Patient Cost Transparency Implementation Guide
2.0.0-draft - STU 2 - Draft 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-draft 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 Case and Actors
... 3 Good Faith Estimate (GFE) Coordination Overview
... 4 Good Faith Estimate (GFE) Submission and AEOB Overview
... 5 Technical Background and Underlying Technologies
... 6 Formal Specification
... 7 Good Faith Estimate (GFE) Coordination Specification
... 8 Good Faith Estimate (GFE) Submission and AEOB Specification
... 9 Terminology Licensure
... 10 Security
... 11 Downloads
... 12 Change Log
... 13 Artifacts Summary
.... 13.1 Patient Cost Transparency Implementation Guide Coordination Platform Capability Statement
.... 13.2 Patient Cost Transparency Implementation Guide Coordination Requester Capability Statement
.... 13.3 Patient Cost Transparency Implementation Guide GFE Contributor Capability Statement
.... 13.4 Patient Cost Transparency Implementation Guide Payer Capability Statement
.... 13.5 Retrieve GFE Packet
.... 13.6 Submit a GFE resource for the creation of an AEOB
.... 13.7 aeob-date-of-service
.... 13.8 TaskReplaces
.... 13.9 TaskRequestedPeriod
.... 13.10 PCT Coverage
.... 13.11 PCT Organization
.... 13.12 PCT Practitioner
.... 13.13 PCT GFE Bundle
.... 13.14 PCT GFE Composition
.... 13.15 PCT GFE Contributor Task
.... 13.16 PCT GFE Coordination Bundle
.... 13.17 PCT GFE Coordination Task
.... 13.18 PCT GFE DeviceRequest
.... 13.19 PCT GFE Information Bundle
.... 13.20 PCT GFE MedicationRequest
.... 13.21 PCT GFE Missing Bundle
.... 13.22 PCT GFE Packet
.... 13.23 PCT GFE Packet Document Reference
.... 13.24 PCT GFE ServiceRequest
.... 13.25 PCT Good Faith Estimate Summary
.... 13.26 PCT Good Faith Estimate Institutional
.... 13.27 PCT Good Faith Estimate Professional
.... 13.28 PCT Service Location
.... 13.29 PCT Advanced EOB
.... 13.30 PCT Advanced EOB Summary
.... 13.31 PCT AEOB Adjudication Error
.... 13.32 PCT AEOB Complete
.... 13.33 PCT AEOB Composition
.... 13.34 PCT AEOB Packet
.... 13.35 PCT AEOB Packet Document Reference
.... 13.36 PCT GFE Validation Error
.... 13.37 PCT AEOB Bundle
.... 13.38 PCT GFE Collection Bundle
.... 13.39 Packet Estimate Request Initiation Time
.... 13.40 Packet Linking Identifier
.... 13.41 Packet Linking Identifier
.... 13.42 Packet Procedure or Service
.... 13.43 Packet Procedure or Service
.... 13.44 Benefit Remaining
.... 13.45 CountrySubdivisionCode
.... 13.46 GFE Reference
.... 13.47 GFEBillingProviderLineItemCtrlNum
.... 13.48 GFEConsentForBalanceBilling
.... 13.49 GFEDisclaimer
.... 13.50 GFEServiceLinkingInfo
.... 13.51 In Network Provider Options Link
.... 13.52 PCTEndpoint
.... 13.53 Planned Service Period
.... 13.54 ProcessNote Class
.... 13.55 ProviderEventMethodology
.... 13.56 ProviderTaxonomy
.... 13.57 ReferralNumber
.... 13.58 Request Initiation Time
.... 13.59 Self-Pay Declared
.... 13.60 Service Description
.... 13.61 Significant condition involved
.... 13.62 Significant Procedures and/or products involved
.... 13.63 Subject To Medical Management
.... 13.64 Claim Medical Product or Service Value Set
.... 13.65 GFE Coordination Task Status Codes
.... 13.66 ICD-10 Procedure Codes
.... 13.67 NUBC Point Of Origin
.... 13.68 NUBC Priority (Type) of Admission or Visit
.... 13.69 PCT Adjudication Value Set
.... 13.70 PCT Adjustment Reason
.... 13.71 PCT AEOB Process Note Types
.... 13.72 PCT benefitBalance.category codes
.... 13.73 PCT Care Team Role Value Set
.... 13.74 PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
