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Template Policy activity 2007‑04‑01

Id2.16.840.1.113883.10.20.1.26Effective Date2007‑04‑01
Statuspending Under pre-publication reviewVersion Label
NamePolicyActivityDisplay NamePolicy activity
Description
3.1.2.1.2 Policy Activity

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.

CONF-48: A policy activity (templateId 2.16.840.1.113883.10.20.1.26) SHALL be represented with Act.
CONF-49: The value for “Act / @classCode” in a policy activity SHALL be “ACT” 2.16.840.1.113883.5.6 ActClass STATIC.
CONF-50: The value for “Act / @moodCode” in a policy activity SHALL be “EVN” 2.16.840.1.113883.5.1001 ActMood STATIC.
CONF-51: A policy activity SHALL contain at least one Act / id, which represents the group or contract number related to the insurance policy or program.
CONF-52: A policy activity SHALL contain exactly one Act / statusCode.
CONF-53: The value for “Act / statusCode” in a policy activity SHALL be “completed” 2.16.840.1.113883.5.14 ActStatus STATIC.
CONF-54: A policy activity SHOULD contain zero to one Act / code., which represents the type of coverage.
CONF-55: The value for “Act / code” in a policy activity SHOULD be selected from ValueSet 2.16.840.1.113883.1.11.19832 ActCoverageType DYNAMIC.
CONF-56: A policy activity SHALL contain exactly one Act / performer [@typeCode=”PRF”], representing the payer.
CONF-57: A payer in a policy activity SHALL contain one or more performer / assignedEntity / id, to represent the payer identification number. For pharamacy benefit programs this can be valued using the RxBIN and RxPCN numbers assigned by ANSI and NCPDP respectively. When a nationally recognized payer identification number is available, it would be placed here.
CONF-58: A policy activity SHALL contain exactly one Act / participant [@typeCode=”COV”], representing the covered party.
CONF-59: A covered party in a policy activity SHOULD contain one or more participant / participantRole / id, to represent the patient’s member or subscriber identifier with respect to the payer.
CONF-60: A covered party in a policy activity SHOULD contain exactly one participant / participantRole / code, to represent the reason for coverage (e.g. Self, Family dependent, student).
CONF-61: The value for “participant / participantRole / code” in a policy activity’s covered party MAY be selected from ValueSet 2.16.840.1.113883.1.11.19809 PolicyOrProgramCoverageRoleType DYNAMIC.
CONF-62: A covered party in a policy activity MAY contain exactly one participant / time, to represent the time period over which the patient is covered.
CONF-63: A policy activity MAY contain exactly one Act / participant [@typeCode=”HLD”], representing the subscriber.
CONF-64: A subscriber in a policy activity SHOULD contain one or more participant / participantRole / id, to represent the subscriber’s identifier with respect to the payer.
CONF-65: A subscriber in a policy activity MAY contain exactly one participant / time, to represent the time period for which the subscriber is enrolled.
CONF-66: The value for “Act / entryRelationship / @typeCode” in a policy activity SHALL be “REFR” 2.16.840.1.113883.5.1002 ActRelationshipType STATIC.
CONF-67: 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. CONF-68: A description of the coverage plan SHALL contain one or more Act / Id, to represent the plan identifier.

