Da Vinci PDex Plan Net
1.2.0 - STU1.2 United States of America flag

Da Vinci PDex Plan Net, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 1.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. 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

Official URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network Version: 1.2.0
Standards status: Trial-use Computable Name: PlannetNetwork

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.

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization C 0..* USCoreOrganizationProfile(7.0.0) A grouping of people or organizations with a common purpose
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
org-1: The organization SHALL at least have a name or an identifier, and possibly more than one
... 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... location-reference S 0..* Reference(Plan-Net Location) Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... 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:All Slices Content/Rules for all slices
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
..... type SΣ 0..1 CodeableConcept Description 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.


ele-1: All FHIR elements must have a @value or children
..... system SΣ 0..1 uri The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... identifier:NPI SΣC 0..* Identifier National Provider Identifier (NPI)
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
..... system 1..1 uri The namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... identifier:CLIA ΣC 0..* Identifier Clinical Laboratory Improvement Amendments (CLIA) Number for laboratories
ele-1: All FHIR elements must have a @value or children
us-core-18: CLIA number must be 10 digits with a letter "D" in third position

Required Pattern: At least the following
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
.... identifier:NAIC ΣC 0..* Identifier NAIC Code
ele-1: All FHIR elements must have a @value or children
us-core-19: NAIC must be 5 digits

Required Pattern: At least the following
..... system 1..1 uri The namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.6.300
... active ?!SΣ 1..1 boolean Whether the organization's record is still in active use
ele-1: All FHIR elements must have a @value or children
Fixed Value: true
... type SΣ 1..1 CodeableConcept Kind of organization
Binding: Network Type VS (required)
ele-1: All FHIR elements must have a @value or children
... name SΣC 1..1 string Name used for the organization
ele-1: All FHIR elements must have a @value or children
... address SC 0..* Address An address for the organization
ele-1: All FHIR elements must have a @value or children
org-2: An address of an organization can never be of use 'home'
.... 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
Example General: 49 MEADOW ST
.... city SΣ 0..1 string Name of city, town etc.
ele-1: All FHIR elements must have a @value or children
Example General: Erewhon
Example General: EVERYTOWN
.... 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
Example General: OK
.... postalCode SΣ 0..1 string US Zip Codes
ele-1: All FHIR elements must have a @value or children
Example General: 9132
Example General: 74047
.... 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
... partOf SΣ 1..1 Reference(Plan-Net Organization) The organization that manages this network
ele-1: All FHIR elements must have a @value or children
... contact S 0..* BackboneElement Contact for the organization for a certain purpose
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... name S 0..1 HumanName A name associated with the contact
ele-1: All FHIR elements must have a @value or children
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
ele-1: All FHIR elements must have a @value or children
..... Slices for extension Content/Rules for all slices
...... contactpoint-availabletime 0..* (Complex) Contactpoint Availabletime
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... 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
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... 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
... endpoint S 0..* Reference(Plan-Net Endpoint) Technical endpoints providing access to services operated for the organization
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Organization.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Organization.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Organization.typerequiredNetworkTypeVS
http://hl7.org/fhir/us/davinci-pdex-plan-net/ValueSet/NetworkTypeVS
from this IG
Organization.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
Organization.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
Organization.address.userequiredAddressUse
http://hl7.org/fhir/ValueSet/address-use|4.0.1
from the FHIR Standard
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes (a valid code from https://www.usps.com/)
http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state
Organization.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
Organization.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
us-core-16errorOrganization.identifier:NPINPI must be 10 digits
: value.matches('^[0-9]{10}$')
us-core-17errorOrganization.identifier:NPINPI check digit must be valid (Luhn algorithm check)
: (((select(value.substring(0,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(1,1).toInteger())+(select(value.substring(2,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(3,1).toInteger())+(select(value.substring(4,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(5,1).toInteger())+(select(value.substring(6,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(7,1).toInteger())+(select(value.substring(8,1).toInteger()).select(iif($this<5, $this*2, (($this*2)-9))))+(value.substring(9,1).toInteger()) + 24)mod 10=0)
us-core-18errorOrganization.identifier:CLIACLIA number must be 10 digits with a letter "D" in third position
: value.matches('^[0-9]{2}D[0-9]{7}$')
us-core-19errorOrganization.identifier:NAICNAIC must be 5 digits
: value.matches('^[0-9]{5}$')

 

Other representations of profile: CSV, Excel, Schematron