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: Trial-use | Maturity Level: 2 |
Mappings for the davinci-pct-aeob resource profile.
| PCTAdvancedEOB | ||
| ExplanationOfBenefit | Event | |
| identifier | Event.identifier | |
| identifier (INTER) | Event.identifier | |
| identifier (uniqueclaimid) | Event.identifier | |
| status | Event.status | |
| type | Event.code | |
| patient | Event.subject | |
| created | Event.occurrence[x] | |
| enterer | Event.performer.agent | |
| insurer | Event.performer.agent | |
| facility | Event.performer.location | |
| PCTAdvancedEOB | ||
| ExplanationOfBenefit | ||
| identifier | FiveWs.identifier | |
| identifier (INTER) | FiveWs.identifier | |
| identifier (uniqueclaimid) | FiveWs.identifier | |
| status | FiveWs.status | |
| type | FiveWs.class | |
| subType | FiveWs.class | |
| use | FiveWs.class | |
| patient | FiveWs.subject[x], FiveWs.subject | |
| billablePeriod | FiveWs.done[x] | |
| created | FiveWs.recorded | |
| enterer | FiveWs.author | |
| insurer | FiveWs.author | |
| provider | FiveWs.source | |
| referral | FiveWs.cause | |
| facility | FiveWs.where[x] | |
| claim | FiveWs.why[x] | |
| careTeam | ||
| provider | FiveWs.actor | |
| item | ||
| serviced[x] | FiveWs.done[x] | |
| location[x] | FiveWs.where[x] | |
| addItem | ||
| provider | FiveWs.source | |
| serviced[x] | FiveWs.done[x] | |
| location[x] | FiveWs.where[x] | |
| PCTAdvancedEOB | ||
| ExplanationOfBenefit | ||
| identifier | ||
| identifier (INTER) | ||
| use | N/A | |
| type | CX.5 | |
| system | CX.4 / EI-2-4 | |
| value | CX.1 / EI.1 | |
| period | CX.7 + CX.8 | |
| assigner | CX.4 / (CX.4,CX.9,CX.10) | |
| identifier (uniqueclaimid) | ||
| use | N/A | |
| type | CX.5 | |
| system | CX.4 / EI-2-4 | |
| value | CX.1 / EI.1 | |
| period | CX.7 + CX.8 | |
| assigner | CX.4 / (CX.4,CX.9,CX.10) | |
| priority | Request.priority | |
| claim | ||
| identifier | ||
| use | N/A | |
| type | CX.5 | |
| system | CX.4 / EI-2-4 | |
| value | CX.1 / EI.1 | |
| period | CX.7 + CX.8 | |
| assigner | CX.4 / (CX.4,CX.9,CX.10) | |
| insurance | Coverage | |
| PCTAdvancedEOB | ||
| ExplanationOfBenefit | Entity. Role, or Act | |
| text | Act.text? | |
| contained | N/A | |
| modifierExtension | N/A | |
| identifier | ||
| identifier (INTER) | ||
| id | n/a | |
| extension | n/a | |
| use | Role.code or implied by context | |
| type | Role.code or implied by context | |
| system | II.root or Role.id.root | |
| value | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) | |
| period | Role.effectiveTime or implied by context | |
| assigner | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper | |
| identifier (uniqueclaimid) | ||
| id | n/a | |
| extension | n/a | |
| use | Role.code or implied by context | |
| type | Role.code or implied by context | |
| system | II.root or Role.id.root | |
| value | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) | |
| period | Role.effectiveTime or implied by context | |
| assigner | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper | |
| related | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| payee | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| claim | ||
| id | n/a | |
| extension | n/a | |
| reference | N/A | |
| type | N/A | |
| identifier | .identifier | |
| id | n/a | |
| extension | n/a | |
| use | Role.code or implied by context | |
| type | Role.code or implied by context | |
| system | II.root or Role.id.root | |
| value | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) | |
| period | Role.effectiveTime or implied by context | |
| assigner | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper | |
| display | N/A | |
| careTeam | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| supportingInfo | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| diagnosis | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| procedure | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| insurance | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| accident | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| item | ||
| id | n/a | |
| modifierExtension | N/A | |
| adjudication | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (medicalmanagement) | ||
| id | n/a | |
| modifierExtension | N/A | |
| adjudication (benefitpaymentstatus) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (adjustmentreason) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (submitted) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (memberliability) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (eligible) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (benefit) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| detail | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| subDetail | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| addItem | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| detail | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| subDetail | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (medicalmanagement) | ||
| id | n/a | |
| modifierExtension | N/A | |
| adjudication (billingnetworkstatus) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (renderingnetworkstatus) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (benefitpaymentstatus) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (adjustmentreason) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (submitted) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (memberliability) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (eligible) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| adjudication (benefit) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (submitted) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (memberliability) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (innetwork) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (outofnetwork) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (noncovered) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (negotiated) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (eligible) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| total (benefit) | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| payment | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| processNote | ||
| id | n/a | |
| modifierExtension | N/A | |
| benefitBalance | ||
| id | n/a | |
| extension | n/a | |
| modifierExtension | N/A | |
| financial | ||
| id | n/a | |
| modifierExtension | N/A | |
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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