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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Patient Cost Transparency Implementation Guide Home Page
... 2 Use Case and Actors
... 3 Good Faith Estimate (GFE) Coordination Overview
... 4 Good Faith Estimate (GFE) Submission and AEOB Overview
... 5 Technical Background and Underlying Technologies
... 6 Formal Specification
... 7 Good Faith Estimate (GFE) Coordination Specification
... 8 Good Faith Estimate (GFE) Submission and AEOB Specification
... 9 Terminology Licensure
... 10 Security
... 11 Downloads
... 12 Change Log
... 13 Artifacts Summary
.... 13.1 Patient Cost Transparency Implementation Guide Coordination Platform Capability Statement
.... 13.2 Patient Cost Transparency Implementation Guide Coordination Requester Capability Statement
.... 13.3 Patient Cost Transparency Implementation Guide GFE Contributor Capability Statement
.... 13.4 Patient Cost Transparency Implementation Guide Payer Capability Statement
.... 13.5 Retrieve GFE Collection Bundle
.... 13.6 Submit a GFE resource for the creation of an AEOB
.... 13.7 aeob-date-of-service
.... 13.8 TaskReplaces
.... 13.9 TaskRequestedPeriod
.... 13.10 PCT Coverage
.... 13.11 PCT Organization
.... 13.12 PCT Practitioner
.... 13.13 PCT GFE Bundle
.... 13.14 PCT GFE Collection Bundle
.... 13.15 PCT GFE Contributor Task
.... 13.16 PCT GFE Coordination Bundle
.... 13.17 PCT GFE Coordination Task
.... 13.18 PCT GFE DeviceRequest
.... 13.19 PCT GFE Information Bundle
.... 13.20 PCT GFE MedicationRequest
.... 13.21 PCT GFE Missing Bundle
.... 13.22 PCT GFE ServiceRequest
.... 13.23 PCT Good Faith Estimate Summary
.... 13.24 PCT Good Faith Estimate Institutional
.... 13.25 PCT Good Faith Estimate Professional
.... 13.26 PCT Service Location
.... 13.27 PCT Advanced EOB
.... 13.28 PCT Advanced EOB Summary
.... 13.29 PCT AEOB Adjudication Error
.... 13.30 PCT AEOB Bundle
.... 13.31 PCT AEOB Complete
.... 13.32 PCT GFE Validation Error
.... 13.33 Benefit Remaining
.... 13.34 CountrySubdivisionCode
.... 13.35 GFE Reference
.... 13.36 GFEBillingProviderLineItemCtrlNum
.... 13.37 GFEConsentForBalanceBilling
.... 13.38 GFEDisclaimer
.... 13.39 GFEServiceLinkingInfo
.... 13.40 In Network Provider Options Link
.... 13.41 PCTEndpoint
.... 13.42 Planned Service Period
.... 13.43 ProcessNote Class
.... 13.44 ProviderEventMethodology
.... 13.45 ProviderTaxonomy
.... 13.46 ReferralNumber
.... 13.47 Request Initiation Time
.... 13.48 Self-Pay Declared
.... 13.49 Service Description
.... 13.50 Subject To Medical Management
.... 13.51 Claim Medical Product or Service Value Set
.... 13.52 GFE Coordination Task Status Codes
.... 13.53 ICD-10 Procedure Codes
.... 13.54 NUBC Point Of Origin
.... 13.55 NUBC Priority (Type) of Admission or Visit
.... 13.56 PCT Adjudication Value Set
.... 13.57 PCT Adjustment Reason
.... 13.58 PCT Advance Explanation of Benefit Type Value Set
.... 13.59 PCT AEOB Process Note Types
.... 13.60 PCT benefitBalance.category codes
.... 13.61 PCT Care Team Role Value Set
