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

Technical Background and Underlying Technologies

Page standards status: Informative

Da Vinci

Da Vinci is an HL7-sponsored project that brings together the U.S. payer, providers, and technology suppliers (including Billing Management System vendors) to help payers and providers to positively impact clinical, quality, cost, and care management outcomes using FHIR-related technologies. The project organizes meetings (face-to-face and conference calls) as well as Connectathons to find ways to leverage FHIR technologies to support and integrate value-based care (VBC) data exchange across communities. Da Vinci identifies VBC use cases of interest to its member and the community as a whole.

The process that Da Vinci has adopted includes:

  1. identify business, clinical, technical and testing requirements,
  2. develop and ballot a FHIR based implementation guide (IG),
  3. develop a reference implementation (RI) that is used to demonstrate that the concepts in the IG are possible to implement,
  4. pilot the standard
  5. support the production use of the IG to enable exchange of data to support interoperability for value-based care.

Additional information about Da Vinci, its members, the use cases and the implementation guides being developed can all be found on the HL7 website. Meeting minutes and other materials can be found on the Da Vinci Confluence page.

FHIR

This IG uses terminology, notations and design principles that are specific to FHIR. It’s important to be familiar with some of the basic principles of FHIR as well as general guidance on how to read FHIR specifications. Readers who are unfamiliar with FHIR are encouraged to read the following prior to reading the rest of this IG.

US Core Version

US Core STU 3.1.1

Implementers should also familiarize themselves with the FHIR resources used within this IG.

Relationship to Other Implementation Guides

Good Faith Estimate Coordination Relationships

PCT OrganizationHRex OrganizationUS Core OrganizationPCT PractitionerHRex PractitionerHRex PractitionerRoleUS Core PractitionerUS Core PractitionerRolePCT CoverageHRex CoverageUS Core PatientHRex Patient DemographicsGFE Bundle (contributor only)GFE Request Information BundlePCT Service LocationPCT ServiceRequestPCT MedicationRequestPCT DeviceRequestFHIR NutritionOrderFHIR VisionPrescriptionFHIR DocumentReferenceGFE Coordination Request TaskCoordination or Contributorrequester 1..1requester 1..1requester 1..1input[request info bundle] 1..1output[gfe bundle] 1..1entry[patient] 1..2entry[coverage] 1..1"entry[service-location] 0..*entry[organization] 1..1entry[practitioner] 1..1entry[practitioner] 1..1entry[requested-items] 0..*entry[requested-items] 0..*entry[requested-items] 0..*entry[requested-items] 0..*entry[requested-items] 0..*entry[attachment] 0..*

Good Faith Estimate Relationships

PCT OrganizationHRex OrganizationUS Core OrganizationPCT PractitionerHRex PractitionerUS Core PractitionerPCT CoverageHRex CoverageUS Core PatientHRex Patient DemographicsGood Faith Estimateprofessional or institutionalpatient 1..1insurance.coverage 1..*provider 1..1payee.party 0..1provider 1..1insurer 1..1provider 0..1supportingInfo:serviceFacility 0..1

Advanced Explanation Of Benefit Relationships

PCT OrganizationHRex OrganizationUS Core OrganizationPCT PractitionerHRex PractitionerUS Core PractitionerPCT CoverageHRex CoverageUS Core PatientHRex Patient DemographicsAdvanced Explanation of BenefitsGood Faith Estimateprofessional or institutionalpatient 1..1insurance.coverage 1..*provider 1..1provider 1..1insurer 1..1gfeReference 1..*

US Core

Provider billing and payer claims adjudication systems for those profiles defined by US Core SHALL use the specification defined by US Core in exchanging information with payers. Implementers should be familiar with this specification. Claim, ExplanationOfBenefit and Coverage resource profiles are not defined by US Core.

Da Vinci PCT implementations SHALL conform to the US Core IG Must Support Guidance where US Core IG resources are used.

Da Vinci HRex

Provider billing and payer systems SHALL use the specification defined by the Da Vinci HRex IG Da Vinci HRex IG when exchanging information, as defined by the Privacy and Security section of this IG. Implementers should be familiar with this specification.