procedure / procedure[x] |
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| ExplanationOfBenefit / procedure / udi |
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| ExplanationOfBenefit / precedence |
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| ExplanationOfBenefit / insurance |
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Coverage |
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| ExplanationOfBenefit / insurance / id |
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n/a |
| ExplanationOfBenefit / insurance / extension |
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n/a |
| ExplanationOfBenefit / insurance / modifierExtension |
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N/A |
| ExplanationOfBenefit / insurance / focal |
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| ExplanationOfBenefit / insurance / coverage |
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| ExplanationOfBenefit / insurance / preAuthRef |
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| ExplanationOfBenefit / accident |
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| ExplanationOfBenefit / accident / id |
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n/a |
| ExplanationOfBenefit / accident / extension |
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n/a |
| ExplanationOfBenefit / accident / modifierExtension |
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N/A |
| ExplanationOfBenefit / accident / date |
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| ExplanationOfBenefit / accident / type |
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| ExplanationOfBenefit / accident / location[x] |
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| ExplanationOfBenefit / item |
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| ExplanationOfBenefit / addItem |
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 ExplanationOfBenefit / adjudication |
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 ExplanationOfBenefit / Slices for total |
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| ExplanationOfBenefit / Slices for total / total:All Slices |
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 ExplanationOfBenefit / Slices for total / total:All Slices / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:All Slices / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:All Slices / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:All Slices / category |
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| ExplanationOfBenefit / Slices for total / total:All Slices / amount |
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| ExplanationOfBenefit / Slices for total / total:submitted |
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| ExplanationOfBenefit / Slices for total / total:submitted / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:submitted / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:submitted / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:submitted / category |
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| ExplanationOfBenefit / Slices for total / total:submitted / amount |
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| ExplanationOfBenefit / Slices for total / total:memberliability |
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| ExplanationOfBenefit / Slices for total / total:memberliability / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:memberliability / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:memberliability / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:memberliability / category |
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| ExplanationOfBenefit / Slices for total / total:memberliability / amount |
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| ExplanationOfBenefit / Slices for total / total:eligible |
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| ExplanationOfBenefit / Slices for total / total:eligible / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:eligible / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:eligible / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:eligible / category |
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| ExplanationOfBenefit / Slices for total / total:eligible / amount |
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| ExplanationOfBenefit / Slices for total / total:innetwork |
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| ExplanationOfBenefit / Slices for total / total:innetwork / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:innetwork / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:innetwork / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:innetwork / category |
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| ExplanationOfBenefit / Slices for total / total:innetwork / amount |
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| ExplanationOfBenefit / Slices for total / total:outofnetwork |
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| ExplanationOfBenefit / Slices for total / total:outofnetwork / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:outofnetwork / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:outofnetwork / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:outofnetwork / category |
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| ExplanationOfBenefit / Slices for total / total:outofnetwork / amount |
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| ExplanationOfBenefit / Slices for total / total:noncovered |
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| ExplanationOfBenefit / Slices for total / total:noncovered / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:noncovered / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:noncovered / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:noncovered / category |
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| ExplanationOfBenefit / Slices for total / total:noncovered / amount |
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| ExplanationOfBenefit / Slices for total / total:negotiated |
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| ExplanationOfBenefit / Slices for total / total:negotiated / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:negotiated / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:negotiated / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:negotiated / category |
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| ExplanationOfBenefit / Slices for total / total:negotiated / amount |
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| ExplanationOfBenefit / Slices for total / total:benefit |
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| ExplanationOfBenefit / Slices for total / total:benefit / id |
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n/a |
| ExplanationOfBenefit / Slices for total / total:benefit / extension |
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n/a |
| ExplanationOfBenefit / Slices for total / total:benefit / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for total / total:benefit / category |
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| ExplanationOfBenefit / Slices for total / total:benefit / amount |
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| ExplanationOfBenefit / payment |
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| ExplanationOfBenefit / formCode |
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| ExplanationOfBenefit / form |
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| ExplanationOfBenefit / processNote |
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| ExplanationOfBenefit / processNote / id |
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n/a |
| ExplanationOfBenefit / processNote / Slices for extension |
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| ExplanationOfBenefit / processNote / Slices for extension / extension:processNoteClass |
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| ExplanationOfBenefit / processNote / modifierExtension |
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N/A |
| ExplanationOfBenefit / processNote / number |
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| ExplanationOfBenefit / processNote / type |
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| ExplanationOfBenefit / processNote / text |
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| ExplanationOfBenefit / processNote / language |
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| ExplanationOfBenefit / benefitPeriod |
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| ExplanationOfBenefit / benefitBalance |
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| ExplanationOfBenefit / benefitBalance / id |
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n/a |
| ExplanationOfBenefit / benefitBalance / extension |
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n/a |
| ExplanationOfBenefit / benefitBalance / modifierExtension |
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N/A |
| ExplanationOfBenefit / benefitBalance / category |
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| ExplanationOfBenefit / benefitBalance / category / id |
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n/a |
| ExplanationOfBenefit / benefitBalance / category / extension |
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n/a |
| ExplanationOfBenefit / benefitBalance / category / coding |
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| ExplanationOfBenefit / benefitBalance / category / text |
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C*E.9. But note many systems use C*E.2 for this |
./originalText[mediaType/code="text/plain"]/data |
| ExplanationOfBenefit / benefitBalance / excluded |
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| ExplanationOfBenefit / benefitBalance / name |
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| ExplanationOfBenefit / benefitBalance / description |
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| ExplanationOfBenefit / benefitBalance / network |
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| ExplanationOfBenefit / benefitBalance / unit |
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| ExplanationOfBenefit / benefitBalance / term |
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| ExplanationOfBenefit / benefitBalance / financial |
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| ExplanationOfBenefit / benefitBalance / financial / id |
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n/a |
| ExplanationOfBenefit / benefitBalance / financial / Slices for extension |
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| ExplanationOfBenefit / benefitBalance / financial / Slices for extension / extension:remaining |
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| ExplanationOfBenefit / benefitBalance / financial / modifierExtension |
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N/A |
| ExplanationOfBenefit / benefitBalance / financial / type |
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| ExplanationOfBenefit / benefitBalance / financial / Slices for allowed[x] |
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| ExplanationOfBenefit / benefitBalance / financial / Slices for allowed[x] / allowed[x]:allowedMoney |
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| ExplanationOfBenefit / benefitBalance / financial / Slices for used[x] |
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| ExplanationOfBenefit / benefitBalance / financial / Slices for used[x] / used[x]:usedMoney |
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Documentation for this format |
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Propose a change