The GFE Bundle was used to submit GFE (Claims) resources and supporting information to a payer in the gfe-submit operation in STU1. In STU2 with the introduction of supporting GFEs from multiple providers, it is necessary for the provider specific GFEs to remain in tact and be able to be submitted in an enveloping bundle (A GFE Collection Bundle) which will now be used in the gfe-submit operation.

• Update the GFE Bundle description from:
  "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."

to:
"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 Collection Bundle 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 or more than one coverage. This does not serve as a replacement for eligibility, prior authorization or other financial and administrative use cases."

• Add the profile davinci-pct-gfe-collection-bundle of a Bundle resource including the following requirements
  • Description:  PCT GFE Collection Bundle that contains GFE Bundles from GFE contributing providers. This collection of GFE Bundles from contributing providers 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 or more than one coverage. This does not serve as a replacement for eligibility, prior authorization or other financial and administrative use cases.
  • 
    type - collection
  • timestamp 1..1
  • entry 1..*
  • entry.fullUrl 1..1
  • entry.search 0..0
  • entry.request 0..0
  • slices on entry
    • patient 1..1 only HRexPatientDemographics
    • coverage 0..1 MS 
    • organization only PCTOrganization 0..2 (description: "SHALL have a submitting provider or submitting organization, but not both. May also have a payer organization")
    • practitioner only PCTPractitioner 0..1 (description: "SHALL have a submitting provider or submitting organization, but not both")
    • gfe-bundle only GFE Bundle 0..* MS (description: "SHOULD include ontributing provider specific GFE bundle"
    • gfe-missing only GFEMissingBundle 0..* (description: MAY include bundle(s) with information about a unfulfilled GFE request)
    • attachment only DocumentReference 0..* (description: "MAY have attachments as DocumentReference resource(s)"
  • Invariant requiring (entry[organization] where type is not 'pay' or 'ins') xor entry[practitioner]
  • Invariant requiring at least a GFE Bundle or a GFEMissingBundle
• Add GFEMissingBundle profile on Bundle with the following requirements:
  • 
    Title: "PCT GFE Missing Bundle"
  • 
    Description: "PCT GFE Missing Bundle is used to indicate when a GFE request was made from a GFE Request Contributing Provider, but no GFE Bundle was submitted (attached to the Contributing Provider Task)."
  • timestamp 1..1
  • entry 1..*
  • entry.fullUrl 1..1
  • entry.search 0..0
  • entry.request 0..0
  • slices on entry
    • patient 1..1 only HRexPatientDemographics
    • coverage 0..1 MS 
    • organization only PCTOrganization 0..* (description: "MAY have the payer organization and may have provider organization(s)")
    • practitioner only PCTPractitioner 0..1 (description: "MAY have the provider Practitioner(s)")
    • request-items only PCTServiceRequest, PCTMedicationRequest, PCTDeviceRequest, NutritionOrder, or VisionPrescription 1..* MS (description: "Items the request is about"
• Update GFE-Submit operation
  • title:
    • from: Submit a GFE resource for the creation of an AEOB
    • to: Submit a GFE Collection Bundle for the creation of an AEOB Bundle
  • IN resource parameter for bundle description:
    • from: A Bundle containing a single or multiple GFE resources plus referenced resources.
      to: A GFE Collection Bundle containing information about the patient, payer organization, coverage, submitter, and one or more contributing provider specific GFE Bundles.