CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.0.0 - STU1

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 Financial Management Working 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/carin-bb/ and changes regularly. See the Directory of published versions

Resource Profile: C4BB Practitioner

Defining URL:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner
Version:1.0.0
Name:C4BBPractitioner
Title:C4BB Practitioner
Status:Active as of 2020-11-23T16:49:10+00:00
Definition:

This profile builds upon the US Core Practitioner profile. It is used to convey information about the practitioner who provided to the patient services described on the claim.

Publisher:HL7 Financial Management Working Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is:

http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner

Notes on Fields

  • The Practitioner FHIR Resource defines a comprehensive set of data elements.  Many of them are not relevant to this use case.  When reviewing the Profile Snapshot, several data elements previously hidden are now exposed.  Fields intended for consideration to be provided in the API are marked as Must Support; i.e., a red S or have a minimum cardinality of 1.  All other data elements are not expected to be sent by a Responder; if they are sent a Requestor can choose to ignore them
  • Payers may decide to provide either the data that was in effect as of the date of service or the current data.
  • .identifier[NPI], .identifier[tax]: One of these identifiers must be provided
  • .meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last. Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.
  • The numbers, e.g. (1), following the data element descriptions correlate to the MapID in the CPCDS Data Dictionary and the Mapping Worksheet as described here.

Formal Views of Profile Content

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

This structure is derived from USCorePractitionerProfile

Summary

Mandatory: 3 elements
Must-Support: 4 elements

This structure is derived from USCorePractitionerProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*USCorePractitionerProfileA person with a formal responsibility in the provisioning of healthcare or related services
Practitioner-identifier: Practitioner.identifier must include an NPI or a Tax ID
... meta S1..1MetaMetadata about the resource
.... lastUpdated S1..1instantWhen the resource version last changed
.... profile S1..*canonical(StructureDefinition)Profiles this resource claims to conform to
... identifier:NPI 0..1IdentifierAn identifier for the person as this agent
Required Pattern: At least the following
.... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: npi
.... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
... identifier:tax S0..*IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
.... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: TAX
.... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.4
... address 0..*AddressAddress(es) of the practitioner that are not role specific (typically home address)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*USCorePractitionerProfileA person with a formal responsibility in the provisioning of healthcare or related services
Practitioner-identifier: Practitioner.identifier must include an NPI or a Tax ID
... id Σ0..1stringLogical id of this artifact
... meta SΣ1..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile SΣ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..*(Slice Definition)An identifier for the person as this agent
Slice: Unordered, Open by pattern:$this
.... identifier:NPI SΣ0..1IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: npi
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:tax SΣ0..*IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: TAX
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.4
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
... active Σ0..1booleanWhether this practitioner's record is in active use
... name SΣ1..*HumanNameThe name(s) associated with the practitioner
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

.... text Σ0..1stringText representation of the full name
.... family SΣ1..1stringFamily name (often called 'Surname')
.... given Σ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period Σ0..1PeriodTime period when name was/is in use
... telecom Σ0..*ContactPointA contact detail for the practitioner (that apply to all roles)
... address Σ0..*AddressAddress(es) of the practitioner that are not role specific (typically home address)
... gender Σ0..1codemale | female | other | unknown
Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.

... birthDate Σ0..1dateThe date on which the practitioner was born
... photo 0..*AttachmentImage of the person
... qualification 0..*BackboneElementCertification, licenses, or training pertaining to the provision of care
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier 0..*IdentifierAn identifier for this qualification for the practitioner
.... code 1..1CodeableConceptCoded representation of the qualification
Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.

