Package | hl7.fhir.us.davinci-pct |
Type | StructureDefinition |
Id | Id |
FHIR Version | R4 |
Source | http://hl7.org/fhir/us/davinci-pct/https://build.fhir.org/ig/HL7/davinci-pct/StructureDefinition-davinci-pct-gfe-institutional.html |
Url | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional |
Version | 2.0.0-ballot |
Status | active |
Date | 2024-07-17T23:57:02+00:00 |
Name | PCTGFEInstitutional |
Title | PCT Good Faith Estimate Institutional |
Experimental | False |
Realm | us |
Authority | hl7 |
Description | PCT Good Faith Estimate Institutional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for an institutional GFE submission. |
Type | Claim |
Kind | resource |
CapabilityStatement | |
davinci-pct | Patient Cost Transparency Implementation Guide Payer Capability Statement |
http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-bundle | PCT GFE Bundle |
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition davinci-pct-gfe-institutional
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | Claim | |||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer |
Slices for identifier | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type | |
identifier:PLAC | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim | |
type | 1..1 | CodeableConcept | Description of identifier Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC | |
display | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier | |
system | S | 0..1 | uri | The namespace for the identifier value |
value | 1..1 | string | The value that is unique | |
identifier:INTER | 0..* | Identifier | Intermediary System Identifier | |
type | 1..1 | CodeableConcept | Description of identifier Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: INTER | |
display | 1..1 | string | Representation defined by the system Fixed Value: Intermediary System Identifier | |
type | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional | |
use | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination | |
patient | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | |
billablePeriod | S | 0..1 | Period | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims. |
insurer | S | 0..1 | Reference(PCT Organization) | Required if insured estimate |
provider | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE | |
extension | 1..* | Extension | Extension | |
Slices for extension | Content/Rules for all slices | |||
providerTaxonomy | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible) | |
Slices for extension | Content/Rules for all slices | |||
consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling |
priority | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) | |
payee | S | 0..1 | BackboneElement | Recipient of benefits payable |
party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
referral | ||||
extension | 1..* | Extension | Extension | |
Slices for extension | Content/Rules for all slices | |||
referralNumber | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber | |
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
careTeam:All Slices | Content/Rules for all slices | |||
provider | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | |
role | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) | |
qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) | |
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team |
provider | 1..1 | Reference(PCT Practitioner) | Practitioner or organization | |
role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending | |
qualification | 1..1 | CodeableConcept | Practitioner credential or specialization | |
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team |
provider | 1..1 | Reference(PCT Practitioner) | Practitioner or organization | |
role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating | |
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team |
provider | 1..1 | Reference(PCT Practitioner) | Practitioner or organization | |
role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team |
role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
Slices for supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
supportingInfo:All Slices | Content/Rules for all slices | |||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) | |
supportingInfo:typeOfBill | 1..1 | BackboneElement | Supporting information | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill | |
code | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required) | |
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |
Slices for value[x] | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this | |
value[x]:valueReference | 1..1 | Reference(PCT Organization) | Data to be provided | |
supportingInfo:drg | 0..1 | BackboneElement | Supporting information | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg | |
code | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required) | |
supportingInfo:pointoforigin | 0..1 | BackboneElement | Supporting information | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin | |
code | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required) | |
supportingInfo:admtype | 0..1 | BackboneElement | Supporting information | |
category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype | |
code | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required) | |