Patient Cost Transparency Implementation Guide
1.0.0 - STU 1 United States of America flag

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: PCTCoverage - Mappings

Active as of 2023-03-30

Mappings for the davinci-pct-coverage resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

PCTCoverage
CoverageEvent
   identifierEvent.identifier
   statusEvent.status
   beneficiaryEvent.subject
   periodEvent.occurrence[x]

Mappings for RIM Mapping (http://hl7.org/v3)

PCTCoverage
CoverageEntity. Role, or Act, Coverage
   textAct.text?
   containedN/A
   extensionN/A
   modifierExtensionN/A
   identifier.id
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   statusAct.status
   subscriber
      idn/a
      extensionn/a
      referenceN/A
      typeN/A
      identifier.identifier
      displayN/A
   periodAct.effectiveTime
   class
      idn/a
      extensionn/a
      modifierExtensionN/A
      type
   class (group)
      idn/a
      extensionn/a
      modifierExtensionN/A
      type
   class (plan)
      idn/a
      extensionn/a
      modifierExtensionN/A
      type
         idn/a
         extensionn/a
         codingunion(., ./translation)
         text./originalText[mediaType/code="text/plain"]/data
   costToBeneficiary
      idn/a
      extensionn/a
      modifierExtensionN/A
      exception
         idn/a
         extensionn/a
         modifierExtensionN/A
   contractn/a

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

PCTCoverage
Coverage
   identifierFiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   policyHolderFiveWs.subject[x], FiveWs.subject
   subscriberFiveWs.subject[x], FiveWs.subject
   subscriberIdFiveWs.subject[x], FiveWs.subject
   beneficiaryFiveWs.subject[x], FiveWs.subject
   periodFiveWs.done[x]
   payorFiveWs.author

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

PCTCoverage
Coverage
   identifierC02
   policyHolderD01 through D09
   subscriberD01 through D09
   subscriberIdD01 through D09
   beneficiaryD01 through D09
   dependentC17
   relationshipC03
   payorA05
   class
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (group)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (plan)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   networkD10
   costToBeneficiary
      value[x]C11 (Division,Section)
   contractD01 through D09

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

PCTCoverage
Coverage
   identifierIN1-2
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   typeIN1-15
   policyHolderIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIdIN1-16, 18, 19-name of insured, address, date of birth
   beneficiaryIN1-16, 18, 19-name of insured, address, date of birth
   dependent- No exact HL7 v2 equivalent concept seems to exist;
   periodIN1-12 / IN1-13
   payorIN1-3
   class
      type
      valueIN1-8
      nameIN1-8
   class (group)
      type
      valueIN1-8
      nameIN1-8
   class (plan)
      type
         codingC*E.1-8, C*E.10-22
         textC*E.9. But note many systems use C*E.2 for this
      valueIN1-8
      nameIN1-8
   order- No exact HL7 v2 equivalent concept seems to exist;
   costToBeneficiary
      value[x]IN1-8
   contractIN1-16, 18, 19

Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

PCTCoverage
Coverage
   identifierC.32, C.33, C.39
   policyHolderC.35
   subscriberC.35
   subscriberIdC.35
   beneficiaryC.35
   payorC.30
   class
      valueC.31
      nameC.31
   class (group)
      valueC.31
      nameC.31
   class (plan)
      valueC.31
      nameC.31
   costToBeneficiary
      value[x]C.31
   contractC.35