| COCT_HD290004UV06 A_BillableClinicalService encounter |
(Link to Excel View) Derived from RMIM: COCT_RM290004UV06 |
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| BillableClinicalService |
Design Comments: Patient classes are not referenced in the billable acts, as they are noted in the parent model (e.g. Invoice message) as the CoveredPartyAsPatient |
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| classCode [1..1] (M) Act (CS) {CNE:V:ActClassRoot, root= "ACT"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:x_ActMoodIntentEvent} |
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| id [0..1] Act (II) |
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| code [1..1] (M) Act (CD) {CWE:D:ActBillableServiceCode} |
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| effectiveTime [1..1] (M) Act (IVL<TS>) |
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| priorityCode [0..*] Act (DSET<CD>) {CWE:D:ActPriority} |
Design Comments: A code or set of codes (e.g., for routine, emergency), specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. Discussion: This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities. |
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| confidentialityCode [0..*] Act (DSET<CD>) {CWE:D:Confidentiality} |
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| repeatNumber [0..1] Act (IVL<INT.NONNEG>) |
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| reasonCode [0..*] Act (DSET<CD>) {CWE:D:ActBillableServiceReason} |
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| subject [0..*] (Subject) | |||||||||
| responsibleParty [0..1] (ResponsibleParty) |
Design Comments: Who is the responsible person (e.g. doctor for a public health nurse) for the service. AKA supervisor. If this is the same as the performer, it need not be specified |
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| secondaryPerformer [0..*] (SecondaryPerformer) |
Design Comments: Assistant to the performer who participated in the delivery of the service. Can specify multiple if it helps these providers submit their own invoices. |
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| performer [0..1] (Performer) |
Design Comments: Primary performer - the Provider who did the service. For clinical services such as an office visit, this is mandatory. For some non-clinical services such as wheelchair repair, then this is required. |
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| location [1..1] (Location) |
Design Comments: The location identifier is used for the Diagnostic Approval Number (facility id) and the Claim Centre Number if required |
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| reason1 [0..*] (Reason2) | |||||||||
| reason2 [0..*] (Reason3) | |||||||||
| subjectOf [0..*] (Subject2) | |||||||||
| componentOf [0..1] (Component1) | |||||||||
| Subject | |||||||||
| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationTargetSubject, root= "SBJ"} |
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| contextControlCode [0..1] Participation (CS) {CNE:V:ContextControl} |
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| patient [1..1] (R_PatientUniversal) | |||||||||
| ResponsibleParty [Constraint: " The responsibleParty shall be played by a ProviderPerson "] |
Design Comments: Who is the responsible person (e.g. doctor for a public health nurse) for the service. AKA supervisor. If this is the same as the performer, it need not be specified |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationResponsibleParty, root= "RESP"} |
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| assignedEntity [1..1] (AssignedEntity) | |||||||||
| SecondaryPerformer |
Design Comments: Assistant to the performer who participated in the delivery of the service. Can specify multiple if it helps these providers submit their own invoices. |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationSecondaryPerformer, root= "SPRF"} |
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| functionCode [0..1] Participation (CD) {CWE:D:ParticipationFunction} |
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| assignedEntity [1..1] (AssignedEntity) | |||||||||
| Performer |
Design Comments: Primary performer - the Provider who did the service. For clinical services such as an office visit, this is mandatory. For some non-clinical services such as wheelchair repair, then this is required. |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationPhysicalPerformer, root= "PRF"} |
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| functionCode [0..1] Participation (CD) {CWE:D:ParticipationFunction} |
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| assignedEntity [1..1] (AssignedEntity) | |||||||||
| AssignedEntity | |||||||||
| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassAssignedEntity, root= "ASSIGNED"} |
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| id [0..*] Role (DSET<II>) |
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| code [0..1] Role (CD) {CWE:D:AssignedRoleType} |
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| assignedProviderPerson [0..1] (ProviderPerson) | |||||||||
| indirectAuthority [0..*] (IndirectAuthorithyOver) | |||||||||
| ProviderPerson | |||||||||
| classCode [1..1] (M) Person (CS) {CNE:V:EntityClassPerson, root= "PSN"} |
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| determinerCode [1..1] (M) Person (CS) {CNE:V:EntityDeterminerSpecific, root= "INSTANCE"} |
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| name [1..1] (M) Person (PN) |
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| IndirectAuthorithyOver | |||||||||
| typeCode [1..1] (M) RoleLink (CS) {CNE:V:RoleLinkHasIndirectAuthorityOver, root= "INDAUTH"} |
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| healthCareProvider [1..1] (HealthCareProvider) | |||||||||
| HealthCareProvider | |||||||||
| classCode [1..1] (M) LicensedEntity (CS) {CNE:V:RoleClassHealthcareProvider, root= "PROV"} |
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| id [0..*] LicensedEntity (DSET<II>) |
