This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v0.1.0: STU 1 Draft) based on FHIR R4. . For a full list of available versions, see the Directory of published versions
Generated Narrative
Resource "PCT-AEOB-1"
Profile: PCT Advanced EOB
GFE Reference: Bundle/PCT-GFE-Bundle-Inst-1
Disclaimer: Estimate Only ...
Expiration Date: 2021-10-31
status: active
type: Institutional (Claim Type Codes#institutional)
use: claim
patient: Patient/patient1001 " BETTERHALF"
created: 2021-10-12
insurer: Organization/org1001 "Umbrella Insurance Company"
provider: Organization/org1002 "Boston Radiology Center"
priority: Normal (Process Priority Codes#normal)
outcome: complete
- | Focal | Coverage |
* | true | Coverage/coverage1001 |
item
EstimatedDateOfService: 2021-10-31
sequence: 1
revenue: Revenue Code 1 (PCT GFE Item Revenue Code System#2011)
productOrService: Some CPT Code 1 (PCT GFE Item Procedure Code System#33502)
modifier: Some CPT Code 2 (PCT GFE Item Procedure Code System#34503)
adjudication
Subject To Medical Management: Concurrent Review (Details: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSubjectToMedicalMgmtReasonCS code concurrent-review = 'Concurrent Review', stated as 'Concurrent Review')
category: Paid to provider (PCT Adjudication Category Type#paidtoprovider)
total
category: Submitted Amount (Adjudication Value Codes#submitted)