Patient Cost Transparency Implementation Guide
2.0.2 - 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 2.0.2 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

Table of Contents

Page standards status: Informative
0 Table of Contents
1 Patient Cost Transparency Implementation Guide Home Page
2 Reading This IG
3 Use Case and Actors
4 Good Faith Estimate (GFE) Coordination Overview (Multi-Provider)
5 Good Faith Estimate (GFE) Submission and AEOB Overview
6 Patient Access to GFE and AEOB
7 Project and Participants
8 Formal Specification
9 Good Faith Estimate (GFE) Coordination Specification (Multi-Provider)
10 Good Faith Estimate (GFE) Submission and AEOB Specification
11 Terminology Licensure
12 Security
13 Downloads
14 Change Log
15 Artifacts Summary
15.1 Patient Cost Transparency Implementation Guide Coordination Platform Capability Statement
15.2 Patient Cost Transparency Implementation Guide Coordination Requester Capability Statement
15.3 Patient Cost Transparency Implementation Guide GFE Contributor Capability Statement
15.4 Patient Cost Transparency Implementation Guide Payer Capability Statement
15.5 Patient Cost Transparency Implementation Guide Provider Capability Statement
15.6 Good Faith Estimate Coordination Request
15.7 Retrieve GFE Packet
15.8 Submit a GFE resource for the creation of an AEOB
15.9 aeob-date-of-service
15.10 DocumentReference docStatus
15.11 Packet Condition
15.12 Packet Estimate Request Initiation Time
15.13 Packet Linking Identifier
15.14 Packet Planned Period Of Service
15.15 Packet Procedure or Service
15.16 RelatedTask
15.17 TaskRequestedPeriod
15.18 PCT Coverage
15.19 PCT Organization
15.20 PCT Practitioner
15.21 PCT GFE Bundle
15.22 PCT GFE Composition
15.23 PCT GFE Contributor Task
15.24 PCT GFE Coordination Bundle
15.25 PCT GFE Coordination Task
15.26 PCT GFE DeviceRequest
15.27 PCT GFE Information Bundle
15.28 PCT GFE MedicationRequest
15.29 PCT GFE Missing Bundle
15.30 PCT GFE Packet
15.31 PCT GFE Packet Document Reference
15.32 PCT GFE ServiceRequest
15.33 PCT Good Faith Estimate Summary
15.34 PCT Good Faith Estimate Institutional
15.35 PCT Good Faith Estimate Professional
15.36 PCT Service Location
15.37 PCT Advanced EOB
15.38 PCT Advanced EOB Summary
15.39 PCT AEOB Adjudication Error
15.40 PCT AEOB Complete
15.41 PCT AEOB Composition
15.42 PCT AEOB Packet
15.43 PCT AEOB Packet Document Reference
15.44 PCT GFE Validation Error
15.45 Subscription - AEOB Available for Author Notification
15.46 Subscription - AEOB Available for Subject Notification
15.47 Subscription - GFE Available for Author Notification
15.48 Subscription - GFE Available for Subject Notification
15.49 Subscription - GFE Coordination Task Update Notification
15.50 SubscriptionTopic - AEOB Available for Author Notification
15.51 SubscriptionTopic - AEOB Available for Subject Notification
15.52 SubscriptionTopic - GFE Available for Author Notification
15.53 SubscriptionTopic - GFE Available for Subject Notification
15.54 SubscriptionTopic - GFE Coordination Task Notification
15.55 Benefit Remaining
15.56 GFE Reference
15.57 GFEBillingProviderLineItemCtrlNum
15.58 GFEConsentForBalanceBilling
15.59 GFEDisclaimer
15.60 GFERelatedTask
15.61 GFEServiceLinkingInfo
15.62 In Network Provider Options Link
15.63 Planned Service Period
15.64 ProcessNote Class
15.65 ProviderEventMethodology
15.66 ProviderTaxonomy
15.67 ReferralNumber
15.68 Request Initiation Time
15.69 RequestOriginationType
15.70 Self-Pay Declared
15.71 Service Description
15.72 Significant condition involved
15.73 Significant Procedures and/or products involved
