Template 2.16.840.1.113883.10.20.22.4.61 Policy Activity

2012‑01‑12

Template 2.16.840.1.113883.10.20.22.4.61 - PolicyActivity
Id 2.16.840.1.113883.10.20.22.4.61
Classification cdaentrylevel
Context Parent nodes of template element with id 2.16.840.1.113883.10.20.22.4.61
Label conf‑789
Version valid from 2012‑01‑12 status draft
Description A policy activity represents the policy or program providing the coverage. The person for whom payment is being provided (i.e., the patient) is the covered party. The subscriber of the policy or program is represented as a participant that is the holder the coverage. The payer is represented as the performer of the policy activity.
Used in 1 template:

Id Name as of
2.16.840.1.113883.10.20.22.4.60 CoverageActivity  Coverage Activity 2012‑01‑12
link11 Dependency: 2.16.840.1.113883.10.20.22.2.18 PayersSection  Payers Section 2012‑01‑12
Item DT Card Conf Desc Label
cda:act
conf-789
treetree @classCode
1..1 F ACT
treetree @moodCode
1..1 F EVN
treetree cda:templateId
II 1..1 M conf‑8900
treeblank treetree @root
1..1 F 2.16.840.1.113883.10.20.22.4.61
treetree cda:id
II 1..* M This id is a unique identifier for the policy or program providing the coverage conf‑8901
treetree cda:statusCode
CS 1..1 M conf‑8902
treeblank treetree @code
1..1 F completed
treeblank treetree @codeSystem
1..1 F 2.16.840.1.113883.5.14
treeblank treetree @displayName
1..1 F Completed
treetree cda:code
CE 0..1 R conf‑8903
treeblank treetree cda:code
0..1 R conf‑8904
CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.3221.5.2 flexibility dynamic
alert Error: Cannot find value set "2.16.840.1.113883.3.88.12.3221.5.2"
treetree cda:performer
1..2 M This performer represents the Payer. conf‑8906
treeblank treetree @typeCode
1..1 F PRF
treeblank treetree cda:assignedEntity
1..1 M conf‑8908
treeblank treeblank treetree cda:id
II 1..* M conf‑8909
treeblank treeblank treetree cda:code
CE 0..1 R conf‑8914
treeblank treeblank treeblank treetree cda:code
CE 1..1 M conf‑8915
CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10416 flexibility dynamic
alert Error: Cannot find value set "2.16.840.1.113883.1.11.10416"
treeblank treeblank treetree cda:addr
AD 0..1 O conf‑8910
Schematron assert Role red error
Test cda:streetAddressLine and cda:city and (cda:country!='US' or (cda:country='US' and cda:state and cda:postalCode))
Message
The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
TEL 0..1 O conf‑8911
treeblank treeblank treetree cda:representedOrganization
0..1 R conf‑8912
treeblank treeblank treeblank treetree cda:name
PN 0..1 R conf‑8913
treetree cda:performer
0..1 R This performer represents the Guarantor. conf‑8961
treeblank treetree @code
1..1 F PRF
treeblank treetree @codeSystem
1..1 F 2.16.840.1.113883.5.90
treeblank treetree @displayName
1..1 F Performer
treeblank treetree cda:time
IVL_TS 0..1 R conf‑8963
treeblank treetree cda:assignedEntity
1..1 M conf‑8962
treeblank treeblank treetree cda:code
CE 0..1 R conf‑8968
treeblank treeblank treeblank treetree cda:code
CE 0..1 R conf‑10566
treeblank treeblank treeblank treeblank treetree @code
1..1 F GUAR
treeblank treeblank treeblank treeblank treetree @codeSystem
1..1 F 2.16.840.1.113883.5.111
treeblank treeblank treeblank treeblank treetree @displayName
1..1 F guarantor
treeblank treeblank treetree cda:addr
AD 0..1 R conf‑8964
Schematron assert Role red error
Test cda:streetAddressLine and cda:city and (cda:country!='US' or (cda:country='US' and cda:state and cda:postalCode))
Message
The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
TEL 0..1 R conf‑8965
Schematron assert Role red error
Test cda:assignedEntity[cda:assignedPerson/cda:name | cda:representedOrganization/cda:name]
Message
SHOULD include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name
treetree cda:participant
1..1 M conf‑8916
treeblank treetree @typeCode
1..1 F COV
treeblank treetree cda:time
IVL_TS 0..1 R conf‑8918
treeblank treeblank treetree cda:low
TS 0..1 R conf‑8919
treeblank treeblank treetree cda:high
TS 0..1 R conf‑8920
treeblank treetree cda:participantRole
1..1 M conf‑8921
treeblank treeblank treetree cda:id
II 1..* M This id is a unique identifier for the covered party member. Implementers SHOULD use the same GUID for each instance of a member identifier from the same health plan conf‑8922
treeblank treeblank treetree cda:code
CE 0..1 R conf‑8923
treeblank treeblank treeblank treetree cda:code
CE 1..1 M conf‑8924
CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.18877 flexibility dynamic
alert Error: Cannot find value set "2.16.840.1.113883.1.11.18877"
treeblank treeblank treetree cda:addr
AD 0..1 R conf‑8956
Schematron assert Role red error
Test cda:streetAddressLine and cda:city and (cda:country!='US' or (cda:country='US' and cda:state and cda:postalCode))
Message
The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:playingEntity
0..1 R If the member date of birth as recorded by the health plan differs from the patient date of birth as recorded in the registration/medication summary, then the member date of birth SHALL be recorded in sdwg:birthTime. The prefix sdtc: SHALL be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the birthTime element. conf‑8932
treeblank treeblank treeblank treetree cda:name
PN 1..1 M If the member name as recorded by the health plan differs from the patient name as recorded in the registration/medication summary (e.g., due to marriage or for other reasons), then the member name SHALL be recorded in the name element conf‑8930
treetree cda:participant
0..1 R When the Subscriber is the patient, the participant element describing the subscriber SHALL NOT be present. This information will be recorded instead in the data elements used to record member information conf‑8934
treeblank treetree @typeCode
1..1 F HLD
treeblank treetree cda:time
IVL_TS 0..1 O conf‑8938
treeblank treetree cda:participantRole
1..1 M conf‑8936
treeblank treeblank treetree cda:id
II 1..* M This id is a unique identifier for the subscriber of the coverage conf‑8937
treeblank treeblank treetree cda:addr
AD 0..1 R conf‑8925
Schematron assert Role red error
Test cda:streetAddressLine and cda:city and (cda:country!='US' or (cda:country='US' and cda:state and cda:postalCode))
Message
The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treetree cda:entryRelationship
1..* M The target of a policy activity with act/entryRelationship/@typeCode="REFR" SHALL be an authorization activity (templateId 2.16.840.1.113883.10.20.1.19) OR an act, with act[@classCode="ACT"] and act[@moodCode="DEF"], representing a description of the coverage plan
A description of the coverage plan SHALL contain one or more act/id, to represent the plan identifier, and an act/text with the name of the plan
conf‑8939
treeblank treetree @typeCode
1..1 F REFR