Da Vinci - Payer Coverage Decision Exchange (PCDE)
1.0.0 - STU 1

Da Vinci - Payer Coverage Decision Exchange (PCDE), published by HL7 International - Financial Management Work Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/davinci-pcde/ and changes regularly. See the Directory of published versions

## Example Bundle: PCDE Document example

Generated Narrative: Composition

Resource Composition "1"

Profile: PCDE Coverage Transition Composition Profile

status: FINAL

type: Coverage Transition Document (PCDE Temporary Codes#pcde)

date: 2019-07-21 11:09:00+0700

author: Practitioner/1

title: Coverage Decision Exchange Document (Joe Smith, 2019-07-21)

### Events

- | Detail
* | Coverage/1

## Active Treatments

### Consulation re: MCI

- CarePlan/1

### Prior coverage

- Claim/1
- ClaimResponse/1

### Supporting information

Joe Smith is a subscriber to Maryland Capital Insurance Company. During a regular physical, Dr. James Gardener, Joe’s primary care physician, diagnosed a potential heart problem, acute myocardial infarction; unspecified site. Dr. Gardener had referred Joe to Dr. Susan Watson, a cardiologist for a consultation. During the consultation examination, Dr. Watson determined that Joe’s diagnosis requires hospitalization and a surgical procedure, a triple bypass venous graft. The operation and recovery was at Montgomery Hospital.

- DocumentReference/1

## Additional Document Content

2. http://originalinsuranceinc.com/fhir/Patient/1 (Patient/1)

> JOE SMITH Male, DoB: ( id: 444222222)

3. http://originalinsuranceinc.com/fhir/Coverage/1 (Coverage/1)

> Generated Narrative: Coverage

> Resource Coverage "1"

> status: ACTIVE

> subscriberId: id: 12345678

> beneficiary: Patient/1

> payor: Organization/1

4. http://originalinsuranceinc.com/fhir/Organization/1 (Organization/1)

> Generated Narrative: Organization

> Resource Organization "1"

> identifier: id: 789312

> active: true

> name: MARYLAND CAPITAL INSURANCE COMPANY

5. http://originalinsuranceinc.com/fhir/CarePlan/1 (CarePlan/1)

> Generated Narrative: CarePlan

> Resource CarePlan "1"

> instantiatesUri: http://originalinsuranceinc.com/consultReviewURI

> status: ACTIVE

> intent: PLAN

> category: Assessment and Plan of Treatment (US Core CarePlan Category Extension Codes#assess-plan)

> subject: Patient/1

6. http://originalinsuranceinc.com/fhir/Claim/1 (Claim/1)

> Generated Narrative: Claim

> Resource Claim "1"

> identifier: id: 111099

> status: ACTIVE

> type: Professional (Claim Type Codes#professional)

> use: PREAUTHORIZATION

> patient: Patient/1

> created: 2019-07-20

> insurer: Organization/1

> provider: http://example.org/fhir/Organization/provider

> priority: Normal (Process Priority Codes#normal)

> ### CareTeams

> - | Sequence | Provider
> * | 1 | http://example.org/fhir/Organization/provider

> ### Diagnoses

> - | Sequence | Diagnosis[x]
> * | 1 | Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

> ### Insurances

> - | Sequence | Focal | Coverage
> * | 1 | true | Coverage/1

> ### Items

> - | Extension | Sequence | CareTeamSequence | DiagnosisSequence | ProductOrService | Location[x]
> * | , , | 1 | 1 | 1 | Consultation (1365#3) | 11 (CMS Place of Service Codes (POS)#11)

7. http://originalinsuranceinc.com/fhir/ClaimResponse/1 (ClaimResponse/1)

> Generated Narrative: ClaimResponse

> Resource ClaimResponse "1"

> identifier: id: 111099

> status: ACTIVE

> type: Professional (Claim Type Codes#professional)

> use: PREAUTHORIZATION

> patient: Patient/1

> created: 2019-07-20

> insurer: Organization/1

> requestor: http://example.org/fhir/Organization/provider

> outcome: COMPLETE

> > item

> > > ReviewAction

> > > value: AUTH0001

> > > value: Certified in total (306#A1)

> > AuthorizedDate: 2005-05-02 --> 2005-06-02

> > itemSequence: 1

> > ### Adjudications

> > - | Category
> > * | Submitted Amount (Adjudication Value Codes#submitted)

8. http://originalinsuranceinc.com/fhir/Practitioner/1 (Practitioner/1)

> Generated Narrative: Practitioner

> Resource Practitioner "1"

> identifier: id: 8189991234

> name: JAMES GARDENER

9. http://originalinsuranceinc.com/fhir/ServiceRequest/1 (ServiceRequest/1)

> Generated Narrative: ServiceRequest

> Resource ServiceRequest "1"

> status: ACTIVE

> intent: ORDER

> code: Consultation (1365#3)

> quantity: 1 VS

> subject: Patient/1

> performer: PractitionerRole/1

10. http://originalinsuranceinc.com/fhir/Condition/1 (Condition/1)

> Generated Narrative: Condition

> Resource Condition "1"

> category: Encounter Diagnosis (Condition Category Codes#encounter-diagnosis)

> code: Acute myocardial infarction of unspecified site, episode of care unspecified (icd-9-cm#410.90)

> subject: Patient/1

> recordedDate: 2005-04-30

11. http://originalinsuranceinc.com/fhir/PractitionerRole/1 (PractitionerRole/1)

> Generated Narrative: PractitionerRole

> Resource PractitionerRole "1"

> practitioner: Practitioner/2

> code: Provider (ENTITY_IDENTIFIER_CODE#1P)

12. http://originalinsuranceinc.com/fhir/Practitioner/2 (Practitioner/2)

> Generated Narrative: Practitioner

> Resource Practitioner "2"

> identifier: id: 987654321

> name: SUSAN WATSON

> telecom: ph: 4029993456

13. http://originalinsuranceinc.com/fhir/DocumentReference/1 (DocumentReference/1)

> Generated Narrative: DocumentReference

> Resource DocumentReference "1"

> status: CURRENT

> docStatus: FINAL

> type: Discharge summary (LOINC#18842-5)

> subject: Patient/1

> author: Practitioner/1

> > content