×

To enhance security, Multi-Factor Authentication (MFA) is mandatory for all HL7 users. More information

Section 1c: FHIR®
Section 3: Implementation Guides

HL7 FHIR® Implementation Guide: Patient Cost Transparency, Edition 2.0.1 - US Realm

DESCRIPTION

This IG provides detailed guidance to support providers and payers exchanging financial information for specific services and items using FHIR-based standards. This exchange involves the ability for multiple providers involved in a patient’s service to coordinate and produce one comprehensive GFE, and a provider submitting a Good Faith Estimate (GFE) to a payer, and the payer generating an Advanced Explanation of Benefits (AEOB) for a patient (which may optionally be returned to the submitting provider). This information about the cost of healthcare items or services may enable better decision making by the patient in consultation with the provider.

 

See the specification at http://hl7.org/fhir/us/davinci-pct/STU2.0.1

ALTERNATIVE NAMES

HL7 FHIR® Implementation Guide: Patient Cost Transparency, Edition 2.0.1 - US Realm may also go by the following names or acronyms:

"HL7 FHIR® IG: Patient Cost Transparency, R1 - US Realm",PCT,Patient Cost Transparency (PCT)

BENEFITS

  • Supports creating good faith estimates (GFEs) and advanced explanation of benefits (AEOBs) for anticipated patient items and services in support of the federal regulation, in particular the No Surprises Act, found under Division BB - Private Health Insurance and Public Health Provisions of the Consolidated Appropriations Act of 2021.

DEVELOPMENT BACKGROUND

The 2.0.1 Errata release addresses technical issues that would cause issues with implementation including correcting code system urls and the GFE coordination request operation code and parameters.

RELATED DOCUMENTS

HL7 FHIR® Implementation Guide: Patient Cost Transparency, Edition 2.0.1 - US Realm

STU DOCUMENTS

HL7 FHIR® Implementation Guide: Patient Cost Transparency, Edition 2.0.1 - US Realm See the standard at http://hl7.org/fhir/us/davinci-pct/STU2.0.1. (Submit Feedback on STU)
HL7 FHIR® Implementation Guide: Patient Cost Transparency, Release 1 - US Realm See the standard at http://hl7.org/fhir/us/davinci-pct/STU1.1. Expiration Oct 2025

TOPIC

  • Financial Management

BALLOT TYPE

  • STU

STATUS DATE

2025-10-08

RESPONSIBLE WORK GROUP

Financial Management

PRODUCT TYPE

  • Implementation Guide

STAKEHOLDERS

  • Clinical and Public Health Laboratories
  • Clinical Decision Support Systems Vendors
  • EHR, PHR Vendors
  • Emergency Services Providers
  • Health Care IT Vendors
  • Healthcare Institutions
  • Lab Vendors
  • Medical Imaging Service Providers
  • Quality Reporting Agencies
  • Regulatory Agency
  • Standards Development Organizations (SDOs)

FAMILY

  • FHIR

CURRENT STATE

  • Active

REALM

  • US Realm