This operation is used by an entity to submit one or multiple GFEs as a Bundle containing the GFE(s) and other referenced resources for processing. The only input parameter is the single Bundle resource with one or multiple GFE(s) - each of which is based on the Claim resource, (along with other referenced resources) and the only output is a single Bundle with the AEOB - which is based on the ExplanationOfBenefit resource, (and other referenced resources) or an OperationOutcome resource.

PCT AEOB Bundle that contains necessary resources for an AEOBs. Organizations for both the payer and provider SHALL be included.

The No Surprises Act requires that group health plans and insurers provide advance cost estimates, called advanced explanations of benefits (advanced EOBs), for scheduled services. This profile is used for exchanging the Advanced EOB data.

PCT Coverage is a profile for capturing data that reflect a payer’s coverage that was effective as of the proposed date of service or the date of admission of the GFE.

PCT GFE Bundle that contains necessary resources as a GFE Submission for obtaining an AEOB. Organizations for both the provider and payer SHALL be included.

PCT Good Faith Estimate Institutional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for an institutional GFE submission.

PCT Good Faith Estimate Professional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission.

The PCT Location profile builds upon the US Core Location profile and is used with other PCT profile resources.

The PCT Organization profile builds upon the US Core Organization profile. It is used to convey a payer, provider, payee, or service facility organization.

The PCT Patient profile builds upon the US Core Patient profile. It is used to convey information about the patient who will be receiving the services as described on the GFE.

The PCT Practitioner profile builds upon the US Core Practitioner profile. It is used to convey information about the practitioner who will be providing services to the patient as described on the GFE.

The PCT PractitionerRole profile builds upon the US Core PractitionerRole profile. It is used to convey information about the practitioner who will be providing services to the patient as described on the GFE.

This extension is used to provide the Compound Drug Linking Number.

This extension is used to provide the Country Subdivision Code - from Part 2 of ISO 3166.

This extension allows the payer to declare a disclaimer concerning the estimated costs provided in the AEOB.

This extension is used to provide the estimated date or dates of service or product delivery

This extension is used to indicate a specific date after which the issued AEOB is considered obsolete.

This extension is used to provide the GFE Billing Provider Line Item Control Number.

This extension is used to indicate the GFE Provider Assigned Identifier.

This extension is used to reference the GFE submitted by an entity that started the process for obtaining an Advanced EOB.

This extension is used to provide the GFE Service Linking Information.

This extension is used to indicate the scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB.

This extension is used to provide the GFE Service Identifier for Transmission Intermediaries.

This extension is used to provide a reference to a web site for finding information on the out-of-network provider.

This extension is used to provide an endpoint.

This extension is used for indicating how the provider determined the number of providers involved–through internal experience/analysis or an external methodology.

This extension is used to indicate the taxonomy code of the provider.

This extension is used to provide the Referral Number.

This extension is used to provide a reason to explain how the estimate may change subject to medical management.

Codes to specify the the functional roles of the care team members.

Codes for the classification of insurance coverage copay types for patient. This is an extension of the CoverageCopayTypeCodes value set

Codes to specify the type of diagnosis

ICD-10 Codes to specify the type of diagnosis

CMS Place of Service codes

Sample Adjudication codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.

CPT - HCPCS - HIPPS codes to report medical procedures and services under public and private health insurance programs

CPT - HCPCS codes to report medical procedures and services under public and private health insurance programs

The FDA published list of NDC codes for finished drug products

NUBC UB-04 Revenue codes

NUBC Uniform Billing (UB-04) codes to indicate the specific Type of Bill (TOB), e.g., hospital inpatient, outpatient, replacements, voids, etc. The first digit is a leading zero*. The fourth digit defines the frequency of the bill for the institutional and electronic professional claim.

Codes for the classification of organization contact purposes

Codes to specify the type of identifiers for organizations to indicate usage for a specific purpose

Codes to specify the type of entity involved in the PCT GFE process

Combination of CMS HCPCS and AMA CPT codes to specify the type of surgical procedure

Codes to specify the type of procedure

Codes for the classification of subject-to-medical-management reasons

Codes to specify the type of the supplied supporting information

Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.

PCT code system for defining the functional roles of the care team members.

Defining codes for the classification of insurance coverage copay types for patient

Defining codes for the classification of diagnosis types

Defining codes to report medical procedures and services under public and private health insurance programs

Defining codes to report medical procedures and services under public and private health insurance programs

Defining codes to indicate the specific Type of Bill (TOB)

Organization Contact Purpose Type Code System

Identifier Type codes for defining the type of identifier payers and providers assign to organizations

Organization Type codes for describing the type of organizations involved in the PCT GFE process

Defining codes for the classification of surgical procedure types

Defining codes for the classification of procedure types

Defining codes for the classification of subject-to-medical-management reason types

Defining codes for the classification of the supplied supporting information

An instance of the PCTAdvancedEOB Profile

PCT AEOB Bundle Example 1

PCT GFE Bundle Institutional Example 1

PCT GFE Bundle Professional Example 1

PCT Institutional GFE Example 1

PCT Professional GFE Example 1

An instance of PCTLocation

Institutional GFE Submitter 1

Professional GFE Submitter 1

An instance of Contract

An instance of PCTCoverage

An instance of Endpoint

An instance of PCTOrganization as a payer

An instance of PCTOrganization as a healthcare provider

An instance of Patient

An instance of PCTPractitioner

An instance of PCTPractitioner

An instance of PCTPractitionerRole