.... period 0..1PeriodPeriod during which the qualification is valid
.... issuer 0..1Reference(Organization)Organization that regulates and issues the qualification
... communication 0..*CodeableConceptA language the practitioner can use in patient communication
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.



doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*USCorePractitionerProfileA person with a formal responsibility in the provisioning of healthcare or related services
Practitioner-identifier: Practitioner.identifier must include an NPI or a Tax ID
... meta Σ1..1MetaMetadata about the resource
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... profile Σ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
... identifier Σ1..*(Slice Definition)An identifier for the person as this agent
Slice: Unordered, Open by pattern:$this
.... identifier:NPI Σ0..1IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: npi
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... identifier:tax Σ0..*IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: TAX
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.4
... name Σ1..*HumanNameThe name(s) associated with the practitioner
.... family Σ1..1stringFamily name (often called 'Surname')

doco Documentation for this format

This structure is derived from USCorePractitionerProfile

Summary

Mandatory: 3 elements
Must-Support: 4 elements

Differential View

This structure is derived from USCorePractitionerProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*USCorePractitionerProfileA person with a formal responsibility in the provisioning of healthcare or related services
Practitioner-identifier: Practitioner.identifier must include an NPI or a Tax ID
... meta S1..1MetaMetadata about the resource
.... lastUpdated S1..1instantWhen the resource version last changed
.... profile S1..*canonical(StructureDefinition)Profiles this resource claims to conform to
... identifier:NPI 0..1IdentifierAn identifier for the person as this agent
Required Pattern: At least the following
.... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: npi
.... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
... identifier:tax S0..*IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
.... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: TAX
.... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.4
... address 0..*AddressAddress(es) of the practitioner that are not role specific (typically home address)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner I0..*USCorePractitionerProfileA person with a formal responsibility in the provisioning of healthcare or related services
Practitioner-identifier: Practitioner.identifier must include an NPI or a Tax ID
... id Σ0..1stringLogical id of this artifact
... meta SΣ1..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile SΣ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..*(Slice Definition)An identifier for the person as this agent
Slice: Unordered, Open by pattern:$this
.... identifier:NPI SΣ0..1IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: npi
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:tax SΣ0..*IdentifierAn identifier for the person as this agent

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: TAX
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.4
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
... active Σ0..1booleanWhether this practitioner's record is in active use
... name SΣ1..*HumanNameThe name(s) associated with the practitioner
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

.... text Σ0..1stringText representation of the full name
.... family SΣ1..1stringFamily name (often called 'Surname')
.... given Σ0..*stringGiven names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
.... prefix Σ0..*stringParts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
.... suffix Σ0..*stringParts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
.... period Σ0..1PeriodTime period when name was/is in use
... telecom Σ0..*ContactPointA contact detail for the practitioner (that apply to all roles)
... address Σ0..*AddressAddress(es) of the practitioner that are not role specific (typically home address)
... gender Σ0..1codemale | female | other | unknown
Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.

... birthDate Σ0..1dateThe date on which the practitioner was born
... photo 0..*AttachmentImage of the person
... qualification 0..*BackboneElementCertification, licenses, or training pertaining to the provision of care
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... identifier 0..*IdentifierAn identifier for this qualification for the practitioner
.... code 1..1CodeableConceptCoded representation of the qualification
Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.

.... period 0..1PeriodPeriod during which the qualification is valid
.... issuer 0..1Reference(Organization)Organization that regulates and issues the qualification
... communication 0..*CodeableConceptA language the practitioner can use in patient communication
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.



doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet
Practitioner.meta.securityextensibleAll Security Labels
Practitioner.meta.tagexampleCommonTags
Practitioner.languagepreferredCommonLanguages
Max Binding: AllLanguages
Practitioner.name.userequiredNameUse
Practitioner.genderrequiredAdministrativeGender
Practitioner.qualification.codeexamplev2.0360.2.7
Practitioner.communicationpreferredCommonLanguages
Max Binding: AllLanguages

Constraints

IdPathDetailsRequirements
Practitioner-identifierPractitionerPractitioner.identifier must include an NPI or a Tax ID
: identifier.where(type.where(coding.where(code in ('npi' | 'TAX')).exists()).exists()).exists()