PCTGFEBundle

PCT GFE Bundle

activeDa Vinci PCT2.0.1resource16 key elements

PCT GFE Bundle that contains all resources for a Good faith estimate submitted by a single GFE contributing provider. Organizations for both the provider and payer MAY be included. This single contributing provider GFE Bundle may be included in a set of GFE bundles from other providers in a GFE Packet that can then be made available to the patient or sent to a payer for insurance estimation. The scope of this guide does not include coordination of benefits for more than one coverage. This does not serve as a replacement for eligibility, prior authorization or other financial and administrative use cases.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-bundle
ID
davinci-pct-gfe-bundle
Type
Base Definition
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
identifier
1+
timestamp
1+
entry
1+
entry.fullUrl
1+
:gfe2..*
1+
SHALL have one or more PCTGFEProfessional or PCTGFEInstitutional resource(s)
entry.resource
Claim
1+
:patient1..2
1+
SHALL have the patient subject of care and may have a separate subscriber
entry.resource
Patient
1+
:coverage0..1
S
MAY have one Coverage
entry.resource
Coverage
1+
:organization0..*
S
SHALL have a submitting provider or submitting organization, but not both. May also have a payer organization.
entry.resource
Organization
1+
:practitioner0..*
S
SHALL have a submitting provider or submitting organization, but not both.
entry.resource
Practitioner
1+
:attachment0..*
S
MAY have attachments as DocumentReference resource(s)
entry.resource
DocumentReference
1+