| COCT_MT780005UV09 A_ProviderContract basic |
Derived from RMIM: COCT_RM780005UV09 and HMD: COCT_HD780005UV09 |
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| ProviderContract |
Design Comments: Provider contract is a standard or negotiated agreement between a payer and a provider for the provision of a benefit, aka "Billing Arrangement". |
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| classCode [1..1] (M) FinancialContract (CS) {CNE:V:ActClassFinancialContract, root= "FCNTRCT"} |
Design Comments: The BillingArrangementContract conveys the financial contract typically between a provider and a payer that is expressed with the classCode FCNTCT in definition mood DEF. |
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| moodCode [1..1] (M) FinancialContract (CS) {CNE:V:ActMoodDefinition, root= "DEF"} |
Design Comments: Conveys the type of billing arrangement contract rather than an executed instance. |
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| id [0..*] FinancialContract (DSET<II>) |
Design Comments: The BillingArangementContract identifier is required to be sent if available to identify the contract. |
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| code [0..1] FinancialContract (CD) {CWE:V:ActBillingArrangementCode} |
Design Comments: The BillingArrangementContract code provides specific information about the type of financial contract with a coded concept from the ActBillingArrangementCode value set, e.g., fee-for-service, capitation, block grant, etc. |
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| text [0..1] FinancialContract (ED) |
Design Comments: Descriptive content about the contract. |
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| effectiveTime [0..1] FinancialContract (IVL<TS>) |
Design Comments: Time during which the BillingArrrangementContract is in effect. |
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| reference [0..*] (Reference3) |
Design Comments: The reference is required 0...*, which means that the application must support a FeeSchedule and a valid message may send no data. |
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| Reference3 |
Design Comments: The reference is required 0...*, which means that the application must support a FeeSchedule and a valid message may send no data. |
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| typeCode [1..1] (M) ActRelationship (CS) {CNE:V:ActRelationshipRefersTo, root= "REFR"} |
Design Comments: The reference REFR ActRelationship associates the ProviderContract with the FeeSchedule expressed with the classCode INVE in definition mode. |
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| feeSchedule [1..1] (FeeSchedule) | |||||||||
| FeeSchedule | |||||||||
| classCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActClassInvoiceElement, root= "INVE"} |
Design Comments: The FeeSchedule expressed with the classCode INVE in definition mode. |
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| moodCode [1..1] (M) InvoiceElement (CS) {CNE:V:ActMoodDefinition, root= "DEF"} |
Design Comments: The FeeSchedule mood conveys that this is the type of fee schedule that would be applied to the associated coverage charge under a particular billing arrangement contract. |
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| id [0..*] InvoiceElement (DSET<II>) |
Design Comments: The FeeSchedule id is required be sent if available to uniquely identify a fee schedule. |
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| code [0..1] InvoiceElement (CD) {CWE:D:ActInvoiceElementCode} |
Design Comments: The FeeSchedule code from the ActInvoiceElementCode value set provides specific information about the type of charges that may be invoiced. |
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| unitQuantity [0..1] InvoiceElement (RTO<PQ,PQ>) |
Design Comments: Use if this is more informative than or impacts the unitQuantity carried in the CoverageCharge. |
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| unitPriceAmt [0..1] InvoiceElement (RTO<MO,PQ>) |
Design Comments: Use if this is more informative than or impacts the unitPriceAMT carried in the CoverageCharge. |
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| netAmt [0..1] InvoiceElement (MO) |
Design Comments: Use if this is more informative than or impacts the netAmt carried in the CoverageCharge. |
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| factorNumber [0..1] InvoiceElement (REAL) |
Design Comments: Use if this is more informative than the factorNumber carried in the CoverageCharge. Represents a multiplier used in determining the overall cost of services delivered and/or goods received. |
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| pointsNumber [0..1] InvoiceElement (REAL) |
Design Comments: Use if this is more informative than the pointsNumber carried in the CoverageCharge. Definition: For charges whose quantity is expressed in 'points', this expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. |
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