PA Claim Information - tabular view

No Current Link To VocabularyCoded With Extensions
PORX_RM014001UK06
PAClaim

Personal Administration Claim Information Message
Reference: W5-Section 13.4.3.1

Used by:
[1..1] classCode (CS {CNE:INFO} ){ Fixed="INFO " }

A code indicating that the PAClaim focal act is for information purposes only

  • Fixed value: "INFO"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] id (II)

The unique identifier of the target act being referred to.  This shall be a DCE UUID carried in the root attribute of the id element.

This is the unique number of the event that identifies the payload of the message.

[1..1] code (CD {CNE:SnomedCT} )

A code from the SnomedCT UK subset that describes this message as a personal administration event.

The 'Coded with Original Text' datatype flavour should be used. 

[1..1] effectiveTime (TS)

Date and time stamp for the PAClaimInformation message.

[1..1] recordTarget

A link between the Claim and the patient who has received the medication treatment.

[1..1] typeCode (CS {CNE:RCT} ){ Fixed="RCT " }

A code indicating that the patient's records will hold the information relating to this PA Claim

  • Fixed value: "RCT"
[1..1] patient      [CMET: COCT_MT050012UK04]

NPfIT CMET to identify a person fulfilling the specific role for a patient  receiving the medical treatment.

This information is mandatory.

The following CMET data elements are required and must be provided:

Patient.id                                        (NHS Number)
Patient.addr                                    (address)
Person.name                                   (Name)
Person.administrative GenderCode (Gender)
Person.birthTime                            (Birth date - YYYYMMDD)
GPRegisteredWith.id                      (GP SDS identfier)

[1..1] primaryInformationRecipient

An act relationship that associates the Claim to the reimbursement agency that will process the claim. 

[1..1] typeCode (CS {CNE:PRCP} ){ Fixed="PRCP " }

A code indicating that the receiving organisation is the primary recipient

  • Fixed value: "PRCP"
[1..1] participant      [CMET: UKCT_MT120401UK02]

NPfIT CMET fulfilling the specific role of an organisation to which the Reimbursement Claim will be presented, in this instance this will usually be the PPA. Full details of the organisation and role profile are available from SDS.

This information is mandatory.

The following CMET data elements are required and must be provided:

Organization.id           (Organisation SDS identifier)
Organization.code      (Type of organisation)

[0..1] pertinentInformation1

An act relationship that associates this PA Claim with the PA Reimbursement Claim Rejection message that triggered this resubmission.

[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] inversionInd (BL)

An indicator specifying that the ActRelationship.typeCode should be interpreted as if the roles of the source and target Acts were reversed. The inversion indicator is used when the meaning of ActRelationship.typeCode must be reversed.

In this context the contextConductionInd defaults to "false".

[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "false".

[1..1] negationInd (BL)

When "true" allows the sender to specifically state that the relationship does not apply.
In this context the negationInd defaults to "false".

[1..1] seperatableInd (BL)

This attribute indicates whether or not the source Act is intended to be interpreted independently of the target Act.
If the source act is intended to be interpreted independently the value shall be 'true' otherwise the value shall be 'false'.
The value of seperatableInd shall be evaluated for each usage of the pertinentInformation relationship.
In this context the seperatableInd defaults to "true".

[1..1] pertinentPAReimbursementRejectionRef (PAReimbursementRejectionRef)

The PA Reimbursement claim that has been rejected is pertinent to this PA Claim message.

This information is mandatory when the PA Claim message is resent due to reimbursement rejection and should be ommitted otherwise.

[1..1] pertinentInformation2

An act relationship to link the PA Claim focal act to the primary supply header act in the clinical message.

[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "true".

[1..1] pertinentSupplyHeader (SupplyHeader)

Header (identification) details for the original prescription are pertinent to the PA Claim.

This information is mandatory.

PAReimbursementRejectionRef

An act used to carry information about the PA Reimbursement Claim Rejection message that triggered this resubmission.

Used by: PAClaim
[1..1] classCode (CS {CNE:ADJUD} ){ Fixed="ADJUD " }

A code indicating that the PA Reimbursement Claim Rejection is an adjudication

  • Fixed value: "ADJUD" (financial adjudication)
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] id (II)

The unique identifier of the target act being referred to.  This shall be a DCE UUID carried in the root attribute of the id element.

In this instance, this is an identifier of PA Claim Rejection Message.

SupplyHeader

An act used to carry administrative information in relation to the actual PA Claim event.

Used by: PAClaim
[1..1] classCode (CS {CNE:SBADM} ){ Fixed="SBADM " }

A code to indicate introducing or applying a substance to a subject.

  • Fixed value: "SBADM"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] id (II)

The unique identifier of the target act being referred to.  This shall be a DCE UUID carried in the root attribute of the id element.

In this instance, this is the globally unique number that identifies the individual item administration event from the PANotification Message.

[1..1] code (CD {CNE:SnomedCT-Administration} )

A code from the SnomedCT-Administration UK subset that describes this message as a personal administration of medication.

[1..1] legalAuthenticator

A link between the PA Claim and the signatory for authorisation, namely the individual making the claim for the PA event.

[1..1] typeCode (CS {CNE:LA} ){ Fixed="LA " }

A code to indicate legal authenticator

  • Fixed value: "LA"
[1..1] contextControlCode (CS {CNE:OP} ){ Fixed="OP " }

A code that specifies how this Participation contributes to the context of the current Act, and whether it may be propagated to descendent Acts whose association allows such propagation.

