Generated Narrative: StructureDefinition IHE.PCC.CDA.Payers.Entry Name Flags Card. Type Description & Constraints Act <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-text-ref-value, should-effectiveTime )">C 1..1 Act XML Namespace: urn:hl7-org:v3 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: should-text-ref-value, should-effectiveTime #xD; Slices for templateId 2..* II Slice: Unordered, Open by value:root, value:extension #xD; templateId:payer-act 1..1 II #xD; @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.26 #xD; templateId:payers-entry 1..1 II #xD; @root 1..1 oid, uuid, ruid Required Pattern: 1.3.6.1.4.1.19376.1.5.3.1.4.18 #xD; @classCode 1..1 cs Fixed Value: ACT #xD; @moodCode 1..1 cs Fixed Value: EVN #xD; id 1..1 II #xD; code S 1..1 CD Binding: ActCoverageTypeCode (preferred) #xD; text #xD; reference <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( value-starts-octothorpe )">C 0..1 TEL Constraints: value-starts-octothorpe #xD; statusCode 1..1 CS #xD; @code 1..1 cs Fixed Value: completed #xD; Slices for performer 1..* Performer2 Slice: Unordered, Open by value:templateId.root #xD; performer:payer 1..1 Performer2 This performer represents the Payer. #xD; @typeCode 1..1 cs #xD; assignedEntity <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-code, should-representedOrganization )">C 1..1 AssignedEntity Constraints: should-code, should-representedOrganization #xD; @classCode S 1..1 cs #xD; id S 1..* II #xD; code 0..1 CE #xD; @nullFlavor 0..0 #xD; @code 1..1 cs Binding: Payer Role Codes (extensible) #xD; addr <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-country )">C 1..1 AD Constraints: should-country #xD; telecom C 0..* TEL Constraints: should-use #xD; @use S 1..* cs #xD; representedOrganization C 0..1 Organization Constraints: should-name #xD; @classCode 1..1 cs #xD; name 1..1 ON #xD; performer:guarantor C 0..* Performer2 This performer represents the Guarantor. Constraints: should-time #xD; @typeCode 1..1 cs #xD; time 0..1 IVL_TS #xD; assignedEntity <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( 4537-8967, should-addr, should-telecom )">C 1..1 AssignedEntity Constraints: 4537-8967, should-addr, should-telecom #xD; code 1..1 CE #xD; @code 1..1 cs Required Pattern: GUAR #xD; @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.110 #xD; addr <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-country )">C 0..1 AD Constraints: should-country #xD; telecom C 0..* TEL Constraints: should-use #xD; @use S 1..* cs #xD; Slices for participant 1..* Participant2 Slice: Unordered, Open by value:typeCode #xD; participant:member C 1..1 Participant2 participant Constraints: should-time #xD; @typeCode 1..1 cs Fixed Value: COV #xD; time <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-low, should-high )">C 0..1 IVL_TS This records the policy coverage period or self-pay period. Constraints: should-low, should-high #xD; low 0..1 IVXB_TS #xD; high 0..1 IVXB_TS SHOULD contain high #xD; participantRole <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-addr, should-playingEntity )">C 1..1 ParticipantRole Constraints: should-addr, should-playingEntity #xD; id S 1..* II #xD; code S<a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-code-attr )">C 1..1 CE Constraints: should-code-attr #xD; @code 0..1 cs Binding: Payer Role Codes (extensible) #xD; addr S<a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-country )">C 1..1 AD Constraints: should-country #xD; telecom C 0..* TEL Constraints: should-use #xD; @use S 1..* cs #xD; playingEntity 0..1 PlayingEntity This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons. #xD; name 1..1 PN #xD; sdtcBirthTime 1..1 TS sdtc:birthTime #xD; participant:subscriber 0..1 Participant2 When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information. #xD; @typeCode 1..1 cs Fixed Value: HLD #xD; time 0..1 IVL_TS #xD; participantRole C 1..1 ParticipantRole Constraints: should-addr #xD; id S 1..1 II #xD; addr <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-country )">C 1..1 AD Constraints: should-country #xD; telecom C 0..* TEL Constraints: should-use #xD; @use S 1..* cs #xD; Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by value:act.moodCode #xD; entryRelationship:plan 0..* EntryRelationship Represents the Coverage Plan #xD; @typeCode 1..1 cs Fixed Value: REFR #xD; act 1..1 Act #xD; @classCode 1..1 cs Fixed Value: ACT #xD; @moodCode 1..1 cs Fixed Value: DEF #xD; id 1..1 II Plan identifier #xD; text 1..1 ED Name of the plan #xD; Documentation for this format
IHE Patient Care Coordination Technical Committee
The payer entry allows information about the patient's sources of payment to be recorded. TBD if more
Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.
If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.
When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question
When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.
An II instance must have either a root or an nullFlavor.
A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.
Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).
Identifies the type as an HL7 Registered model
A character string as a unique identifier within the scope of the identifier root.
When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question
A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.
SHALL contain exactly one [1..1] @classCode="ACT" Act (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4537-8872).
SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:4537-8873).
If the root OID of Payer that assigned the identifier is unknown, a local OID can be assigned or a nullFlavor of UNK
The element should be present, and represents the type of coverage provided by the payer. Potential vocabularies to use include: HL7 ActCoverageType (2.16.840.1.113883.5.4) and X12 Data Element 1336 (2.16.840.1.113883.6.255.1336)
Indicates whether the raw byte data is compressed, and what compression algorithm was used.
