Code
|
Display
|
Definition
|
claims-processing
|
Claim Processing |
Request for data necessary from payers to support claims for services. |
preauth-processing
|
Pre-authorization Processing |
Request for data necessary from payers to support pre-authorization for services. |
risk-adjustment
|
Risk Adjustment |
Request for data from payers to calculate differences in beneficiary-level risk factors that can affect quality outcomes or medical costs, regardless of the care provided. |
quality-metrics
|
Quality Metrics |
Request for data used for aggregation, calculation and analysis, and ultimately reporting of quality measures. |
referral
|
Referral |
Request for additional clinical information from referring provider to support performing the requested service. |
social-care
|
Social Care |
Request for data from payers to support the non-medical social needs of individuals, especially the elderly, vulnerable or with special needs. |
authorization-other
|
Other Authorization |
Request for data from payers for other authorization request not otherwise specified. |
care-coordination
|
Care Coordination |
Request for data from payers to create a complete clinical record for each of their members to improve care coordination and provide optimum medical care. |
documentation-general
|
General Documentation |
Request for data used from payers or providers for general documentation. |
orders
|
Orders |
Request for additional clinical information from referring provider to support orders. |
patient-status
|
Patient Status |
Requests for patient health record information from payers to support their payer member records. |
signature
|
Signature |
Request for signatures from payers or providers on requested data. |
care-planning
|
Care Planning |
Request for data from payers or providers to determine how to deliver care for a particular patient, group or community. |
social-risk
|
Social Risk |
Request for data from payers or other providers to assess of social risk, establishing coded health concerns/problems, creating patient driven goals, managing interventions, and measuring outcomes. |
operations-noe
|
Operations Not Otherwise Enumerated |
Existing concepts do not define a more detailed [Healthcare Operations as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code. |
payment-noe
|
Payment Not Otherwise Enumerated |
[Existing concepts do not define a more detailed [Payment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code. |
treatment-noe
|
Treatment Not Otherwise Enumerated |
Existing concepts do not define a more detailed [Treatment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code. |
purpose-of-use
|
Purpose Of Use |
Purpose of use for the requested data. |
signature-flag
|
Signature Flag |
Flag to indicate whether the requested data requires a signature. |
tracking-id
|
Tracking Id |
A business identifier that ties requested attachments back to the claim or prior-authorization (referred to as the “re-association tracking control numbers”). |
multiple-submits-flag
|
Multiple Submits Flag |
Flag to indicate whether the requested data can be submitted in multiple transactions. If true the data can be submitted in separate transactions. if false *all* the data should be submitted in a single transaction. |
payer-url
|
Payer URL |
$submit-attachment operation endpoint where the requested data can be submitted |
service-date
|
Service Date |
Date of service or starting date of the service for the claim or prior authorization. |
attachment-request-code
|
Coded Attachment Request |
A Task by a Payer requesting attachments for a Provider claim or prior-authorization using LOINC attachment codes. |
data-request-code
|
Data Request Code |
A Task requesting data using a code. |
data-request-query
|
Data Request Query |
A Task requesting data using FHIR query syntax. |
data-request-questionnaire
|
Data Request Questionnaire |
A Task requesting data using a data request questionnaire ([FHIR Questionnaire](http://hl7.org/fhir/questionnaire.html)). |
attachment-request-questionnaire
|
Attachment Request Questionnaire |
A Task by a Payer requesting attachments or additional data for a Provider claim or prior-authorization using a data request questionnaire ([FHIR Questionnaire](http://hl7.org/fhir/questionnaire.html)). |