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 Subscription - AEOB Available for Author Notification
.... 13.38 Subscription - AEOB Available for Subject Notification
.... 13.39 Subscription - GFE Available for Subject Notification
.... 13.40 Subscription - GFE Coordination Task Update Notification
.... 13.41 SubscriptionTopic - AEOB Available for Author Notification
.... 13.42 SubscriptionTopic - AEOB Available for Subject Notification
.... 13.43 SubscriptionTopic - GFE Available for Author Notification
.... 13.44 SubscriptionTopic - GFE Available for Subject Notification
.... 13.45 SubscriptionTopic - GFE Coordination Task Notification
.... 13.46 Packet Estimate Request Initiation Time
.... 13.47 Packet Linking Identifier
.... 13.48 Packet Planned Period Of Service
.... 13.49 Packet Procedure or Service
.... 13.50 Packet Procedure or Service
.... 13.51 Subscription - GFE Available for Author Notification
.... 13.52 Benefit Remaining
.... 13.53 CountrySubdivisionCode
.... 13.54 GFE Reference
.... 13.55 GFEBillingProviderLineItemCtrlNum
.... 13.56 GFEConsentForBalanceBilling
.... 13.57 GFEDisclaimer
.... 13.58 GFERelatedTask
.... 13.59 GFEServiceLinkingInfo
.... 13.60 In Network Provider Options Link
.... 13.61 PCTEndpoint
.... 13.62 Planned Service Period
.... 13.63 ProcessNote Class
.... 13.64 ProviderEventMethodology
.... 13.65 ProviderTaxonomy
.... 13.66 ReferralNumber
.... 13.67 Request Initiation Time
.... 13.68 RequestOriginationType
.... 13.69 Self-Pay Declared
.... 13.70 Service Description
.... 13.71 Significant condition involved
.... 13.72 Significant Procedures and/or products involved
.... 13.73 Subject To Medical Management
.... 13.74 Claim Medical Product or Service Value Set
.... 13.75 GFE Coordination Task Status Codes
.... 13.76 ICD-10 Procedure Codes
.... 13.77 NUBC Point Of Origin
.... 13.78 NUBC Priority (Type) of Admission or Visit
.... 13.79 PCT Adjudication Value Set
.... 13.80 PCT Adjustment Reason
.... 13.81 PCT AEOB Process Note Types
.... 13.82 PCT benefitBalance.category codes
.... 13.83 PCT Care Team Role Value Set
.... 13.84 PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
.... 13.85 PCT Diagnosis Type Value Set
.... 13.86 PCT Financial Type Value Set
.... 13.87 PCT GFE CMS Place of Service Value Set
.... 13.88 PCT GFE Contributor Task Status Reason Codes ValueSet
.... 13.89 PCT GFE Frequency Code Value Set
.... 13.90 PCT GFE Item Adjudication Value Set
.... 13.91 PCT GFE Item CPT - HCPCS Value Set
.... 13.92 PCT GFE Item NDC Value Set
.... 13.93 PCT GFE NUBC Revenue Value Set
.... 13.94 PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
.... 13.95 PCT GFE Request Coordination Task Status Reason Codes ValueSet
.... 13.96 PCT GFE Request Task Business Status ValueSet
.... 13.97 PCT GFE Request Type Codes ValueSet
.... 13.98 PCT GFE Task Relationship
.... 13.99 PCT ICD-10 Diagnostic Codes
.... 13.100 PCT Organization Contact Purpose Value Set
.... 13.101 PCT Organization Identifier Type Value Set
.... 13.102 PCT Organization Type Value Set
.... 13.103 PCT Payer Benefit Payment Status
.... 13.104 PCT Payer Provider Network Status
.... 13.105 PCT Procedure Type Value Set
.... 13.106 PCT Subject-To-Medical-Management Reason Value Set
.... 13.107 PCT Supporting Info Type Value Set
.... 13.108 PCT Total Value Set
.... 13.109 Provider GFE Contributor Task Status Codes
.... 13.110 US Claim DRG Codes
.... 13.111 US Claim DRG Codes
.... 13.112 PCT Adjudication Category CodeSystem
.... 13.113 PCT Adjudication Code System
.... 13.114 PCT AEOB Process Note Code System
.... 13.115 PCT Diagnosis Type
.... 13.116 PCT Document Types
.... 13.117 PCT Estimate Type Code System
.... 13.118 PCT Financial Type Code System
.... 13.119 PCT GFE Frequency Code System
.... 13.120 PCT GFE Request Task Business Status Code System
.... 13.121 PCT GFE Request Task Status Reason Code Code System
.... 13.122 PCT GFE Request Type Codes Code System
.... 13.123 PCT GFE Supporting Info Type Code System
.... 13.124 PCT Identifier Type
.... 13.125 PCT Network Status
.... 13.126 PCT Organization Contact Purpose Type Code System
.... 13.127 PCT Organization Identifier Type Code System
.... 13.128 PCT Packet Section Codes
.... 13.129 PCT Procedure Type
.... 13.130 PCT Subject-To-Medical-Management Reason Code System
.... 13.131 contract1001
.... 13.132 coverage1001
.... 13.133 endpoint001
.... 13.134 example-aeob-available-author-subscription-full
.... 13.135 example-aeob-available-author-subscription-id-only
.... 13.136 example-gfe-available-author-subscription-full
.... 13.137 example-gfe-available-author-subscription-id-only
.... 13.138 example-gfe-available-subject-subscription-full
.... 13.139 example-gfe-task-subscription
.... 13.140 example-gfe-task-subscription-partof
.... 13.141 org1001
.... 13.142 org1002
.... 13.143 patient1001
.... 13.144 PCT-AEOB-1
.... 13.145 PCT-AEOB-Adjudication-Error-Example-1
.... 13.146 PCT-AEOB-Complete-Example-1
.... 13.147 PCT-AEOB-DocumentReference-1
.... 13.148 PCT-AEOB-Packet-1
.... 13.149 PCT-AEOB-Summary-1
.... 13.150 PCT-DeviceRequest-1
.... 13.151 PCT-GFE-Bundle-Inst-1
.... 13.152 PCT-GFE-Bundle-Prof-1
.... 13.153 PCT-GFE-Contributor-Task-1
.... 13.154 PCT-GFE-Contributor-Task-2
.... 13.155 PCT-GFE-Coordination-Bundle-1
.... 13.156 PCT-GFE-Coordination-Task-1
.... 13.157 PCT-GFE-DocumentReference-Inst-1
.... 13.158 PCT-GFE-DocumentReference-Prof-1
.... 13.159 PCT-GFE-Information-Bundle-1
.... 13.160 PCT-GFE-Institutional-1
.... 13.161 PCT-GFE-Institutional-MRI
.... 13.162 PCT-GFE-Missing-Bundle-1
.... 13.163 PCT-GFE-Packet-Inst-1
.... 13.164 PCT-GFE-Packet-Prof-1
.... 13.165 PCT-GFE-Professional-MRI
.... 13.166 PCT-GFE-Summary-1
.... 13.167 PCT-GFE-Summary-MRI
.... 13.168 PCT-GFE-Validation-Error-Example-1
.... 13.169 PCT-MedicationRequest-1
.... 13.170 PCT-ServiceLocation-1
.... 13.171 PCT-ServiceRequest-1
.... 13.172 prac001
.... 13.173 prac002
.... 13.174 Submitter-Org-1
.... 13.175 Submitter-Practitioner-1