| COCT_MT740000UV04 A_BillableOralHealthService universal |
Derived from RMIM: COCT_RM740000UV04 and HMD: COCT_HD740000UV04 |
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| OralHealthService |
Design Comments: "This is what I did" |
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| classCode [1..1] (M) Procedure (CS) {CNE:V:ActClassProcedure, root= "PROC"} |
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| moodCode [1..1] (M) Procedure (CS) {CNE:V:x_ActMoodIntentEvent} |
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| id [1..1] (M) Procedure (II) |
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| code [1..1] (M) Procedure (CS) {CNE:D:ActOralHealthProcedureCode} |
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| effectiveTime [0..1] Procedure (IVL<TS>) |
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| reasonCode [0..5] Procedure (DSET<CS>) {CNE:D:OralH_NotDefined} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (e.g. appliance lost, stolen, very high cavity rate, no flouride in drinking water. |
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| targetSiteCode [0..*] Procedure (DSET<CD>) {CNE:D:OralHealthHumanActSite} |
UsageNotes: ERROR - Business name from Visio is too long and was truncated. Full businessName follows. (International tooth, sextant, quad or arch, modifiers are used to describe tooth surface |
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| responsibleParty [0..1] (ResponsibleParty) |
Design Comments: Who is the responsible person (e.g. dentist for a hygienist) for the service. If this is the same as the performer, it need not be specified |
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| performer [0..1] (Performer) |
Design Comments: Performer is not always present in OH claims. Can be used to indicate hygienist, working under a dentist who is the responsible party. |
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| location [0..*] (Location) | |||||||||
| pertinentInformation1 [0..*] (PertinentInformation1) | |||||||||
| pertinentInformation2 [0..*] (PertinentInformation2) | |||||||||
| referencedBy [0..1] (Reference) | |||||||||
| ResponsibleParty |
Design Comments: Who is the responsible person (e.g. dentist for a hygienist) for the service. 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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| healthCareProvider [1..1] (HealthCareProvider) | |||||||||
| Performer |
Design Comments: Performer is not always present in OH claims. Can be used to indicate hygienist, working under a dentist who is the responsible party. |
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| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationPhysicalPerformer, root= "PRF"} |
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| healthCareProvider [1..1] (HealthCareProvider) |
Design Comments: Provider (e.g. dentist, denturist, oral hygenist) |
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| HealthCareProvider |
Design Comments: Provider (e.g. dentist, denturist, oral hygenist) |
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| 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) {CNE:D:PractitionerCertifiedEntityType} |
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| healthCareProviderPerson [0..1] (ProviderPerson) |
Design Comments: Telecom, addr are only required if provider is not known to the Payor |
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| ProviderPerson [Constraint: " Association/ProviderPerson can only be specified for the Referrer for a non-known Provider (e.g. out of jurisdiction). "] |
Design Comments: Telecom, addr are only required if provider is not known to the Payor |
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| 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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| telecom [0..1] Person (TEL) |
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| addr [0..1] Person (AD) |
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| Location | |||||||||
| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationTargetLocation, root= "LOC"} |
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| serviceDeliveryLocation [1..1] (R_ServiceDeliveryLocationContact) | |||||||||
| PertinentInformation1 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipPertains, root= "PERT"} |
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| oralHealthSubstanceAdministration [1..1] (OralHealthSubstanceAdministration) |
Design Comments: This is a trigger to the adjudicator that an invoice will be submitted for the administration of anesthetic. |
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| OralHealthSubstanceAdministration |
Design Comments: This is a trigger to the adjudicator that an invoice will be submitted for the administration of anesthetic. |
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| classCode [1..1] (M) SubstanceAdministration (CS) {CNE:V:ActClassSubstanceAdministration, root= "SBADM"} |
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| moodCode [1..1] (M) SubstanceAdministration (CS) {CNE:V:ActMoodEventOccurrence, root= "EVN"} |
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| code [0..1] SubstanceAdministration (CD) {CNE:D:ActOralHealthProcedureCode} |
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| reasonCode [0..*] SubstanceAdministration (DSET<CS>) {CNE:D:OralH_NotDefined} |
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| PertinentInformation2 | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipPertains, root= "PERT"} |
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| sequenceNumber [0..1] ActRelationship (INT.NONNEG) |
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| diagnosis [1..1] (Diagnosis) | |||||||||
| Diagnosis | |||||||||
| 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) {CNE:C:ActCode:ObservationDiagnosisTypes, fixed value= "ObservationDiagnosisTypes"} |
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| text [0..1] Observation (ST) |
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| value [1..1] (M) Observation (CD) {CNE:D:DiagnosisValue} |
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| Reference | |||||||||
| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipRefersTo, root= "REFR"} |
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| referral [1..1] (Referral) | |||||||||
| Referral | |||||||||
| 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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| reasonCode [1..1] Act (CS) {CNE:D:Ac_NotDefined} |
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| referrer [0..1] (Referrer) | |||||||||
| Referrer | |||||||||
| typeCode [1..1] (M) Participation (CS) {CNE:V:ParticipationReferrer, root= "REF"} |
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| healthCareProvider [1..1] (HealthCareProvider) | |||||||||