15.74 Subject To Medical Management
15.75 Claim Medical Product or Service Value Set
15.76 GFE Coordination Task Status Codes
15.77 ICD-10 Procedure Codes
15.78 NUBC Point Of Origin
15.79 NUBC Priority (Type) of Admission or Visit
15.80 PCT Adjudication Value Set
15.81 PCT Adjustment Reason
15.82 PCT AEOB Process Note Types
15.83 PCT benefitBalance.category codes
15.84 PCT Care Team Role Value Set
15.85 PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
15.86 PCT Financial Type Value Set
15.87 PCT GFE CMS Place of Service Value Set
15.88 PCT GFE Contributor Task Status Reason Codes ValueSet
15.89 PCT GFE Item Adjudication Value Set
15.90 PCT GFE Item CPT - HCPCS Value Set
15.91 PCT GFE Item NDC Value Set
15.92 PCT GFE NUBC Revenue Value Set
15.93 PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
15.94 PCT GFE Request Coordination Task Status Reason Codes ValueSet
15.95 PCT GFE Request Task Business Status ValueSet
15.96 PCT GFE Request Type Codes ValueSet
15.97 PCT GFE Task Relationship
15.98 PCT ICD-10 Diagnostic Codes
15.99 PCT Organization Contact Purpose Value Set
15.100 PCT Organization Type Value Set
15.101 PCT Payer Benefit Payment Status
15.102 PCT Payer Provider Network Status
15.103 PCT Procedure Type Value Set
15.104 PCT Supporting Info Type Value Set
15.105 PCT Task Attachment Mime Types
15.106 PCT Total Value Set
15.107 Provider GFE Contributor Task Status Codes
15.108 US Claim DRG Codes
15.109 PCT Adjudication Category CodeSystem
15.110 PCT Adjudication Code System
15.111 PCT AEOB Process Note Code System
15.112 PCT Document Types
15.113 PCT Estimate Type Code System
15.114 PCT Financial Type Code System
15.115 PCT GFE Request Task Business Status Code System
15.116 PCT GFE Request Task Status Reason Code Code System
15.117 PCT GFE Request Type Codes Code System
15.118 PCT GFE Supporting Info Type Code System
15.119 PCT Network Status
15.120 PCT Organization Contact Purpose Type Code System
15.121 PCT Packet Section Codes
15.122 PCT Procedure Type
15.123 coverage1001
15.124 example-aeob-available-author-subscription-full
15.125 example-aeob-available-author-subscription-id-only
15.126 example-aeob-available-subject-subscription
15.127 example-gfe-available-author-subscription-full
15.128 example-gfe-available-author-subscription-id-only
15.129 example-gfe-available-subject-subscription-full
15.130 example-gfe-task-subscription
15.131 example-gfe-task-subscription-partof
15.132 org1001
15.133 org1002
15.134 patient1001
15.135 PCT-AEOB-1
15.136 PCT-AEOB-Adjudication-Error-Example-1
15.137 PCT-AEOB-Complete-Example-1
15.138 PCT-AEOB-DocumentReference-1
15.139 PCT-AEOB-Packet-1
15.140 PCT-AEOB-Summary-1
15.141 PCT-DeviceRequest-1
15.142 PCT-GFE-Bundle-Inst-1
15.143 PCT-GFE-Bundle-Prof-1
15.144 PCT-GFE-Contributor-Replacement-Task-1
15.145 PCT-GFE-Contributor-Replacement-Task-2
15.146 PCT-GFE-Contributor-Task-1
15.147 PCT-GFE-Contributor-Task-2
15.148 PCT-GFE-Coordination-Bundle-1
15.149 PCT-GFE-Coordination-Replacement-Task-1
15.150 PCT-GFE-Coordination-Task-1
15.151 PCT-GFE-DocumentReference-Inst-1
15.152 PCT-GFE-DocumentReference-Prof-1
15.153 PCT-GFE-Information-Bundle-1
15.154 PCT-GFE-Institutional-1
15.155 PCT-GFE-Institutional-MRI
15.156 PCT-GFE-Missing-Bundle-1
15.157 PCT-GFE-Packet-Inst-1
15.158 PCT-GFE-Packet-Prof-1
15.159 PCT-GFE-Professional-MRI
15.160 PCT-GFE-Summary-1
15.161 PCT-GFE-Summary-MRI
15.162 PCT-GFE-Validation-Error-Example-1
15.163 PCT-MedicationRequest-1
15.164 PCT-ServiceLocation-1
15.165 PCT-ServiceRequest-1
15.166 prac001
15.167 prac002
15.168 selfpaycoverage2001
15.169 Submitter-Org-1
15.170 Submitter-Practitioner-1