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
| Page standards status: Informative |
Generated Narrative: ExplanationOfBenefit
Resource ExplanationOfBenefit "PCT-AEOB-Summary-1"
Profile: PCT Advanced EOB Summary
Service Description: Example service
In Network Provider Options Link: http://example.com/out-of-network.html
status: active
type: Estimate Summary (PCT Estimate Type Code System#estimate-summary)
use: predetermination
patient: Patient/patient1001 " BETTERHALF"
billablePeriod: 2022-01-01 --> 2022-01-01
created: 2021-10-12
insurer: Organization/org1001 "Umbrella Insurance Company"
provider: ??
outcome: complete
| Focal | Coverage |
| true | Coverage/coverage1001 |
total
category: Submitted Amount (Adjudication Value Codes#submitted)
Amounts
Value Currency 200 USD
| Extension | Text |
| processNote disclaimer text |
benefitPeriod: 2022-01-01 --> 2022-01-01
benefitBalance
category: Medical Care (X12 Service Type Codes#1)
unit: Individual (Unit Type Codes#individual)
term: Annual (Benefit Term Codes#annual)
Financials
Extension Type Allowed[x] Used[x] Allowed (PCT Financial Type Code System#allowed) $1.00 (USD) $1.00 (USD)
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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