| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
Act
|
||||
classCode
|
1..1 | Required Pattern: ACT | ||
|
moodCode
|
1..1 | Required Pattern: EVN | ||
Slices for templateId
|
Slice: Unordered, Open by value:root, value:extension | |||
templateId:primary
|
1..1 | |||
root
|
1..1 | Required Pattern: 2.16.840.1.113883.10.20.22.4.61 | ||
extension
|
1..1 | Required Pattern: 2015-08-01 | ||
|
id
|
1..* |
This id is a unique identifier for the policy or program providing the coverage |
||
|
code
|
1..1 | Binding: todo ( preferred ) | ||
Slices for translation
|
Slice: Unordered, Open by | |||
|
translation:translation1
|
1..* |
Binding:
Payer Type
( preferred
) |
||
|
statusCode
|
1..1 | |||
|
code
|
1..1 | Required Pattern: completed | ||
|
Slices for performer
|
This performer represents the Guarantor.
Slice: Unordered, Open by value:templateId, value:assignedEntity |
|||
performer:performer1
|
1..1 | This performer represents the Payer. | ||
typeCode
|
1..1 | Required Pattern: PRF | ||
|
templateId
|
1..1 | |||
root
|
1..1 | Required Pattern: 2.16.840.1.113883.10.20.22.4.87 | ||
|
assignedEntity
|
1..1 | |||
|
id
|
1..* | |||
|
code
|
0..1 | |||
|
code
|
1..1 | Binding: Financially Responsible Party Type Value Set ( preferred ) | ||
addr
|
0..1 | http://hl7.org/fhir/cda/StructureDefinition/AD | ||
|
telecom
|
0..* | |||
|
representedOrganization
|
0..1 | |||
|
name
|
0..1 | |||
|
performer:performer2
|
0..* | Required Pattern: PRF | ||
|
templateId
|
1..1 | |||
|
root
|
1..1 | Required Pattern: 2.16.840.1.113883.10.20.22.4.88 | ||
|
time
|
0..1 | |||
|
assignedEntity
|
C | 1..1 | 1198-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:1198-8967). | |
|
code
|
1..1 | |||
|
code
|
1..1 | Required Pattern: GUAR | ||
|
codeSystem
|
1..1 | Required Pattern: 2.16.840.1.113883.5.110 | ||
|
addr
|
0..1 | http://hl7.org/fhir/cda/StructureDefinition/AD | ||
|
telecom
|
0..* | |||
|
Slices for participant
|
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.
Slice: Unordered, Open by value:templateId, value:participantRole, value:typeCode |
|||
|
participant:participant1
|
1..1 | |||
|
typeCode
|
1..1 | Required Pattern: COV | ||
|
templateId
|
1..1 | |||
|
root
|
1..1 | Required Pattern: 2.16.840.1.113883.10.20.22.4.89 | ||
|
time
|
0..1 | |||
|
low
|
0..1 | |||
|
high
|
0..1 | |||
|
participantRole
|
1..1 | |||
|
id
|
C | 1..* |
1198-8984:
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:1198-8984). |
|
|
code
|
1..1 | |||
|
code
|
0..1 | Binding: Coverage Role Type Value Set ( preferred ) | ||
|
addr
|
C | 0..1 | 1198-10484: The content of addr **SHALL** be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2) (CONF:1198-10484). | |
|
playingEntity
|
0..1 | |||
|
birthTime
|
C | 1..1 |
If the covered party?s date of birth is recorded differently in the health plan and in the registration/pharmacy benefit summary, use the date of birth as it is recorded in the health plan. 1198-31345: 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:1198-31345). |
|
|
name
|
1..* |
If the covered party?s name is recorded differently in the health plan and in the registration/pharmacy benefit summary (due to marriage or for other reasons), use the name as it is recorded in the health plan. |
||
|
participant:participant2
|
C | 0..1 | 1198-17139: 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:1198-17139). | |
|
typeCode
|
1..1 | Required Pattern: HLD | ||
|
templateId
|
1..1 | |||
|
root
|
1..1 | Required Pattern: 2.16.840.1.113883.10.20.22.4.90 | ||
|
time
|
0..1 | |||
|
participantRole
|
1..1 | |||
|
id
|
C | 1..* |
1198-10120:
This id is a unique identifier for the subscriber of the coverage (CONF:1198-10120). |
|
|
addr
|
C | 0..1 | 1198-10483: The content of addr **SHALL** be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2) (CONF:1198-10483). | |
|
Slices for entryRelationship
|
Slice: Unordered, Open by value:typeCode | |||
|
entryRelationship:entryRelationship1
|
C | 1..* |
1198-8942:
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:1198-8942). 1198-8943: 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:1198-8943). |
|
|
typeCode
|
1..1 | Required Pattern: REFR | ||
|
Documentation for this format
|
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