| COCT_HD500000UV04 R_CoveredParty universal |
(Link to Excel View) Derived from RMIM: COCT_RM500000UV04 |
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| CoveredParty |
Design Comments: Covered Person Identifier (Assigned by carrier - root of OID) = Subscriber+Dependents Can be a single covered party, an organization, an animal or a group of patients and/or a group of animals. Covered party may be a patient who for the purposes of the invoice is a covered party. |
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| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassCoveredParty, root= "COVPTY"} |
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| id [1..1] Role (II) |
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| code [0..1] Role (CS) {CNE:V:CoverageRoleType} |
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| effectiveTime [0..1] Role (IVL<TS>) |
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| beneficiaryOf [1..1] (Beneficiary) | |||||||||
| Beneficiary | |||||||||
| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationBeneficiary, root= "BEN"} |
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| sequenceNumber [0..1] Participation (INT.NONNEG) |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (For a specific policy, what order is the covered party when there are multiple covered parties under a policy |
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| policyOrAccount [1..1] (PolicyOrAccount) | |||||||||
| PolicyOrAccount | |||||||||
| classCode [1..1] (M) FinancialContract (CS) {CNE:V:ActClassCoverage, root= "COV"} |
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| moodCode [1..1] (M) FinancialContract (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| id [1..*] FinancialContract (DSET<II>) |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (Can have multiple identifiers for the policy, such as a unique policy id & a concatenation of individual identifiers (e.g. group, section, plan, division, etc. |
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| code [0..1] FinancialContract (CD) {CNE:V:ActInsurancePolicyCode} |
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| statusCode [0..1] FinancialContract (CS) {CNE:V:ActStatus} |
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| effectiveTime [0..1] FinancialContract (IVL<TS>) |
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| holder [0..1] (Holder) | |||||||||
| author [1..1] (Author) |
Design Comments: Insurance carrier for the insurance policy |
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| limitation [0..1] (Limitation) |
Design Comments: What accommodation types are covered by a specific policy? |
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| Holder | |||||||||
| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationHolder, root= "HLD"} |
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| policyHolder [1..1] (PolicyHolder) | |||||||||
| PolicyHolder | |||||||||
| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassPolicyHolder, root= "POLHOLD"} |
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| id [0..1] Role (II) |
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| policyHolderChoice [1..1] (PolicyHolderChoice) | |||||||||
| PolicyHolderChoice | |||||||||
| choice of PolicyHolderPerson | |||||||||
| or PolicyHolderOrganization | |||||||||
| PolicyHolderPerson | |||||||||
| 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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| birthTime [0..1] Person (TS) |
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| asEmployment [0..*] (Employment) | |||||||||
| Employment | |||||||||
| classCode [1..1] (M) Employee (CS) {CNE:V:RoleClassEmployee, root= "EMP"} |
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| id [0..*] Employee (DSET<II>) |
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| employerOrganization [0..1] (EmployerOrganization) | |||||||||
| EmployerOrganization | |||||||||
| classCode [1..1] (M) Organization (CS) {CNE:V:EntityClassOrganization, root= "ORG"} |
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| determinerCode [1..1] (M) Organization (CS) {CNE:V:EntityDeterminerSpecific, root= "INSTANCE"} |
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| name [0..1] Organization (ON) |
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| PolicyHolderOrganization | |||||||||
| classCode [1..1] (M) Organization (CS) {CNE:V:EntityClassOrganization, root= "ORG"} |
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| determinerCode [1..1] (M) Organization (CS) {CNE:V:EntityDeterminerSpecific, root= "INSTANCE"} |
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| name [0..1] Organization (TN) |
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| addr [0..1] Organization (AD) |
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| Author |
Design Comments: Insurance carrier for the insurance policy |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationAuthorOriginator, root= "AUT"} |
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| carrierRole [1..1] (CarrierRole) | |||||||||
| CarrierRole | |||||||||
| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassUnderwriter, root= "UNDWRT"} |
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| id [1..1] (M) Role (II) |
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| underwritingCarrierOrganization [0..1] (CarrierOrganization) | |||||||||
| CarrierOrganization | |||||||||
| classCode [1..1] (M) Organization (CS) {CNE:V:EntityClassOrganization, root= "ORG"} |
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| determinerCode [1..1] (M) Organization (CS) {CNE:V:EntityDeterminerSpecific, root= "INSTANCE"} |
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| name [1..1] (M) Organization (TN) |
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| Limitation |
Design Comments: What accommodation types are covered by a specific policy? |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipLimitedBy, root= "LIMIT"} |
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| accommodationCoverage [1..1] (AccommodationCoverage) | |||||||||
| AccommodationCoverage | |||||||||
| classCode [1..1] (M) Act (CS) {CNE:V:ActClassAccommodation, root= "ACCM"} |
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| moodCode [1..1] (M) Act (CS) {CNE:V:ActMoodDefinition, root= "DEF"} |
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| code [1..1] (M) Act (CS) {CNE:V:ActEncounterAccommodationCode} |
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