CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1 flag

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. 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

Official URL: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner Version: 2.1.0
Standards status: Trial-use Computable Name: C4BBPractitioner

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.

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 CPCDS data elements are defined in the data element comments.  The numbers, e.g. (1), following the data element descriptions in the comments correlate to the MapID in the CPCDS Data Dictionary and the Mapping Worksheet as described here.
  • meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest.

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Practitioner C 0..* USCorePractitionerProfile(6.1.0) A person with a formal responsibility in the provisioning of healthcare or related services
This profile also complies with the profile US Core Practitioner Profile (3.1.1)
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
Practitioner-identifier: Practitioner.identifier must include an NPI or a Tax ID
practitioner-meta-profile-version: Practitioner: meta.profile with canonical and major.minor. version required.
... meta SΣ 1..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
.... lastUpdated SΣ 0..1 instant When the resource version last changed
ele-1: All FHIR elements must have a @value or children
.... profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... identifier:NPI SΣC 0..1 Identifier National Provider Identifier
ele-1: All FHIR elements must have a @value or children
us-core-16: NPI must be 10 digits
us-core-17: NPI check digit must be valid (Luhn algorithm check)

Required Pattern: At least the following
..... type 1..1 CodeableConcept Description of identifier
Fixed Value: (complex)
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: NPI
..... system 1..1 uri The namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... identifier:tax SΣ 0..* Identifier Tax ID Number
ele-1: All FHIR elements must have a @value or children

Required Pattern: At least the following
..... type 1..1 CodeableConcept Description of identifier
Fixed Value: (complex)
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: TAX
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.4
... name SΣ 1..* HumanName The name(s) associated with the practitioner
ele-1: All FHIR elements must have a @value or children
.... use ?!Σ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.


ele-1: All FHIR elements must have a @value or children
.... family SΣ 1..1 string Family name (often called 'Surname')
ele-1: All FHIR elements must have a @value or children
... telecom SΣ 0..* ContactPoint A contact detail for the practitioner (that apply to all roles)
ele-1: All FHIR elements must have a @value or children
.... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.


ele-1: All FHIR elements must have a @value or children
.... value SΣ 0..1 string The actual contact point details
ele-1: All FHIR elements must have a @value or children
.... use ?!Σ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.


ele-1: All FHIR elements must have a @value or children
... address SΣ 0..* Address Address(es) of the practitioner
ele-1: All FHIR elements must have a @value or children
.... use ?!Σ 0..1 code home | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


ele-1: All FHIR elements must have a @value or children
Example General: home
.... line SΣ 0..4 string Street name, number, direction & P.O. Box etc.
ele-1: All FHIR elements must have a @value or children
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ 0..1 string Name of city, town etc.
ele-1: All FHIR elements must have a @value or children
Example General: Erewhon
.... state SΣ 0..1 string Sub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.


ele-1: All FHIR elements must have a @value or children
.... postalCode SΣ 0..1 string US Zip Codes
ele-1: All FHIR elements must have a @value or children
Example General: 9132
.... country SΣ 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Practitioner.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
Practitioner.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
Practitioner.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
Practitioner.address.userequiredAddressUse
http://hl7.org/fhir/ValueSet/address-use|4.0.1
from the FHIR Standard
Practitioner.address.stateextensibleUspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state

Constraints

IdGradePath(s)DetailsRequirements
Practitioner-identifiererrorPractitionerPractitioner.identifier must include an NPI or a Tax ID
: identifier.where(type.where(coding.where(code in ('NPI' | 'TAX')).exists()).exists()).exists()
practitioner-meta-profile-versionwarningPractitionerPractitioner: meta.profile with canonical and major.minor. version required.
: meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner|2.1'))

 

Other representations of profile: CSV, Excel, Schematron