Source | hl7.cda.us.ccda#current:Consolidated CDA Release 2.1 StructureDefinition Publication (v5.0.0) |
resourceType | StructureDefinition |
id | 2.16.840.1.113883.10.20.22.4.61 |
canonical | http://hl7.org/cda/us/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.4.61 |
version | 2.1 |
status | draft |
publisher | Health Level Seven |
name | PolicyActivityV4 |
title | Policy Activity (V4) |
date | 2023-08-24T14:33:15+00:00 |
description | A policy activity represents the policy or program providing the coverage. The person for whom payment is being provided (i.e., the patient) is the covered party. The subscriber of the policy or program is represented as a participant that is the holder of the coverage. The payer is represented as the performer of the policy activity. |
jurisdictions | us |
fhirVersion | 5.0.0 |
kind | logical |
abstract | false |
sdTtype | http://hl7.org/cda/stds/core/StructureDefinition/Act |
derivation | constraint |
base | http://hl7.org/cda/stds/core/StructureDefinition/Act |
Usages |
|
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Act | CDAR2.Act |
XML Namespace:
urn:hl7-org:v3 This logical model cannot be the target of a reference |
||
classCode | 1..1 |
classCode Fixed Value: ACT |
||
moodCode | 1..1 |
moodCode Fixed Value: EVN |
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Slices for templateId | 1 .. | Slice: Unordered, Open by value:root, value:extension | ||
templateId:templateId1 | 1..1 | templateId | ||
root | 1..1 |
root Required Pattern: 2.16.840.1.113883.10.20.22.4.61 |
||
extension | 1..1 |
extension Required Pattern: 2023-05-01 |
||
id | 1..* |
id |
||
code | 1..1 |
code Binding: todo ( preferred ) |
||
Slices for translation | 1 .. | Slice: Unordered, Open by value:code | ||
translation:translation1 | 1..* |
translation |
||
code | 0..1 |
code Binding: Payer Type ( preferred ) |
||
statusCode | 1..1 | statusCode | ||
code | 1..1 |
code Fixed Value: completed |
||
Slices for performer | 1 .. | Slice: Unordered, Open by value:templateId, value:assignedEntity, value:typeCode | ||
performer:performer1 | 1..1 | performer | ||
typeCode | 1..1 |
typeCode Fixed Value: PRF |
||
templateId | 1..1 | templateId | ||
root | 1..1 |
root Required Pattern: 2.16.840.1.113883.10.20.22.4.87 |
||
assignedEntity | 1..1 | assignedEntity | ||
id | 1..* |
id |
||
code | 0..1 | code | ||
code | 1..1 |
code Binding: Financially Responsible Party Type Value Set ( preferred ) |
||
addr | 0..1 | http://hl7.org/cda/stds/core/StructureDefinition/AD | addr | |
telecom | 0..* |
telecom |
||
representedOrganization | 0..1 | representedOrganization | ||
name | 0..1 | name | ||
performer:performer2 | 0..* |
performer |
||
typeCode | 1..1 |
typeCode Fixed Value: PRF |
||
templateId | 1..1 | templateId | ||
root | 1..1 |
root Required Pattern: 2.16.840.1.113883.10.20.22.4.88 |
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time | 0..1 | time | ||
assignedEntity | C | 1..1 |
assignedEntity 4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). |
|
code | 1..1 | code | ||
code | 1..1 |
code Required Pattern: GUAR |
||
codeSystem | 1..1 |
codeSystem Required Pattern: 2.16.840.1.113883.5.110 |
||
addr | 0..1 | http://hl7.org/cda/stds/core/StructureDefinition/AD | addr | |
telecom | 0..* |
telecom |
||
Slices for participant | 1 .. | Slice: Unordered, Open by value:templateId, value:participantRole, value:typeCode | ||
participant:participant1 | 1..1 | participant | ||
typeCode | 1..1 |
typeCode Fixed Value: COV |
||
templateId | 1..1 | templateId | ||
root | 1..1 |
root Required Pattern: 2.16.840.1.113883.10.20.22.4.89 |
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time | 0..1 | time | ||
low | 0..1 | low | ||
high | 0..1 | high | ||
participantRole | 1..1 | participantRole | ||
id | C | 1..* |
id 4537-8984: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984). |
|
code | 1..1 | code | ||
code | 0..1 |
code Binding: Coverage Role Type Value Set ( preferred ) |
||
addr | 0..1 | http://hl7.org/cda/stds/core/StructureDefinition/AD | addr | |
playingEntity | 0..1 | playingEntity | ||
name | 1..1 | name | ||
sdtcBirthTime | C | 1..1 |
sdtc:birthTime 4537-31345: The prefix sdtc: **SHALL** be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the birthTime element (CONF:4537-31345). |
|
participant:participant2 | C | 0..1 |
participant 4537-17139: When the Subscriber is the patient, the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). |
|
typeCode | 1..1 |
typeCode Fixed Value: HLD |
||
templateId | 1..1 | templateId | ||
root | 1..1 |
root Required Pattern: 2.16.840.1.113883.10.20.22.4.90 |
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time | 0..1 | time | ||
participantRole | 1..1 | participantRole | ||
id | C | 1..* |
id 4537-10120: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120). |
|
addr | 0..1 | http://hl7.org/cda/stds/core/StructureDefinition/AD | addr | |
Slices for entryRelationship | Slice: Unordered, Open by value:typeCode | |||
entryRelationship:entryRelationship1 | C | 0..* |
entryRelationship 4537-8942: The target of a policy activity with act/entryRelationship/@typeCode="REFR" **SHALL** be an authorization activity (templateId 2.16.840.1.113883.10.20.1.19) *OR* an act, with act[@classCode="ACT"] and act[@moodCode="DEF"], representing a description of the coverage plan (CONF:4537-8942). 4537-8943: A description of the coverage plan **SHALL** contain one or more act/id, to represent the plan identifier, and an act/text with the name of the plan (CONF:4537-8943). |
|
typeCode | 1..1 |
typeCode Fixed Value: REFR |
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Documentation for this format |
Produced 08 Sep 2023