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| code [0..1] LicensedEntity (CD) {CWE:D:HealthcareProviderRoleType} |
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| effectiveTime [0..1] LicensedEntity (IVL<TS>) |
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| healthCareProviderPerson [0..1] (ProviderPerson) | |||||||||
| Location |
Design Comments: The location identifier is used for the Diagnostic Approval Number (facility id) and the Claim Centre Number if required |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationTargetLocation, root= "LOC"} |
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| serviceDeliveryLocation [1..1] (R_ServiceDeliveryLocationContact) | |||||||||
| Reason2 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipReason, root= "RSON"} |
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| priorityNumber [0..1] ActRelationship (REAL) |
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| administrativeDiagnosis [1..1] (AdministrativeDiagnosis) | |||||||||
| AdministrativeDiagnosis | |||||||||
| classCode [1..1] (M) Observation (CS) {CNE:V:ActClassObservation, root= "OBS"} |
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| moodCode [1..1] (M) Observation (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| code [1..1] (M) Observation (CD) {CWE:D:ActCode} |
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| text [0..1] Observation (ST) |
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| effectiveTime [0..1] Observation (IVL<TS>) |
Design Comments: May be used to indicate the time or interval of time during which the administrative diagnosis was made. |
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| value [1..1] Observation (CD) {CWE:D:DiagnosisValue} |
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| Reason3 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipReason, root= "RSON"} |
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| sequenceNumber [0..1] ActRelationship (INT.NONNEG) |
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| patientCareProvisionRequest [1..1] (PatientCareProvisionRequest) | |||||||||
| PatientCareProvisionRequest | |||||||||
| classCode [1..1] (M) Act (CS) {CNE:V:ActClassCareProvision, root= "PCPR"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodRequest, root= "RQO"} |
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| id [0..*] Act (DSET<II>) |
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| effectiveTime [0..1] Act (IVL<TS>) |
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| author [0..1] (Author2) |
Design Comments: Referrer. |
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| Author2 |
Design Comments: Referrer. |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationAuthorOriginator, root= "AUT"} |
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| time [0..1] Participation (IVL<TS>) |
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| assignedEntity [1..1] (AssignedEntity) | |||||||||
| Subject2 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipHasSubject, root= "SUBJ"} |
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| billableModifier [1..1] (BillableModifier) |
Design Comments: In the V2 chapter 6 post transactions, procedure and procedure modifiers are sent in two places. The first is an attribute of the financial detail (FT1 segment) and the second is an attribute of the procedure detail (PR1 segment). The attributes in the FT1 segment are used to link to the corresponding procedure detail PR1 segment. Procedure is in FT1;25 and PR1;3 Procedure modifiers are in FT1;26 and PR1;16 (they repeat) |
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| BillableModifier |
Design Comments: In the V2 chapter 6 post transactions, procedure and procedure modifiers are sent in two places. The first is an attribute of the financial detail (FT1 segment) and the second is an attribute of the procedure detail (PR1 segment). The attributes in the FT1 segment are used to link to the corresponding procedure detail PR1 segment. Procedure is in FT1;25 and PR1;3 Procedure modifiers are in FT1;26 and PR1;16 (they repeat) |
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| classCode [1..1] (M) Observation (CS) {CNE:V:ActClassObservation, root= "OBS"} |
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| moodCode [1..1] (M) Observation (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| code [0..1] Observation (CD) {CWE:V:ActBillableModifierCode} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (Codes modifying ActBillableCodes, e.g., CPT Left, Right, which may be incorporated in any resulting Invoice as an InvoiceElement.modiferCode |
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| Component1 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipHasComponent, root= "COMP"} |
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| patientEncounter [1..1] (PatientEncounter) | |||||||||
| PatientEncounter | |||||||||
| classCode [1..1] (M) PatientEncounter (CS) {CNE:V:ActClassEncounter, root= "ENC"} |
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| moodCode [1..1] (M) PatientEncounter (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [0..1] PatientEncounter (II) |
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| code [0..1] PatientEncounter (CD) {CWE:V:ActEncounterCode} |
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| effectiveTime [0..1] PatientEncounter (IVL<TS>) |
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| activityTime [0..1] PatientEncounter (IVL<TS>) |
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| priorityCode [0..1] PatientEncounter (CD) {CWE:V:x_EncounterAdmissionUrgency} |
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| admissionReferralSourceCode [0..1] PatientEncounter (CD) {CWE:D:EncounterReferralSource} |
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| dischargeDispositionCode [0..1] PatientEncounter (CD) {CWE:D:EncounterDischargeDisposition} |
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