ContextParent nodes of template element with id 2.16.840.1.113883.10.20.1.26
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 1 transaction and 3 templates, Uses 8 templates
Used by as NameVersion
2.16.840.1.113883.3.1937.777.4.4.1Transactionfinal Continuity of Care Document (CCD) (Release 1.1)2013‑01‑31
2.16.840.1.113883.10.20.1linkpending CCD v1.0 Templates Root2007‑04‑01
2.16.840.1.113883.10.20.1.9linkpending Payers section2007‑04‑01
2.16.840.1.113883.10.20.1.20Containmentpending Coverage activity2007‑04‑01
Uses as NameVersion
2.16.840.1.113883.3.1937.777.4.10.1Containmentpending CCD PersonDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.2Containmentpending CCD OrganizationDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.3Containmentpending CCD Subject (Body)DYNAMIC
2.16.840.1.113883.3.1937.777.4.10.6Containmentpending CCD DeviceDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.10Containmentpending CCD PlayingEntityDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.12Containmentpending CCD Participant (Body)DYNAMIC
2.16.840.1.113883.10.20.1.19Containmentpending Authorization activityDYNAMIC
2.16.840.1.113883.10.20.1.40Containmentpending CommentDYNAMIC
RelationshipSpecialization: template 2.16.840.1.113883.10.12.301 (2005‑09‑07)
Example
Example
<act classCode="ACT" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.20.1.26"/>  <!-- Policy activity template -->
  <id root="3e676a50-7aac-11db-9fe1-0800200c9a66"/>  <code code="EHCPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Extended healthcare"/>  <statusCode code="completed"/>  <performer typeCode="PRF">
    <assignedEntity>
      <id root="329fcdf0-7ab3-11db-9fe1-0800200c9a66"/>      <representedOrganization>
        <name>Good Health Insurance</name>      </representedOrganization>    </assignedEntity>  </performer>  <participant typeCode="COV">
    <participantRole>
      <id root="14d4a520-7aae-11db-9fe1-0800200c9a66"/>      <code code="SELF" domain="RoleCode" displayName="Self"/>    </participantRole>  </participant>  <entryRelationship typeCode="REFR">
    <act classCode="ACT" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.1.19"/>      <!-- Authorization activity template -->
      <id root="f4dce790-8328-11db-9fe1-0800200c9a66"/>      <code nullFlavor="NA"/>      <entryRelationship typeCode="SUBJ">
        <procedure classCode="PROC" moodCode="PRMS">
          <code code="73761001" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>        </procedure>      </entryRelationship>    </act>  </entryRelationship></act>
ItemDTCardConfDescriptionLabel
hl7:act
Polidotsvity
@classCode
cs1 … 1RCONF‑49
 CONF
@classCode shall be "ACT"
@moodCode
cs1 … 1RCONF‑50
 CONF
@moodCode shall be "EVN"
@negationInd
bl0 … 1 
hl7:templateId
II1 … 1MCONF‑48
@root
uid1 … 1F2.16.840.1.113883.10.20.1.26
hl7:id
II1 … *CONF‑51
hl7:code
CD1 … 1MCONF‑54 / CONF‑55
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.19855 ActCoverageTypeCode (DYNAMIC)
hl7:text
ED0 … 1Polidotsvity
hl7:statusCode
CS1 … 1MCONF‑51 / CONF‑52
@code
CONF1 … 1Fcompleted
hl7:effectiveTime
IVL_TS0 … 1Polidotsvity
hl7:priorityCode
CE0 … 1Polidotsvity
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16866 ActPriority (DYNAMIC)
hl7:languageCode
CS0 … 1Polidotsvity
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 HumanLanguage (DYNAMIC)
hl7:subject
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.3 CCD Subject (Body) (DYNAMIC)Polidotsvity
hl7:performer
1 … 1CONF‑56
@typeCode
cs1 … 1FPRF
hl7:time
IVL_TS0 … 1CONF‑56
hl7:modeCode
CE0 … 1CONF‑56
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16543 ParticipationMode (DYNAMIC)
hl7:assignedEntity
1 … 1CONF‑56
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.11595 RoleClassAssignedEntity (DYNAMIC)
hl7:id
II1 … *RCONF‑57
hl7:code
CE0 … 1CONF‑56
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CONF‑56
hl7:telecom
TEL0 … *CONF‑56
hl7:assignedPerson
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CONF‑56
hl7:representedOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CONF‑56
hl7:participant
1 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.12 CCD Participant (Body) (DYNAMIC)CONF‑58
where [@typeCode='COV']
@typeCode
cs1 … 1FCOV
@contextControlCode
cs0 … 1FOP
hl7:time
IVL_TS0 … 1CONF‑62
hl7:awarenessCode
CE0 … 1CONF‑58
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10310 TargetAwareness (DYNAMIC)
hl7:participantRole
1 … 1CONF‑58
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.11555 RoleClass (DYNAMIC)
hl7:id
II1 … *CONF‑59
hl7:code
CE1 … 1CONF-60: A covered party in a policy activity SHOULD contain exactly one participant / participantRole / code, to represent the reason for coverage (e.g. Self, Family dependent, student).
