Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
US
Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
US
This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "PCT-GFE-Missing-Bundle-1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle"
]
},
"type" : "collection",
"timestamp" : "2024-03-27T11:01:00+05:00",
"entry" : [
{
"id" : "org1002",
"fullUrl" : "http://example.org/fhir/Organization/org1002",
"resource" : {
"resourceType" : "Organization",
"id" : "org1002",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"org1002\"></a><a name=\"hcorg1002\"></a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Organization "org1002"</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: National provider identifier/1234568095, Tax ID number/TAX-3211001</p><p><b>active</b>: true</p><p><b>type</b>: Healthcare Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html\">Organization type</a>#prov)</span></p><p><b>name</b>: Boston Radiology Center</p><p><b>telecom</b>: ph: 781-232-3200(WORK)</p><p><b>address</b>: 32 Fruit Street Boston MA 02114 US</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "NPI"
}
]
},
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1234568095"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "TAX"
}
]
},
"system" : "urn:oid:2.16.840.1.113883.4.4",
"value" : "TAX-3211001"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "prov",
"display" : "Healthcare Provider"
}
]
}
],
"name" : "Boston Radiology Center",
"telecom" : [
{
"system" : "phone",
"value" : "781-232-3200",
"use" : "work"
}
],
"address" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode",
"valueCoding" : {
"system" : "urn:iso:std:iso:3166:-2",
"code" : "US-MA"
}
}
],
"line" : [
"32 Fruit Street"
],
"city" : "Boston",
"state" : "MA",
"postalCode" : "02114",
"country" : "US"
}
]
}
},
{
"id" : "patient1001",
"fullUrl" : "http://example.org/fhir/Patient/patient1001",
"resource" : {
"resourceType" : "Patient",
"id" : "patient1001",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}\">unmarried</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Languages spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (United States)</span> (preferred)</td></tr></table></div>"
},
"identifier" : [
{
"system" : "http://example.com/identifiers/patient",
"value" : "1001"
}
],
"name" : [
{
"text" : "Eve Betterhalf",
"family" : "Betterhalf",
"given" : [
"Eve"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "781-949-4949",
"use" : "mobile"
}
],
"gender" : "female",
"birthDate" : "1955-07-23",
"address" : [
{
"text" : "222 Burlington Road, Bedford MA 01730"
}
],
"maritalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code" : "U",
"display" : "unmarried"
}
]
},
"communication" : [
{
"language" : {
"coding" : [
{
"system" : "urn:ietf:bcp:47",
"code" : "en-US",
"display" : "English (United States)"
}
]
},
"preferred" : true
}
]
}
},
{
"id" : "coverage1001",
"fullUrl" : "http://example.org/fhir/Coverage/coverage1001",
"resource" : {
"resourceType" : "Coverage",
"id" : "coverage1001",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"coverage1001\"></a><a name=\"hccoverage1001\"></a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Coverage "coverage1001"</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-coverage.html\">PCT Coverage</a></p></div><p><b>Extension Definition for Coverage.kind for Version 5.0</b>: insurance</p><p><b>status</b>: active</p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> " BETTERHALF"</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2021-01-01 --> 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> "Umbrella Insurance Company"</p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td>Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan)</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><h3>CostToBeneficiaries</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>Copay Percentage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-copay-type.html\">Coverage Copay Type Codes</a>#copaypct)</span></td><td>20</td></tr></table></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind",
"valueCode" : "insurance"
},
{
"url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared",
"valueBoolean" : false
}
],
"status" : "active",
"subscriberId" : "PFP123450000",
"beneficiary" : {
🔗 "reference" : "Patient/patient1001"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self",
"display" : "Self"
}
]
},
"period" : {
"start" : "2021-01-01",
"end" : "2022-01-01"
},
"payor" : [
{
🔗 "reference" : "Organization/org1001"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan",
"display" : "Plan"
}
]
},
"value" : "Premim Family Plus",
"name" : "Premim Family Plus Plan"
}
],
"costToBeneficiary" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
"code" : "copaypct",
"display" : "Copay Percentage"
}
]
},
"valueQuantity" : {
"value" : 20
}
}
]
}
},
{
"id" : "PCT-DeviceRequest-1",
"fullUrl" : "http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1",
"resource" : {
"resourceType" : "DeviceRequest",
"id" : "PCT-DeviceRequest-1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"PCT-DeviceRequest-1\"></a><a name=\"hcPCT-DeviceRequest-1\"></a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource DeviceRequest "PCT-DeviceRequest-1"</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-devicerequest.html\">PCT GFE DeviceRequest</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: proposal</p><p><b>code</b>: KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(HCPCSReleaseCodeSets#L1820)</span></p><p><b>subject</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> " BETTERHALF"</p></div>"
},
"status" : "active",
"intent" : "proposal",
"codeCodeableConcept" : {
"coding" : [
{
"system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code" : "L1820",
"display" : "KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT"
}
]
},
"subject" : {
🔗 "reference" : "Patient/patient1001"
}
}
}
]
}
IG © 2023+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pct#2.0.0-ballot based on FHIR 4.0.1. Generated 2024-04-08
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