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

Reading This IG

Page standards status: Informative

Underlying Technologies

This guide is based on the HL7 FHIR standard. This architecture is intended to maximize the number of provider and payer systems that conform to this guide, as well as to allow for easy growth and extensibility of system capabilities in the future.

Implementers of this specification therefore need to understand some basic information about these referenced specifications.

FHIR

This implementation guide uses terminology, notations and design principles that are specific to FHIR. Before reading this implementation guide, it's important to be familiar with some of the basic principles of FHIR as well as general guidance on how to read FHIR specifications. Readers who are unfamiliar with FHIR are encouraged to read (or at least skim) the following prior to reading the rest of this implementation guide.

• FHIR Overview
• Developer's Introduction (or Clinical Introduction)
• FHIR Data Types
• Using Codes
• References Between Resources
• How to Read Resource & Profile Definitions and additional IG reading guidance
• Base Resource

This implementation guide supports the R4 version of the FHIR standard and builds on the US Core 3.1.1 (USCDI v1), 6.1 (USCDI v3) and 7.0 (USCDI v4) implementation guides and implementers need to familiarize themselves with the profiles in those guides. The profiles in this IG conform with all three releases of US Core.

This IG also draws on content from the Da Vinci Health Record Exchange (HRex) and Subscriptions R5 Backport implementation guides.

Implementers should also familiarize themselves with the FHIR resources used within the guide:

Resource	Relevance
Bundle	Used when delivering collections of resources in several API calls
CapabilityStatement	Used to define conformance expectations for this guide
Claim	The resource type used by a providers to provide a Good Faith Estimate of services or products
CodeSystem	Used to define custom codes specific to this guide
Composition	Used in document bundles to provide a single coherent statement of meaning of what is in the document and the relationship of top-level resources in the bundle
Coverage	Used to identify the member and the relevant insurance coverage to a payer
DeviceRequest	One of the resources that may be used in a request to contribute a GFE explaining what services or products are needed
DocumentReference	A reference to estimate documents that provides metadata about the document so that the document can be discovered, managed, and notifications can be subscribed to
ExplanationOfBenefit	The resource type used by a payer to provide the Advanced Explanation Of Benefit for insured members
Location	Supporting information used to identify a proposed location for services or products to be performed or delivered
Organization	Used when identifying organizational providers or facilities in GFE Coordination Tasks and involved in the services or products listed in the GFEs, and payers for which an AEOB is being requested
Medication	Supporting information for medication requests
MedicationRequest	One of the resources that may be used in a request to contribute a GFE explaining what services or products are needed
NutritionOrder	One of the resources that may be used in a request to contribute a GFE explaining what services or products are needed
OperationDefinition	Defines the parameters and requirements for an operation. THis guide defined a few use case specific operations
OperationOutcome	Provides sets of error, warning and information messages that provide detailed information about the outcome of an attempted system operation.
Patient	Demographic information relevant to all requests
Practitioner	Used when identifying individual practitioner providers or facilities in GFE Coordination Tasks and involved in the services or products listed in the GFEs
PractitionerRole	Used when identifying practitioner provider roles in GFE Coordination Tasks
SearchParameter	Defines the a searchable element defined by this IG used for searching and subscriptions
ServiceRequest	One of the resources that may be used in a request to contribute a GFE explaining what services or products are needed
StructureDefinition	Used when profiling resources and defining extensions
Subscription	A resource used to define a push-based subscription from a server to another system.
SubscriptionTopic	A resource used define a set of events that a client can subscribe to. This resource is defined in FHIR 4B and later versions. Be aware that this resource is not supported by FHIR R4 systems. Subscription Topics in R4 can be defined using a Basic profile resource with extensions.
Task	Used to manage dispatching to GFE contributing providers
ValueSet	Used to define collections of codes used by PCT profiles
VisionPrescription	One of the resources that may be used in a request to contribute a GFE explaining what services or products are needed

Relationship to Other Implementation Guides

Good Faith Estimate Coordination Relationships

Good Faith Estimate Relationships

Advanced Explanation Of Benefit Relationships

US Core

Provider billing and payer claims adjudication systems for those profiles defined by US Core SHALL use the specification defined by US Core in exchanging information with payers. Implementers should be familiar with this specification. Claim, ExplanationOfBenefit and Coverage resource profiles are not defined by US Core.

Da Vinci PCT implementations SHALL conform to the US Core IG General Guidance requirements where US Core IG resources are used.

Da Vinci HRex

Provider billing and payer systems SHALL use the specification defined by the Da Vinci HRex IG Da Vinci HRex IG when exchanging information, as defined by the Privacy and Security section of this IG. Implementers should be familiar with this specification.