StructureDefinition-2.16.840.1.113883.10.20.22.4.61

Sourcehl7.cda.us.ccda#current:Consolidated CDA Release 2.1 StructureDefinition Publication (v5.0.0)
resourceTypeStructureDefinition
id2.16.840.1.113883.10.20.22.4.61
canonicalhttp://hl7.org/cda/us/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.4.61
version2.1
statusdraft
publisherHealth Level Seven
namePolicyActivityV4
titlePolicy Activity (V4)
date2023-08-24T14:33:15+00:00
descriptionA 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.
jurisdictionsus
fhirVersion5.0.0
kindlogical
abstractfalse
sdTtypehttp://hl7.org/cda/stds/core/StructureDefinition/Act
derivationconstraint
basehttp://hl7.org/cda/stds/core/StructureDefinition/Act
Usages
Name Flags Card. Type Description & Constraints doco
. . 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
. . . 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
. . . . . 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
. . . . . 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
. . . . . 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

doco Documentation for this format

Produced 08 Sep 2023