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 |
Profile: PCT Advanced EOB Summary
Service Description: Example service
In Network Provider Options Link: http://example.org/out-of-network.html
status: Active
type: Estimate Summary
use: Predetermination
patient: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)
billablePeriod: 2022-01-01 --> 2022-01-01
created: 2021-10-12
insurer: Organization Umbrella Insurance Company
provider: ?rref?
outcome: Processing Complete
| Focal | Coverage |
| true | Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01 |
total
category: Submitted Amount
Amounts
Value Currency 200 United States dollar
total
category: Member liability
Amounts
Value Currency 20 United States dollar
total
category: Eligible Amount
Amounts
Value Currency 190 United States dollar
| Extension | Text |
| processNote disclaimer text |
benefitPeriod: 2022-01-01 --> 2022-01-01
benefitBalance
category: Medical Care
unit: Individual
term: Annual
Financials
Extension Type Allowed[x] Used[x] Allowed $1.00 (USD) $1.00 (USD)
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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QA Report
| Version History |
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