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

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