.... 13.75 PCT Diagnosis Type Value Set
.... 13.76 PCT Financial Type Value Set
.... 13.77 PCT GFE CMS Place of Service Value Set
.... 13.78 PCT GFE Contributor Task Status Reason Codes ValueSet
.... 13.79 PCT GFE Frequency Code Value Set
.... 13.80 PCT GFE Item Adjudication Value Set
.... 13.81 PCT GFE Item CPT - HCPCS Value Set
.... 13.82 PCT GFE Item NDC Value Set
.... 13.83 PCT GFE NUBC Revenue Value Set
.... 13.84 PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
.... 13.85 PCT GFE Request Coordination Task Status Reason Codes ValueSet
.... 13.86 PCT GFE Request Task Business Status ValueSet
.... 13.87 PCT GFE Request Task Codes ValueSet
.... 13.88 PCT ICD-10 Diagnostic Codes
.... 13.89 PCT Organization Contact Purpose Value Set
.... 13.90 PCT Organization Identifier Type Value Set
.... 13.91 PCT Organization Type Value Set
.... 13.92 PCT Payer Benefit Payment Status
.... 13.93 PCT Payer Provider Network Status
.... 13.94 PCT Procedure Type Value Set
.... 13.95 PCT Subject-To-Medical-Management Reason Value Set
.... 13.96 PCT Supporting Info Type Value Set
.... 13.97 PCT Total Value Set
.... 13.98 Provider GFE Contributor Task Status Codes
.... 13.99 US Claim DRG Codes
.... 13.100 US Claim DRG Codes
.... 13.101 PCT Adjudication Category CodeSystem
.... 13.102 PCT Adjudication Code System
.... 13.103 PCT AEOB Process Note Code System
.... 13.104 PCT Care Team Role
.... 13.105 PCT Diagnosis Type
.... 13.106 PCT Document Types
.... 13.107 PCT Estimate Type Code System
.... 13.108 PCT Financial Type Code System
.... 13.109 PCT GFE Frequency Code System
.... 13.110 PCT GFE Request Task Business Status Code System
.... 13.111 PCT GFE Request Task Codes Code System
.... 13.112 PCT GFE Request Task Status Reason Code Code System
.... 13.113 PCT GFE Supporting Info Type Code System
.... 13.114 PCT Identifier Type
.... 13.115 PCT Network Status
.... 13.116 PCT Organization Contact Purpose Type Code System
.... 13.117 PCT Organization Identifier Type Code System
.... 13.118 PCT Packet Section Codes
.... 13.119 PCT Procedure Type
.... 13.120 PCT Subject-To-Medical-Management Reason Code System
.... 13.121 contract1001
.... 13.122 coverage1001
.... 13.123 endpoint001
.... 13.124 org1001
.... 13.125 org1002
.... 13.126 patient1001
.... 13.127 PCT-AEOB-1
.... 13.128 PCT-AEOB-Adjudication-Error-Example-1
.... 13.129 PCT-AEOB-Bundle-1
.... 13.130 PCT-AEOB-Complete-Example-1
.... 13.131 PCT-AEOB-DocumentReference-1
.... 13.132 PCT-AEOB-Packet-1
.... 13.133 PCT-AEOB-Summary-1
.... 13.134 PCT-DeviceRequest-1
.... 13.135 PCT-GFE-Bundle-Inst-1
.... 13.136 PCT-GFE-Bundle-Prof-1
.... 13.137 PCT-GFE-Collection-Bundle-Inst-1
.... 13.138 PCT-GFE-Collection-Bundle-Prof-1
.... 13.139 PCT-GFE-Contributor-Task-1
.... 13.140 PCT-GFE-Contributor-Task-2
.... 13.141 PCT-GFE-Coordination-Bundle-1
.... 13.142 PCT-GFE-Coordination-Task-1
.... 13.143 PCT-GFE-DocumentReference-Inst-1
.... 13.144 PCT-GFE-DocumentReference-Prof-1
.... 13.145 PCT-GFE-Information-Bundle-1
.... 13.146 PCT-GFE-Institutional-1
.... 13.147 PCT-GFE-Institutional-MRI
.... 13.148 PCT-GFE-Missing-Bundle-1
.... 13.149 PCT-GFE-Packet-Inst-1
.... 13.150 PCT-GFE-Packet-Prof-1
.... 13.151 PCT-GFE-Professional-MRI
.... 13.152 PCT-GFE-Summary-1
.... 13.153 PCT-GFE-Summary-MRI
.... 13.154 PCT-GFE-Validation-Error-Example-1
.... 13.155 PCT-MedicationRequest-1
.... 13.156 PCT-ServiceLocation-1
.... 13.157 PCT-ServiceRequest-1
.... 13.158 prac001
.... 13.159 prac002
.... 13.160 Submitter-Org-1
.... 13.161 Submitter-Practitioner-1