| COCT_MT680002UV04 A_InvoiceCoordination basic |
Derived from RMIM: COCT_RM680002UV04 and HMD: COCT_HD680002UV04 |
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| AdjudicatedInvoiceElementGroup | |||||||||
| classCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| code [1..1] (M) InvoiceElement (CS) {CNE:V:ActInvoiceGroupCode} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (Invoice Type e.g. Healthcare Services, Rx Dispense, Rx Compound, Healthcare Goods, Preferred Accomodation |
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| statusCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActStatus} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (Completed when done, Suspended if waiting for external) (information, Active if delayed by Adjudicator or the EOB is an estimate |
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| netAmt [1..1] (M) InvoiceElement (MO) |
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| author [0..1] (Author1) | |||||||||
| coverage [0..1] (Coverage) |
Design Comments: Association is required, 1..1 and not mandatory, as EOB may have been generated from a non-HL7 EOB and the Provider s/w will not know the Policy Type to put in the target act. |
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| component [0..*] (Component2) | |||||||||
| Author1 | |||||||||
| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationAuthorOriginator, root= "AUT"} |
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| signatureText [0..1] Participation (ST) |
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| adjudicatorRole [1..1] (AdjudicatorRole) | |||||||||
| AdjudicatorRole | |||||||||
| classCode [1..1] (M) Role (CS) {CNE:V:RoleClassRoot, root= "ROL"} |
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| playingAdjudicatorDevice [1..1] (AdjudicatorDevice) | |||||||||
| AdjudicatorDevice | |||||||||
| classCode [1..1] (M) Device (CS) {CNE:V:EntityClassDevice, root= "DEV"} |
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| determinerCode [1..1] (M) Device (CS) {CNE:V:EntityDeterminerSpecific, root= "INSTANCE"} |
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| softwareName [1..1] (M) Device (SC) {CNE:D:SoftwareName} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (COB Source. Which s/w rules were used to create the COB CMET such as CPhA, NeCST. Use modifier for Invoice or PreDet |
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| Coverage |
Design Comments: Association is required, 1..1 and not mandatory, as EOB may have been generated from a non-HL7 EOB and the Provider s/w will not know the Policy Type to put in the target act. |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipCoveredBy, root= "COVBY"} |
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| sequenceNumber [1..1] (M) ActRelationship (INT.NONNEG) |
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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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| code [1..1] FinancialContract (CS) {CNE:V:ActInsurancePolicyCode} |
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| author [1..1] (Author2) | |||||||||
| Author2 | |||||||||
| 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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| Component2 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipHasComponent, root= "COMP"} |
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| adjudicatedInvoiceElementChoice [1..1] (AdjudicatedInvoiceElementChoice) | |||||||||
| AdjudicatedInvoiceElementChoice | |||||||||
| outcomeOf [0..1] (Outcome) | |||||||||
| choice of AdjudicatedInvoiceElementGroup | |||||||||
| or AdjudicatedInvoiceElementDetail | |||||||||
| Outcome | |||||||||
| 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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| code [1..1] (M) Act (CS) {CNE:V:ActAdjudicationCode} |
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| reference [0..*] (Reference) |
Design Comments: Multiple references to submitted invoice elements provides support for code substitution where the number of submitted fee items is consolidated on the adjudication results (e.g. 3 items to 1) |
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| pertinentInformation [0..*] (PertinentInformation) | |||||||||
| Reference [Constraint: " Each submitted invoice element must have 1 AdjudicationResults instance unless its parent is adjudicated as submitted "] |
Design Comments: Multiple references to submitted invoice elements provides support for code substitution where the number of submitted fee items is consolidated on the adjudication results (e.g. 3 items to 1) |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipRefersTo, root= "REFR"} |
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| invoiceElementChoice [1..1] (InvoiceElementChoice) | |||||||||
| InvoiceElementChoice | |||||||||
| choice of InvoiceElementGroup | |||||||||
| or InvoiceElementDetail | |||||||||
| InvoiceElementGroup | |||||||||
| classCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActMoodIntent} |
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| id [1..*] (M) InvoiceElement (DSET<II>) |
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| code [1..1] (M) InvoiceElement (CS) {CNE:V:ActInvoiceGroupCode} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (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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| component [1..*] (Component1) | |||||||||
| Component1 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipHasComponent, root= "COMP"} |
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| invoiceElementChoice [1..1] (InvoiceElementChoice) | |||||||||
| InvoiceElementDetail | |||||||||
| classCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActMoodIntent} |
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| id [1..*] (M) InvoiceElement (DSET<II>) |
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| code [1..1] (M) InvoiceElement (CD) {CNE:D:ActInvoiceDetailCode} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (Product/Service Code e.g. Office Visit ,Taxes, Markup, Dispense, including Product/Service Code Modifier e.g. northern isolation, off hours specialty, on call |
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| unitQuantity [0..1] InvoiceElement (RTO<PQ,PQ>) |
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| unitPriceAmt [0..1] InvoiceElement (RTO<MO,PQ>) |
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| netAmt [1..1] (M) InvoiceElement (MO) |
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| factorNumber [0..1] InvoiceElement (REAL) |
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| PertinentInformation | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipPertains, root= "PERT"} |
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| adjudicationCodeChoice [1..1] (AdjudicationCodeChoice) | |||||||||
| AdjudicationCodeChoice | |||||||||
| choice of AdjudicationResultReason | |||||||||
| or AdjudicationResultInformation | |||||||||
| AdjudicationResultReason | |||||||||
| 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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| value [1..1] (M) Observation (ED) |
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| AdjudicationResultInformation | |||||||||
| 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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| value [1..1] (M) Observation (ED) |
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| AdjudicatedInvoiceElementDetail | |||||||||
| classCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
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| moodCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| code [1..1] (M) InvoiceElement (CD) {CNE:D:ActInvoiceDetailCode} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (Product/Service Code e.g. Office Visit ,Taxes, Markup, Dispense, including Product/Service Code Modifier e.g. northern isolation, off hours specialty, on call |
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| unitQuantity [1..1] (M) InvoiceElement (RTO<PQ,PQ>) |
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| unitPriceAmt [1..1] (M) InvoiceElement (RTO<MO,PQ>) |
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| netAmt [1..1] (M) InvoiceElement (MO) |
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| factorNumber [0..1] InvoiceElement (REAL) |
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| Inherits associations from AdjudicatedInvoiceElementChoice | |||||||||