.... 13.62 PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
.... 13.63 PCT Diagnosis Type Value Set
.... 13.64 PCT Financial Type Value Set
.... 13.65 PCT GFE CMS Place of Service Value Set
.... 13.66 PCT GFE Contributor Task Status Reason Codes ValueSet
.... 13.67 PCT GFE Frequency Code Value Set
.... 13.68 PCT GFE Item Adjudication Value Set
.... 13.69 PCT GFE Item CPT - HCPCS Value Set
.... 13.70 PCT GFE Item NDC Value Set
.... 13.71 PCT GFE NUBC Revenue Value Set
.... 13.72 PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
.... 13.73 PCT GFE Request Coordination Task Status Reason Codes ValueSet
.... 13.74 PCT GFE Request Task Codes ValueSet
.... 13.75 PCT ICD-10 Diagnostic Codes
.... 13.76 PCT Organization Contact Purpose Value Set
.... 13.77 PCT Organization Identifier Type Value Set
.... 13.78 PCT Organization Type Value Set
.... 13.79 PCT Payer Benefit Payment Status
.... 13.80 PCT Payer Provider Network Status
.... 13.81 PCT Procedure Type Value Set
.... 13.82 PCT Subject-To-Medical-Management Reason Value Set
.... 13.83 PCT Supporting Info Type Value Set
.... 13.84 PCT Total Value Set
.... 13.85 Provider GFE Contributor Task Status Codes
.... 13.86 US Claim DRG Codes
.... 13.87 PCT Adjudication Category CodeSystem
.... 13.88 PCT Adjudication Code System
.... 13.89 PCT AEOB Process Note Code System
.... 13.90 PCT Care Team Role
.... 13.91 PCT Diagnosis Type
.... 13.92 PCT Estimate Type Code System
.... 13.93 PCT Financial Type Code System
.... 13.94 PCT GFE Frequency Code System
.... 13.95 PCT GFE Request Task Codes Code System
.... 13.96 PCT GFE Request Task Status Reason Code Code System
.... 13.97 PCT GFE Supporting Info Type Code System
.... 13.98 PCT Identifier Type
.... 13.99 PCT Network Status
.... 13.100 PCT Organization Contact Purpose Type Code System
.... 13.101 PCT Organization Identifier Type Code System
.... 13.102 PCT Procedure Type
.... 13.103 PCT Subject-To-Medical-Management Reason Code System
.... 13.104 contract1001
.... 13.105 coverage1001
.... 13.106 endpoint001
.... 13.107 org1001
.... 13.108 org1002
.... 13.109 patient1001
.... 13.110 PCT-AEOB-1
.... 13.111 PCT-AEOB-Adjudication-Error-Example-1
.... 13.112 PCT-AEOB-Bundle-1
.... 13.113 PCT-AEOB-Complete-Example-1
.... 13.114 PCT-AEOB-Summary-1
.... 13.115 PCT-DeviceRequest-1
.... 13.116 PCT-GFE-Bundle-Inst-1
.... 13.117 PCT-GFE-Bundle-Prof-1
.... 13.118 PCT-GFE-Collection-Bundle-1
.... 13.119 PCT-GFE-Contributor-Task-1
.... 13.120 PCT-GFE-Contributor-Task-2
.... 13.121 PCT-GFE-Coordination-Bundle-1
.... 13.122 PCT-GFE-Coordination-Task-1
.... 13.123 PCT-GFE-Information-Bundle-1
.... 13.124 PCT-GFE-Institutional-1
.... 13.125 PCT-GFE-Institutional-MRI
.... 13.126 PCT-GFE-Missing-Bundle-1
.... 13.127 PCT-GFE-Professional-MRI
.... 13.128 PCT-GFE-Summary-1
.... 13.129 PCT-GFE-Summary-MRI
.... 13.130 PCT-GFE-Validation-Error-Example-1
.... 13.131 PCT-MedicationRequest-1
.... 13.132 PCT-ServiceLocation-1
.... 13.133 PCT-ServiceRequest-1
.... 13.134 prac001
.... 13.135 prac002
.... 13.136 Submitter-Org-1
.... 13.137 Submitter-Practitioner-1