Patient Cost Transparency Implementation Guide
1.1.0 - STU 1 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 1.1.0 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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Patient Cost Transparency Implementation Guide Home Page
... 2 Use Cases and Overview
... 3 Technical Background and Underlying Technologies
... 4 Formal Specification
... 5 Terminology Licensure
... 6 Security
... 7 Downloads
... 8 Change Log
... 9 Artifacts Summary
.... 9.1 Patient Cost Transparency Implementation Guide Capability Statement
.... 9.2 Submit a GFE resource for the creation of an AEOB
.... 9.3 aeob-date-of-service
.... 9.4 PCT Advanced EOB
.... 9.5 PCT AEOB Adjudication Error
.... 9.6 PCT AEOB Bundle
.... 9.7 PCT AEOB Complete
.... 9.8 PCT Coverage
.... 9.9 PCT GFE Bundle
.... 9.10 PCT GFE Validation Error
.... 9.11 PCT Good Faith Estimate Institutional
.... 9.12 PCT Good Faith Estimate Professional
.... 9.13 PCT Organization
.... 9.14 PCT Practitioner
.... 9.15 Benefit Remaining
.... 9.16 CountrySubdivisionCode
.... 9.17 GFE Reference
.... 9.18 GFEBillingProviderLineItemCtrlNum
.... 9.19 GFEConsentForBalanceBilling
.... 9.20 GFEDisclaimer
.... 9.21 GFEServiceLinkingInfo
.... 9.22 GFESubmitter
.... 9.23 In Network Provider Options Link
.... 9.24 PCTEndpoint
.... 9.25 ProcessNote Class
.... 9.26 ProviderEventMethodology
.... 9.27 ProviderTaxonomy
.... 9.28 ReferralNumber
.... 9.29 Service Description
.... 9.30 Subject To Medical Management
.... 9.31 Claim Medical Product or Service Value Set
.... 9.32 ICD-10 Procedure Codes
.... 9.33 NUBC Point Of Origin
.... 9.34 NUBC Priority (Type) of Admission or Visit
.... 9.35 PCT Adjudication Value Set
.... 9.36 PCT Adjustment Reason
.... 9.37 PCT Advance Explanation of Benefit Type Value Set
.... 9.38 PCT AEOB Process Note Types
.... 9.39 PCT benefitBalance.category codes
.... 9.40 PCT Care Team Role Value Set
.... 9.41 PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
.... 9.42 PCT Diagnosis Type Value Set
.... 9.43 PCT Financial Type Value Set
.... 9.44 PCT GFE CMS Place of Service Value Set
.... 9.45 PCT GFE Frequency Code Value Set
.... 9.46 PCT GFE Item Adjudication Value Set
.... 9.47 PCT GFE Item CPT - HCPCS Value Set
.... 9.48 PCT GFE Item NDC Value Set
.... 9.49 PCT GFE NUBC Revenue Value Set
.... 9.50 PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
.... 9.51 PCT ICD-10 Diagnostic Codes
.... 9.52 PCT Organization Contact Purpose Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set
.... 9.53 PCT Organization Identifier Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set
.... 9.54 PCT Organization Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set
.... 9.55 PCT Payer Benefit Payment Status
.... 9.56 PCT Payer Provider Network Status
.... 9.57 PCT Procedure Type Value Set
.... 9.58 PCT Subject-To-Medical-Management Reason Value Set
.... 9.59 PCT Supporting Info Type Value Set
.... 9.60 US Claim DRG Codes
.... 9.61 PCT Adjudication Category CodeSystem
.... 9.62 PCT Adjudication Code System
.... 9.63 PCT AEOB Process Note Code System
.... 9.64 PCT Care Team Role
.... 9.65 PCT Diagnosis Type
.... 9.66 PCT Financial Type Code System
.... 9.67 PCT GFE Frequency Code System
.... 9.68 PCT GFE Supporting Info Type Code System
.... 9.69 PCT Identifier Type
.... 9.70 PCT Network Status
.... 9.71 PCT Organization Contact Purpose Type Code System
.... 9.72 PCT Organization Identifier Type Code System
.... 9.73 PCT Procedure Type
.... 9.74 PCT Subject-To-Medical-Management Reason Code System
.... 9.75 contract1001
.... 9.76 coverage1001
.... 9.77 endpoint001
.... 9.78 org1001
.... 9.79 org1002
.... 9.80 patient1001
.... 9.81 PCT-AEOB-1
.... 9.82 PCT-AEOB-Adjudication-Error-Example-1
.... 9.83 PCT-AEOB-Bundle-1
.... 9.84 PCT-AEOB-Complete-Example-1
.... 9.85 PCT-GFE-Bundle-Inst-1
.... 9.86 PCT-GFE-Bundle-Prof-1
.... 9.87 PCT-GFE-Institutional-1
.... 9.88 PCT-GFE-Institutional-MRI
.... 9.89 PCT-GFE-Professional-MRI
.... 9.90 PCT-GFE-Validation-Error-Example-1
.... 9.91 prac001
.... 9.92 prac002
.... 9.93 Submitter-Org-1
.... 9.94 Submitter-Practitioner-1