CONF-61: The value for “participant / participantRole / code” in a policy activity’s covered party MAY be selected from ValueSet 2.16.840.1.113883.1.11.19809 PolicyOrProgramCoverageRoleType DYNAMIC. 		CONF‑60 / CONF‑61
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CONF‑58
hl7:telecom
TEL0 … *CONF‑58
Choice0 … 1Elements to choose from:
hl7:playingDevice
Contains 2.16.840.1.113883.3.1937.777.4.10.6 CCD Device (DYNAMIC)CONF‑58
hl7:playingEntity
Contains 2.16.840.1.113883.3.1937.777.4.10.10 CCD PlayingEntity (DYNAMIC)CONF‑58
hl7:scopingEntity
0 … 1CONF‑58
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.10882 EntityClass (DYNAMIC)
@determinerCode
cs0 … 1FINSTANCE
hl7:id
II0 … *CONF‑58
hl7:code
CE0 … 1CONF‑58
 CONF
shall be drawn from concept domain "EntityCode"
hl7:desc
ED0 … 1CONF‑58
hl7:participant
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.12 CCD Participant (Body) (DYNAMIC)CONF‑63
where [@typeCode='HLD']
@typeCode
cs1 … 1FCOV
@contextControlCode
cs0 … 1FOP
hl7:time
IVL_TS0 … 1CONF‑65
hl7:awarenessCode
CE0 … 1CONF‑63
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10310 TargetAwareness (DYNAMIC)
hl7:participantRole
1 … 1CONF‑63
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.11555 RoleClass (DYNAMIC)
hl7:id
II1 … *CONF‑64
hl7:code
CE1 … 1CONF‑63
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CONF‑63
hl7:telecom
TEL0 … *CONF‑63
Choice0 … 1Elements to choose from:
hl7:playingDevice
Contains 2.16.840.1.113883.3.1937.777.4.10.6 CCD Device (DYNAMIC)CONF‑63
hl7:playingEntity
Contains 2.16.840.1.113883.3.1937.777.4.10.10 CCD PlayingEntity (DYNAMIC)CONF‑63
hl7:scopingEntity
0 … 1CONF‑63
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.10882 EntityClass (DYNAMIC)
@determinerCode
cs0 … 1FINSTANCE
hl7:id
II0 … *CONF‑63
hl7:code
CE0 … 1CONF‑63
 CONF
shall be drawn from concept domain "EntityCode"
hl7:desc
ED0 … 1CONF‑63
hl7:entryRelationship
1 … *MContains 2.16.840.1.113883.10.20.1.19 Authorization activity (DYNAMIC)CONF‑66 / CONF‑67
@typeCode
cs1 … 1FREFRCONF‑66
@contextConductionInd
bl0 … 1 
@inversionInd
bl0 … 1 
@negationInd
bl0 … 1 
hl7:sequenceNumber
INT0 … 1CONF‑66 / CONF‑67
hl7:seperatableInd
BL0 … 1CONF‑66 / CONF‑67
hl7:entryRelationship
0 … *Contains 2.16.840.1.113883.10.20.1.40 Comment (DYNAMIC)CONF‑502
@typeCode
cs1 … 1R
 CONF
The value of @typeCode shall be drawn from value set 2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship (DYNAMIC)
@contextConductionInd
bl0 … 1 
@inversionInd
bl0 … 1 
@negationInd
bl0 … 1 
hl7:sequenceNumber
INT0 … 1CONF‑502
hl7:seperatableInd
BL0 … 1CONF‑502