The integrity check is a short binary value representing a cryptographically strong checksum that is calculated over the binary data. The purpose of this property, when communicated with a reference is for anyone to validate later whether the reference still resolved to the same data that the reference resolved to when the encapsulated data value with reference was created.
Specifies the algorithm used to compute the integrityCheck value. The cryptographically strong checksum algorithm Secure Hash Algorithm-1 (SHA-1) is currently the industry standard. It has superseded the MD5 algorithm only a couple of years ago, when certain flaws in the security of MD5 were discovered. Currently the SHA-1 hash algorithm is the default choice for the integrity check algorithm. Note that SHA-256 is also entering widespread usage.
For character based information the language property specifies the human language of the text.
Identifies the type of the encapsulated data and identifies a method to interpret or render the data.
Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
Data that is primarily intended for human interpretation or for further machine processing is outside the scope of HL7. This includes unformatted or formatted written language, multimedia data, or structured information as defined by a different standard (e.g., XML-signatures.)
This element is represented in XML as textual content. The actual name "xmlText" will not appear in a CDA instance.
A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.
If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
value.exists() implies value.startsWith('#')
An abbreviated rendition of the full data. A thumbnail requires significantly fewer resources than the full data, while still maintaining some distinctive similarity with the full data. A thumbnail is typically used with by-reference encapsulated data. It allows a user to select data more efficiently before actually downloading through the reference.
The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.
Specifies the code system that defines the code.
If applicable, a version descriptor defined specifically for the given code system.
A name or title for the code, under which the sending system shows the code value to its users.
The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.
The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.
The text or phrase used as the basis for the coding.
Specifies additional codes that increase the specificity of the the primary code.
A set of other concept descriptors that translate this concept descriptor into other code systems.
The <performer> element shall be present to represent the payer of the coverage.
SHALL contain exactly one [1..1] performer (CONF:4537-8906) such that it
SHALL contain exactly one [1..1] assignedEntity (CONF:4537-8908).
This assignedEntity SHOULD contain zero or one [0..1] code (CONF:4537-8914).
Specifies the periods of time during which the telecommunication address can be used. For a telephone number, this can indicate the time of day in which the party can be reached on that telephone. For a web address, it may specify a time range in which the web content is promised to be available under the given address.
One or more codes advising a system or user which telecommunication address in a set of like addresses to select for a given telecommunication need.
This assignedEntity SHOULD contain zero or one [0..1] representedOrganization (CONF:4537-8912).
The representedOrganization, if present, SHOULD contain zero or one [0..1] name (CONF:4537-8913).
This performer represents the Guarantor.
SHOULD contain zero or one [0..1] time (CONF:4537-8963).
SHALL contain exactly one [1..1] assignedEntity (CONF:4537-8962).
**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967).
assignedPerson.name.exists() or representedOrganization.name.exists()
This assignedEntity SHALL contain exactly one [1..1] code (CONF:4537-8968).
This code SHALL contain exactly one [1..1] @code="GUAR" Guarantor (CONF:4537-16096).
This assignedEntity SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:4537-8964).
SHOULD contain zero or one [0..1] participant (CONF:4537-8934) such that it
SHALL contain exactly one [1..1] participant (CONF:4537-8916) such that it
SHALL contain exactly one [1..1] @typeCode="COV" Coverage target (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:4537-8917).
This records the policy coverage period or self-pay period.
SHOULD contain zero or one [0..1] time (CONF:4537-8918).
A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.
A code specifying whether the set component is included (union) or excluded (set-difference) from the set, or other set operations with the current set component and the set as constructed from the representation stream up to the current point.
The time, if present, SHOULD contain zero or one [0..1] low (CONF:4537-8919).
The arithmetic mean of the interval (low plus high divided by 2). The purpose of distinguishing the center as a semantic property is for conversions of intervals from and to point values.
The difference between high and low boundary. The purpose of distinguishing a width property is to handle all cases of incomplete information symmetrically. In any interval representation only two of the three properties high, low, and width need to be stated and the third can be derived.
The time, if present, SHOULD contain zero or one [0..1] high (CONF:4537-8920).
SHALL contain exactly one [1..1] participantRole (CONF:4537-8921).
This participantRole SHALL contain at least one [1..*] id (CONF:4537-8922).
This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
This participantRole SHOULD contain zero or one [0..1] playingEntity (CONF:4537-8932).
The playingEntity, if present, SHALL contain exactly one [1..1] name (CONF:4537-8930).
The purpose of this extension is to allow the recording of the subscriber or member of a health plan in cases where the health plan eligibility system has different information on file than the provider does for the patient.
The playingEntity, if present, SHALL contain exactly one [1..1] sdtc:birthTime (CONF:4537-31344).
When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
SHALL contain exactly one [1..1] @typeCode="HLD" Holder (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:4537-8935).
MAY contain zero or one [0..1] time (CONF:4537-8938).
SHALL contain exactly one [1..1] participantRole (CONF:4537-8936).
This participantRole SHALL contain at least one [1..*] id (CONF:4537-8937).
The entryRelationship.inversionInd can be set to "true" to indicate that the relationship should be interpreted as if the roles of the source and target entries were reversed.
The entryRelationship.contextConductionInd differs from the otherwise common use of this attribute in that in all other cases where this attribute is used, the value is fixed at "true", whereas here the value is defaulted to "true", and can be changed to "false" when referencing an entry in the same document. Setting the context conduction to false when referencing an entry in the same document keeps clear the fact that the referenced object retains its original context.
A description of the coverage plan **SHALL** contain one or more act/id, to represent the plan identifier, and an act/text with the name of the plan (CONF:4537-8943).