description: PCT GFE Bundle that contains necessary resources as a GFE Submission for obtaining an AEOB. Organizations for both the provider and payer SHALL be included. The scope of this guide does not include coordination of benefits or more than one coverage. This does not serve as a replacement for eligibility, prior authorization or other financial and administrative use cases.
package_name: hl7.fhir.us.davinci-pct.r4b
derivation: constraint
name: PCTGFEBundle
type: Bundle
elements:
  identifier: {index: 0}
  type:
    pattern: {type: Code, value: collection}
    index: 1
  timestamp: {index: 2}
  entry:
    array: true
    min: 4
    index: 3
    elements:
      fullUrl: {index: 4}
      search: {index: 5}
      request: {index: 6}
      response: {index: 7}
    required: [fullUrl]
    slicing:
      rules: open
      description: Slice different resources included in the bundle
      discriminator:
      - {path: resource, type: type}
      min: 4
      slices:
        gfe:
          match: {}
          schema:
            short: SHALL have one or more PCTGFEProfessional or PCTGFEInstitutional resource(s)
            array: true
            min: 1
            _required: true
            index: 8
            elements:
              resource: {type: Claim, index: 9}
            required: [resource]
        patient:
          match: {}
          schema:
            short: SHALL have the patient subject of care and may have a separate subscriber
            array: true
            min: 1
            max: 2
            _required: true
            index: 10
            elements:
              resource: {type: Patient, index: 11}
            required: [resource]
        coverage:
          match: {}
          schema:
            short: SHALL have one Coverage
            _required: true
            index: 12
            elements:
              resource: {type: Coverage, index: 13}
            required: [resource]
        organization:
          match: {}
          schema:
            short: SHALL have the payer organization and may have provider organization(s)
            array: true
            min: 1
            _required: true
            index: 14
            elements:
              resource: {type: Organization, index: 15}
            required: [resource]
        practitioner:
          match: {}
          schema:
            short: MAY have the provider Practitioner(s)
            mustSupport: true
            array: true
            index: 16
            elements:
              resource: {type: Practitioner, index: 17}
            required: [resource]
        attachment:
          match: {}
          schema:
            short: MAY have attachments as DocumentReference resource(s)
            mustSupport: true
            array: true
            index: 18
            elements:
              resource: {type: DocumentReference, index: 19}
            required: [resource]
package_version: 1.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-bundle
base: http://hl7.org/fhir/StructureDefinition/Bundle
version: 1.0.0
required: [timestamp, identifier]