DaVinci PDEX Plan Net
1.0.0 - STU1

DaVinci PDEX Plan Net, 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/davinci-pdex-plan-net/ and changes regularly. See the Directory of published versions

Resource Profile: Plan-Net Network

Defining URL:http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network
Version:1.0.0
Name:PlannetNetwork
Title:Plan-Net Network
Status:Active as of 2020-12-20T02:56:54+00:00
Definition:

A Network refers to a healthcare provider insurance network. A healthcare provider insurance network is an aggregation of organizations and individuals that deliver a set of services across a geography through health insurance products/plans. A network is typically owned by a payer.

In the PlanNet IG, individuals and organizations are represented as participants in a PLan-Net Network through the practitionerRole and Plan-Net-organizationAffiliation resources, respectively.

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

The official URL for this profile is:

http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network

Implementation Guidance

  • The Network profile is based on USCore Organization, since there was no contradiction between the USCore profile and the Plan-Net requirements. However, the NPI and CLIA identifier types, which are Must-Support, are clearly intended for provider organizations only and are not expected to be populated for other organization types.
  • The Plan-Net Network and Organization profiles are both based on the Organization profile. To selectively query only Network profiles, search for type = 'ntwk'. To selectively query only Organization profiles, search for type = 'fac,bus,prvgrp,payer,atyprv'.
  • When the contact is a department name, rather than a human (e.g., patient help line), include a blank family and given name, and provide the department name in contact.name.text.
  • Note that the relationship between InsurancePlans and Networks is many-to-many. A plan may be associated with multiple networks, and a network may be associated with many plans. In this IG, this is modeled by having InsurancePlans reference networks (directionality of relationship supports this).
  • To use the location-reference extension to indicate a network coverage area, the preferred form of reference is to create a Location instance with the State or region specified, and possibly provide a GeoJSON.

Formal Views of Profile Content

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

This structure is derived from USCoreOrganizationProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization 0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... meta
.... lastUpdated 1..1instantWhen the resource version last changed
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
.... type S0..1CodeableConceptDescription of identifier
... active 1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type S1..1CodeableConceptKind of organization
Binding: Network Type (required)
... telecom 0..0
... address 0..1AddressAn address for the organization
... partOf S1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-availabletime 0..*(Complex)Extension
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization I0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... id Σ0..1stringLogical id of this artifact
... meta Σ0..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 Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*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..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣI0..*(Slice Definition)Identifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... 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 | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:NPI SΣI0..1IdentifierNational Provider Identifier (NPI)

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)
..... type0..1CodeableConceptDescription of identifier
..... 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:CLIA SΣI0..1IdentifierClinical Laboratory Improvement Amendments (CLIA) Number for laboratories

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)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
..... 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 ?!SΣ1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type SΣ1..1CodeableConceptKind of organization
Binding: Network Type (required)
... name SΣI1..1stringName used for the organization
... alias 0..*stringA list of alternate names that the organization is known as, or was known as in the past
... address SI0..1AddressAn address for the organization
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district Σ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23T00:00:00+11:00","end":"2010-07-01T00:00:00+10:00"}
... partOf SΣ1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... 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
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... contactpoint-availabletime 0..*(Complex)Optional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system SΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization I0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... location-reference 0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
... identifier ΣI0..*(Slice Definition)Identifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ0..1uriThe namespace for the identifier value
..... value Σ0..1stringThe value that is unique
.... identifier:NPI ΣI0..1IdentifierNational Provider Identifier (NPI)

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... identifier:CLIA ΣI0..1IdentifierClinical Laboratory Improvement Amendments (CLIA) Number for laboratories

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
... active ?!Σ1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... name ΣI1..1stringName used for the organization
... address I0..1AddressAn address for the organization
.... line Σ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
.... city Σ0..1stringName of city, town etc.
.... state Σ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode Σ0..1stringUS Zip Codes
.... country Σ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
... partOf Σ1..1Reference(Plan-Net Organization)The organization that manages this network
... contact 0..*BackboneElementContact for the organization for a certain purpose
.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system ΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value Σ0..1stringThe actual contact point details
... endpoint 0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

Differential View

This structure is derived from USCoreOrganizationProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization 0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... meta
.... lastUpdated 1..1instantWhen the resource version last changed
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
.... type S0..1CodeableConceptDescription of identifier
... active 1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type S1..1CodeableConceptKind of organization
Binding: Network Type (required)
... telecom 0..0
... address 0..1AddressAn address for the organization
... partOf S1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-availabletime 0..*(Complex)Extension
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization I0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... id Σ0..1stringLogical id of this artifact
... meta Σ0..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 Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*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..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣI0..*(Slice Definition)Identifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... 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 | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:NPI SΣI0..1IdentifierNational Provider Identifier (NPI)

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)
..... type0..1CodeableConceptDescription of identifier
..... 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:CLIA SΣI0..1IdentifierClinical Laboratory Improvement Amendments (CLIA) Number for laboratories

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)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
..... 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 ?!SΣ1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type SΣ1..1CodeableConceptKind of organization
Binding: Network Type (required)
... name SΣI1..1stringName used for the organization
... alias 0..*stringA list of alternate names that the organization is known as, or was known as in the past
... address SI0..1AddressAn address for the organization
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district Σ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23T00:00:00+11:00","end":"2010-07-01T00:00:00+10:00"}
... partOf SΣ1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... 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
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... contactpoint-availabletime 0..*(Complex)Optional Extensions Element
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system SΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet
Organization.meta.securityextensibleAll Security Labels
Organization.meta.tagexampleCommonTags
Organization.languagepreferredCommonLanguages
Max Binding: AllLanguages
Organization.identifier.userequiredIdentifierUse
Organization.identifier.typeextensibleIdentifier Type Codes
Organization.typerequiredNetworkTypeVS
Organization.address.userequiredAddressUse
Organization.address.typerequiredAddressType
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes
Organization.contact.purposeextensibleContactEntityType
Organization.contact.telecom.systemrequiredContactPointSystem
Organization.contact.telecom.userequiredContactPointUse