source: ccr2ccd-xslt/trunk/make/PayersSectionMedicareTemplate.xml@ 1482

Last change on this file since 1482 was 995, checked in by George Lilly, 14 years ago

updates

File size: 4.1 KB
Line 
1<component>
2<section>
3<!--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-->
4<templateId root="2.16.840.1.113883.10.20.1.9"/>
5<!-- 48768-6 is payment sources and is fixed CQ-188,189,190-->
6<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
7<!--CQ-191,192-->
8<title>Payers</title>
9<text>
10</text>
11<!--medicare-->
12<entry typeCode="DRIV">
13<!--WVP moodCode is DEF is definition to describe the characteristics of who must be involved in an act CQ-194,195-->
14<act classCode="ACT" moodCode="DEF">
15<!--WVP coverage activity template is the 10.20.1.20 CQ-193-->
16<templateId root="2.16.840.1.113883.10.20.1.20"/>
17<!--Coverage Shall Include and Act ID CQ-196-->
18<!--looks like a UUID to me-->
19<id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/><!--FIX!!!???-->
20<!--CQ-197-198 It appears that statusCode="completed" need to follow the code code ... here and below-->
21
22<!--CQ199,200-->
23<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
24<statusCode code="completed"/>
25
26<!--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-->
27<!--It MAY contain an entryRelationship/sequenceNumber CQ-202-->
28<entryRelationship typeCode="COMP">
29<!-- for the act is event with moodCode EVN CQ-205,206,207-->
30<act classCode="ACT" moodCode="EVN">
31<!--Policy activity is the 10.20.1.26 template CQ-205-->
32<templateId root="2.16.840.1.113883.10.20.1.26"/>
33<templateId root="2.16.840.1.113883.3.249.11.100.7"/>
34
35<!-- act/id which is the group or contract number related to the insurance policy or program CQ-208-->
36<id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/><!--!!!FIX-->
37<!--Act statusCode must be completed CQ-210-->
38<!--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
39HSAPOL "Health Spending Account";PUBLICPOL "public healthcare" which is NOT Medicare - maybe a state program for example
40WBCPOL is "workers compensation" CQ-211,212-->
41<!--<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>-->
42<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
43<!--WVP performer type codes are numerous but PRF is performer representing the Payer CQ-213-->
44<statusCode code="completed"/>
45<performer typeCode="PRF">
46
47<!--performer/assignedEntity id is the payer identification and the extension comes from the downloadable resource section I insurance plan TYPE CQ-214-->
48<assignedEntity>
49<id root="2.16.840.1.113883.12.86" extension="MC"/>
50<!--<representedOrganization>
51<name>CMS</name>
52</representedOrganization>-->
53</assignedEntity>
54</performer>
55<!-- Act/participant @typeCode this represents the covered party CQ-215-->
56<participant typeCode="COV">
57<participantRole>
58<!--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
59For 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
60the HIC id/@root shall be 2.16.840.1.113883.3.249.13 CQ-216"RoleCode" in the downloadable resource-->
61<!-- in this case theextension is the patients SSN for a medicare patient so it is the same each time for one patient-->
62<id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
63<!--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-->
64<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
65</participantRole>
66</participant>
67</act>
68</entryRelationship>
69</act>
70</entry>
71</section>
72</component>
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