source: ccr2ccd-xslt/trunk/make/PayersSectionMedicareTemplate.xml@ 1550

<component>
<section>
<!--We are including only a coverage activity for Medicare here. There is also policy activity and and authorization activity that I don't think we need to report for QRDA, at least not for most reports-->
<templateId root="2.16.840.1.113883.10.20.1.9"/>
<!-- 48768-6 is payment sources and is fixed CQ-188,189,190-->
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
<!--CQ-191,192-->
<title>Payers</title>
<text>
</text>
<!--medicare-->
<entry typeCode="DRIV">
<!--WVP moodCode is DEF is definition to describe the characteristics of who must be involved in an act CQ-194,195-->
<act classCode="ACT" moodCode="DEF">
<!--WVP coverage activity template is the 10.20.1.20 CQ-193-->
<templateId root="2.16.840.1.113883.10.20.1.20"/>
<!--Coverage Shall Include and Act ID CQ-196-->
<!--looks like a UUID to me-->
<id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/><!--FIX!!!???-->
<!--CQ-197-198 It appears that statusCode="completed" need to follow the code code ... here and below-->

<!--CQ199,200-->
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
<statusCode code="completed"/>

<!--A coverage activity shall contain on or more act/entryRelationship. The value for  act/entryRelationship/@typeCode shall be COMP which SHALL be  the CMS QRDA Policy Activity CQ-201, 203-->
<!--It MAY contain an entryRelationship/sequenceNumber CQ-202-->
<entryRelationship typeCode="COMP">
<!--  for the act is event with moodCode EVN  CQ-205,206,207-->
<act classCode="ACT" moodCode="EVN">
<!--Policy activity is the 10.20.1.26 template CQ-205-->
<templateId root="2.16.840.1.113883.10.20.1.26"/>
<templateId root="2.16.840.1.113883.3.249.11.100.7"/>

<!-- act/id which is the group or contract number related to the insurance policy or program CQ-208-->
<id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/><!--!!!FIX-->
<!--Act statusCode must be completed CQ-210-->
<!--This SHOULD be present and comes from the downloadable resource S display name is in quotes AUTOPOL - "automobile" policy;EHCPOL additional insurance in addition to Medicare in this case
HSAPOL "Health Spending Account";PUBLICPOL "public healthcare" which is NOT Medicare - maybe a state program for example
WBCPOL is "workers compensation" CQ-211,212-->
<!--<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>-->
<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
<!--WVP performer type codes are numerous but PRF is performer representing the Payer CQ-213-->
<statusCode code="completed"/>
<performer typeCode="PRF">

<!--performer/assignedEntity id is the payer identification and the extension comes from the downloadable resource section I insurance plan TYPE CQ-214-->
<assignedEntity>
<id root="2.16.840.1.113883.12.86" extension="MC"/>
<!--<representedOrganization>
<name>CMS</name>
</representedOrganization>-->
</assignedEntity>
</performer>
<!-- Act/participant @typeCode this represents the covered party CQ-215-->
<participant typeCode="COV">
<participantRole>
<!--A covered party in a policy activity SHOULD contain one or more participant/participantRole/id to represent the patien's member of subscriber identifier with respect to the payer
For participant/paricipantRole/id either the Social Security Number or HIC Number SHALL be submitted for Medicare patients. for SSN the ID @root SHALL be 2.16.840.1.113883.4.1 where
the HIC id/@root shall be 2.16.840.1.113883.3.249.13 CQ-216"RoleCode" in the downloadable resource-->
<!-- in this case theextension is the patients SSN for a medicare patient so it is the same each time for one patient-->
<id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
<!--The covered party in tha policy activity SHOULD contain exactly one particpant/participantRole/code for self, family etc from the valuse set PolicyOrPrograCoverageRoleType 2.16.840.1.113883.1.11.19809 CQ-217,218-->
<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
</participantRole>
</participant>
</act>
</entryRelationship>
</act>
</entry>
</section>
</component>