Patient Cost Transparency Implementation Guide
2.0.0 - STU 2
Patient Cost Transparency Implementation Guide
2.0.0 - STU 2
This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0: STU 2) based on FHIR (HL7® FHIR® Standard) 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
| Page standards status: Informative |
ProviderEventMethodology: EEMM1021
GFEServiceLinkingInfo
- linkingIdentifier:
http://example.org/Claim/identifiers/223452-2342-2435-008002- plannedPeriodOfService: 2022-02-02
identifier: Placer Identifier/GFEProviderAssignedID0001MRI
status: Active
type: Institutional
use: Predetermination
patient: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)
created: 2022-02-02
insurer: Organization Umbrella Insurance Company
provider: Organization GFE Service Help INC.
priority: Normal
| Type |
| Provider |
referral: Referral Number
| Sequence | Category | Code |
| 1 | Type of Bill | example-bill-type |
| Sequence | Diagnosis[x] | Type | PackageCode |
| 1 | Unspecified focal traumatic brain injury | Principal Diagnosis | Head trauma - concussion |
| Sequence | Focal | Coverage |
| 1 | true | Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01 |
item
Service Description: Imaging
sequence: 1
revenue: Magnetic Resonance Technology (MRT) - Brain/brain stem
productOrService: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material
serviced: 2022-02-02
quantity: 1
Nets
Value Currency 266 United States dollar
| Value | Currency |
| 266 | United States dollar |
IG © 2025+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pct#2.0.0 based on FHIR 4.0.1. Generated 2025-10-08
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