Patient Cost Transparency (PCT)

Goal: Develop a standard data exchange in support of patient cost transparency for devices, services and collection of services using FHIR APIs for exchange of data. 

Phase 2 Goal Summary: Support Good Faith Estimate data exchange via FHIR APIs when multiple providers are involved

Objectives: Italicized is phase 2

• Define standard FHIR-based methodology (data input, data output and format) to support requests and responses for patient cost
• Ability to communicate good faith estimates (GFE) for single service, collection of services, and items from provider to payer
• Ability to communicate Advanced Explanation of Benefits (AEOB) in advance of scheduled service or upon request to patient and optionally, to provider.

• Ability for convening provider to notify co-providers and request data to inform good faith estimates (GFE) for expected service(s) and item(s)

• Ability for co-providers to respond to a request for data back to convenor (convening provider, third party, or payer) with cost and planned service(s) or item(s) information.

• Ability for Coordination Platform to communicate GFE to Patient (leveraging existing FHIR API), payer (leveraging existing PCT IG workflow,) and to other providers in the care team, prior to scheduled service or upon request

Project Scope Statement: HL7 Project Scope Statement (PSS) for Patient Cost Transparency

Sponsoring Workgroup: Financial Management

Co-Sponsoring Workgroup:  Payer/Provider Information Exchange (PPIE) (formerly Attachments)

PCT Implementation Guide:

• Published STU1 IG
• Continuous Integration (CI) Build

STU1 Ballot Reconciliation:

• JIRA Dashboard - DaVinci PCT STU1 Balloting Dashboard

Reference Implementation:

• https://github.com/HL7-DaVinci/test-pct-payer

• Endpoint for testing: https://davinci-pct-payer.logicahealth.org/

Test Scripts: Touchstone Da Vinci PCT Test Scripts

Zulip Channel: https://chat.fhir.org/#narrow/stream/301151-Da-Vinci.20PCT

Project Milestones - Phase 2

Conference Call Schedule & Dial-Ins

Occurs weekly on Friday from 11:00 AM to 1:00 PM ET

Join Zoom Meeting: https://hl7-org.zoom.us/j/93358035002?pwd=MmJQc096bHBqdXFOaUlnTFpwc2wzZz09

Meeting ID: 933 5803 5002

Passcode: 8675309

One tap mobile

+13126266799,,93358035002# US (Chicago)

+16465588656,,93358035002# US (New York)

Ballot Milestone Goals:

Patient Cost Transparency Team

Links to Other Resources

• Patient Cost Transparency Supporting Materials

  • Da Vinci PCT Glossary

  • Da Vinci Steering Committee PCT Scope Statement