| QUCR_HD830100UV01 SOFA Details Query Results |
Description: Entry point for SOFA Details Query Results message (Link to Excel View) Derived from RMIM: QUCR_RM830000UV01 |
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| AdjudResultsGroup [Constraint: " The AdjudResultsGroup.netAmt must equal the sum of all immediate children AdjudResultsGroup.netAmt "] |
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| classCode [1..1] (M) Act (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| code [1..1] (M) Act (CS) {CNE:V:ActInvoiceAdjudicationPaymentCode} |
Design Comments: defines the categorization or summary |
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| effectiveTime [1..1] (M) Act (IVL<TS>) |
Design Comments: Time period for the payment or summary period. Can also indicate time period over which the clawback and/or retro adjustment applies |
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| netAmt [1..1] (M) InvoiceElement (MO) |
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| reference [0..*] (AdjudResultsRef) |
Design Comments: Running Totals (SOFA) are not included in Query Results as they only apply to Adjudication Results at the time the Adjudication Results are created by the Adjudicator. |
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| AdjudResultsRef |
Design Comments: Running Totals (SOFA) are not included in Query Results as they only apply to Adjudication Results at the time the Adjudication Results are created by the Adjudicator. |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipRefersTo, root= "REFR"} |
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| adjudicatedInvoiceElementGroup [1..1] (AdjudicatedInvoiceElementGroup) | |||||||||
| AdjudicatedInvoiceElementGroup | |||||||||
| classCode [1..1] (M) Act (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [1..1] (M) Act (II) |
Design Comments: may include data centre and sequence numbers |
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| code [1..1] (M) Act (CS) {CNE:V:ActInvoiceGroupCode} |
Design Comments: Invoice Type e.g. Healthcare Services, Rx Dispense, Rx Compound, Healthcare Goods, Preferred Accomodation |
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| netAmt [1..1] (M) InvoiceElement (MO) |
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| author [0..1] (AdjudicatedInvoiceAuthor) |
Design Comments: This is used to indicate that the submitted Invoice Grouping was adjudicated (& submitted) electronic or written (manual). This is important for Payment Advices, where it can be used to indicate manually adjudicated Invoice Groupings. |
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| outcomeOf [1..1] (AdjudicatedResultOutcome) | |||||||||
| AdjudicatedInvoiceAuthor |
Design Comments: This is used to indicate that the submitted Invoice Grouping was adjudicated (& submitted) electronic or written (manual). This is important for Payment Advices, where it can be used to indicate manually adjudicated Invoice Groupings. |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationAuthorOriginator, root= "AUT"} |
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| time [1..1] (M) Participation (TS) |
Design Comments: adjudication date/time |
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| modeCode [0..1] Participation (CS) {CNE:D:ParticipationMode, default= "RWR"} |
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| adjudicatorRole [1..1] (AdjudicatorRole) | |||||||||
| AdjudicatorRole | |||||||||
| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassRoot, root= "ROL"} |
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| id [1..1] (M) Role (II) |
Design Comments: Adjudicator Id |
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| AdjudicatedResultOutcome | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipOutcome, root= "OUTC"} |
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| adjudicationResult [1..1] (AdjudicationResult) | |||||||||
| AdjudicationResult | |||||||||
| classCode [1..1] (M) Act (CS) {CNE:V:ActClassFinancialAdjudication, root= "ADJUD"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| reference [1..1] (AdjudicationResultReference) | |||||||||
| AdjudicationResultReference | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipRefersTo, root= "REFR"} |
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| invoiceElementGroup [1..1] (InvoiceElementGroup) |
Design Comments: MoodCode: PRP - auth, pre-det, cov ext RQO - invoice |
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| InvoiceElementGroup |
Design Comments: MoodCode: PRP - auth, pre-det, cov ext RQO - invoice |
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| classCode [1..1] (M) Act (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodRequest, root= "RQO"} |
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| id [1..*] (M) Act (DSET<II>) |
Design Comments: may include data centre and sequence numbers |
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