Consolidated CDA Release 2.2, published by Health Level Seven. This is not an authorized publication; it is the continuous build for version 2.2). This version is based on the current content of https://github.com/HL7/CDA-ccda-2.2/ and changes regularly. See the Directory of published versions

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Resource Profile: Payers Section

Official URL: http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.2.18				Version: 2.2
Active as of 2022-05-13				Computable Name: PayersSection
Other Identifiers: : urn:hl7ii:2.16.840.1.113883.10.20.22.2.18:2015-08-01

The Payers Section contains data on the patients payers, whether “third party” insurance, self-pay, other payer or guarantor, or some combination of payers, and is used to define which entity is the responsible fiduciary for the financial aspects of a patients care. Each unique instance of a payer and all the pertinent data needed to contact, bill to, and collect from that payer should be included. Authorization information that can be used to define pertinent referral, authorization tracking number, procedure, therapy, intervention, device, or similar authorizations for the patient or provider, or both should be included. At a minimum, the patients pertinent current payment sources should be listed. The sources of payment are represented as a Coverage Activity, which identifies all of the insurance policies or government or other programs that cover some or all of the patient’s healthcare expenses. The policies or programs are sequenced by preference. The Coverage Activity has a sequence number that represents the preference order. Each policy or program identifies the covered party with respect to the payer, so that the identifiers can be recorded.

Usage:

• Use this Resource Profile: Transfer Summary, Continuity of Care Document (CCD)

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path	Conformance	ValueSet / Code
Section.nullFlavor	required	NullFlavor
Section.classCode	required	Fixed Value: DOCSECT
Section.moodCode	required	Fixed Value: EVN
Section.templateId:primary.nullFlavor	required	NullFlavor
Section.code	extensible	DocumentSectionType
Section.code.nullFlavor	required	NullFlavor
Section.languageCode	required	HumanLanguage
Section.subject.typeCode	required	Fixed Value: SBJ
Section.subject.contextControlCode	required	Fixed Value: OP
Section.subject.awarenessCode	extensible	TargetAwareness
Section.informant.typeCode	required	Fixed Value: INF
Section.informant.contextControlCode	required	Fixed Value: OP

Constraints

Id	Grade	Path	Details	Requirements
only-one-statement	error	Section.entry	SHALL have no more than one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer or act. : (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1
only-one-statement	error	Section.entry:coverage	SHALL have no more than one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer or act. : (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1