Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

US Core Encounter

Page standards status: Informative

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An example mapping of Health Plan data for Members to the US Core 3.1.1 Encounter or US Core 6.1.0 Encounter resource is shown below:

When populating the encounter resource period - if claim has period, populate period; if only a date, populate the end date in a period element.

Add warning text to alert the user that Claims consider the date of service to be the date when the service is completed therefore one generally cannot infer the start date of a diagnosis or the encounter to be the same as the service date of a line item.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core 3.1.1 Encounter or US Core 6.1.0 Encounter resource are:

R4 Element	Name	Cardinality	Type
Encounter.identifier	identifier	0..*	Identifier
Encounter.identifier.system	system	1..1	uri
Encounter.identifier.value	value	1..1	string
Encounter.status	status	1..1	code
Encounter.class	class	1..1	Coding
Encounter.type	type	1..*	CodeableConcept
Encounter.subject	subject	1..1	Reference(US Core Patient Profile)
Encounter.participant	participant	0..*	BackboneElement
Encounter.participant.type	type	0..*	CodeableConcept
Encounter.participant.period	period	0..1	Period
Encounter.participant.individual	individual	0..1	Reference(US Core Practitioner Profile)
Encounter.period	period	0..1	Period
Encounter.reasonCode	reasonCode	0..*	CodeableConcept
Encounter.hospitalization	hospitalization	0..1	BackboneElement
Encounter.hospitalization.dischargeDisposition	dischargeDisposition	0..1	CodeableConcept
Encounter.location	location	0..*	BackboneElement
Encounter.location.location	location	1..1	Reference(Location)

​Table Definition

Fields that can be mapped from the CARIN Blue Button IG CPCDS File are included in the table below:

US Core Element	Must Support	Cardinality	CARIN-BB Element	CPCDS Element Mapping or Implementer Note
Encounter.identifier	S	0..*	ExplanationOfBenefit.identifier	[{"35":"Payer claim unique identifier"}]. Note: Assign Payer System URI for Unique Claim Id in Encounter.identifier.system. SetClaim Id in Encounter.identifier.value
Encounter.identifier.system	S	1..1		Note: Assign Payer System URI for Unique Claim Id in Encounter.identifier.system. Set Claim Id in Encounter.identifier.value
Encounter.identifier.value	S	1..1		Note: Assign Claim Id in Encounter.identifier.value
Encounter.status	S	1..1	ExplanationOfBenefit.status	[{"140":"Claim processing status code "}]
Encounter.statusHistory.period		1..1		[{"177, 178":"Statement From Date Statement Through Date "}]
Encounter.class	S	1..1		Note: Use ExplanationOfBenefit.type [institutional|oral|pharmacy|professional|vision] to map to ActCode [IMP|AMB|AMB|AMB]
Encounter.classHistory.period		1..1	ExplanationOfBenefit.item.serviced.servicedPeriod, ExplanationOfBenefit.item.serviced.servicedDate	[{"18, 19":"Member Admission Date Member Discharge Date"}, {"90, 119":"Service from date, Service to date"}]
Encounter.type	S	1..*	ExplanationOfBenefit.type	HCPCS codes are contained within CPT Code System.
Encounter.subject	S	1..1	ExplanationOfBenefit.patient	[{"Ref (1), Ref (109)":"Member id, Patient account number"}, {"Ref (191)":"Unique Member ID"}, {"Ref (110)":"Medical record number"}]
Encounter.participant.type	S	0..*	ExplanationOfBenefit.careTeam.role	[{"165":"Care Team Role"}]
Encounter.participant.period	S	0..1		Note: Provide information if available
Encounter.participant.individual	S	0..1	ExplanationOfBenefit.careTeam.provider	[{"Ref (93, 96, 98, 99, 173)":"Provider attending, PCP, operating, referring and supervising NPIs"}, {"Ref (166, 169, 182, 171, 174)":"Provider attending, PCP, operating, referring and supervising names"}, {"Ref (94, 167)":"Claim Billing Provider NPI, Claim Billing Provider Name"}]
Encounter.period	S	0..1	ExplanationOfBenefit.item.serviced.servicedPeriod, ExplanationOfBenefit.item.serviced.servicedDate	[{"18, 19":"Member Admission Date Member Discharge Date"}, {"90, 119":"Service from date, Service to date"}]
Encounter.length	S	0..1		. Note: Provide information if available
Encounter.reasonCode	S	0..*		. Note: Provide information if available
Encounter.diagnosis		0..*	ExplanationOfBenefit.diagnosis.onAdmission	[{"21, 22, 23, 30, 31":"Diagnosis Code"}, {"28, 29":"Present on admission"}]
Encounter.hospitalization	S	0..1		. Note: Provide information if available
Encounter.hospitalization.dischargeDisposition	S	0..1		Note: Provide information if available
Encounter.location	S	0..*	ExplanationOfBenefit.locationReference	Note: Reference to location where Encounter took place
Encounter.location.location	S	1..1		Note: Reference to location where Encounter took place

​Table Definition

Example Encounter Resource

An example mapping of an Encounter resource is shown here:

{
  "resourceType" : "Encounter",
  "id" : "example-1",
  "meta" : {
    "lastUpdated" : "2017-05-26T11:56:57.250-04:00",
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p>
<<b>id</b>: example-1
<p><b>meta</b>: </p><p><b>status</b>: finished</p><p><b>class</b>: <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode AMB}\">ambulatory</span></p><p><b>type</b>: <span title=\"Codes: {http://www.ama-assn.org/go/cpt 99201}\">Office Visit</span></p><p><b>subject</b>: <a href=\"Patient-example.html\">Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20</a></p><p><b>period</b>: Nov 1, 2015, 10:00:14 PM --> Nov 1, 2015, 11:00:14 PM</p></div>"
  },
  "status" : "finished",
  "class" : {
    "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
    "code" : "AMB",
    "display" : "ambulatory"
  },
  "type" : [
    {
      "coding" : [
        {
          "system" : "http://www.ama-assn.org/go/cpt",
          "code" : "99201"
        }
      ],
      "text" : "Office Visit"
    }
  ],
  "subject" : {
    "reference" : "Patient/example"
  },
  "period" : {
    "start" : "2015-11-01T17:00:14-05:00",
    "end" : "2015-11-01T18:00:14-05:00"
  }
}

Refer to the US Core Additional examples of the US Core 3.1.1 Implementation Guide or US Core 6.1.0 Implementation Guide for further examples of completed Encounter Profiles.

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