The value of contextControlCode should be set appropriately according to the context of the participation being modelled.

  • Default value: "OP" - Overriding and propagating

The default value of "OP" indicates that the association adds to the existing context associated with the Act, and will propagate to any descendant Acts reached by conducting ActRelationships.

In this instance, a code that this professional propagates through to the clinical statements as the claimant unless specifically overriden for individual acts.

[1..1] time (TS)

The date and time that the claimant signed the claim details

[1..1] signatureText (ED)

The electronic signature of the contents to be signed as "legal and true" by the claimant.

The following information is to be included in the digital signature:

  • Reimbursement Organisation Information
  • Administered Medication Claim Information
[1..1] participant      [CMET: UKCT_MT120201UK03]

NPfIT CMET to identify a person fulfilling the specific role of the legal authenticator. Full details of the person and role profile are available from SDS.

This information is mandatory.

The following CMET data elements are required and must be provided in PlayingEntityChoice:

AgentPerson.id          (SDS role profile code)
Person.id                   (SDS identifier)
Person.name              (Name)
Organization.id           (Organisation SDS identifier)
Organization.name      (Name of organisation)
Organization.telecom  (Telephone number of organisation)
Organization.addr       (Address of organisation)

[1..*] pertinentInformation1

An act relationship between the message header and the PA medication items being claimed for.

[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] inversionInd (BL)

An indicator specifying that the ActRelationship.typeCode should be interpreted as if the roles of the source and target Acts were reversed. The inversion indicator is used when the meaning of ActRelationship.typeCode must be reversed.
In this instance, the inversionInd defaults to "false".

[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "true".

[1..1] negationInd (BL)

When "true" allows the sender to specifically state that the relationship does not apply.
In this context the negationInd defaults to "false".

[1..1] seperatableInd (BL)

This attribute indicates whether or not the source Act is intended to be interpreted independently of the target Act.
If the source act is intended to be interpreted independently the value shall be 'true' otherwise the value shall be 'false'.
The value of seperatableInd shall be evaluated for each usage of the pertinentInformation relationship.
In this context the seperatableInd defaults to "false".

[1..1] pertinentSuppliedLineItem (SuppliedLineItem)

A reference stating that each prescription line item for which a claim is being made is pertinent to the overall claim. At least 1 line item must be specified to a maximum limit of 32.

[1..1] pertinentInformation2

An act relationship to provide a link from the actual PA Claim to the original PA Notification.

[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] inversionInd (BL)

An indicator specifying that the ActRelationship.typeCode should be interpreted as if the roles of the source and target Acts were reversed. The inversion indicator is used when the meaning of ActRelationship.typeCode must be reversed.
In this instance, the inversionInd defaults to "false".

[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "false".

[1..1] negationInd (BL)

When "true" allows the sender to specifically state that the relationship does not apply.
In this context the negationInd defaults to "false".

[1..1] seperatableInd (BL)

This attribute indicates whether or not the source Act is intended to be interpreted independently of the target Act.
If the source act is intended to be interpreted independently the value shall be 'true' otherwise the value shall be 'false'.
The value of seperatableInd shall be evaluated for each usage of the pertinentInformation relationship.
In this context the seperatableInd defaults to "true".

[1..1] pertinentSupplyHeaderRef (SupplyHeaderRef)

A participation to indicate that the original personal administration for which the claim is being made is pertinent to actual personal administration that took place.

This information is mandatory..

SuppliedLineItem

This act represents the actual PA line items under claim.

Used by: SupplyHeader
[1..1] classCode (CS {CNE:SBADM} ){ Fixed="SBADM " }

A code to indicate introducing or applying a substance to a subject.

  • Fixed value: "SBADM"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] id (II)

The unique identifier of the target act being referred to.  This shall be a DCE UUID carried in the root attribute of the id element.

[1..1] code (CD {CNE:SnomedCT-Administration} )

A code from the SnomedCT UK subset that describes personal administration of medication.

[1..1] pertinentInformation1

An act relationship to link the PA line item for which a claim is being and the original PA Notification line item.

[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] inversionInd (BL)

An indicator specifying that the ActRelationship.typeCode should be interpreted as if the roles of the source and target Acts were reversed. The inversion indicator is used when the meaning of ActRelationship.typeCode must be reversed.
In this context the negationInd defaults to "false".

[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "true".

[1..1] negationInd (BL)

When "true" allows the sender to specifically state that the relationship does not apply.
In this context the negationInd defaults to "false".

[1..1] seperatableInd (BL)

This attribute indicates whether or not the source Act is intended to be interpreted independently of the target Act.
If the source act is intended to be interpreted independently the value shall be 'true' otherwise the value shall be 'false'.
The value of seperatableInd shall be evaluated for each usage of the pertinentInformation relationship.
In this context the seperatableInd defaults to "false".

[1..1] pertinentSuppliedLineItemRef (SuppliedLineItemRef)

A reference that the original PA line item medication details for which the claim is being made is pertinent to the actual PA medication.

This information is mandatory.

[1..1] pertinentInformation2

An act relationship between PA line item for which a claim is being and the supplied quantity of medication.

[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] inversionInd (BL)

An indicator specifying that the ActRelationship.typeCode should be interpreted as if the roles of the source and target Acts were reversed. The inversion indicator is used when the meaning of ActRelationship.typeCode must be reversed.
In this context the negationInd defaults to "false".

[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "true".

[1..1] negationInd (BL)

When "true" allows the sender to specifically state that the relationship does not apply.
In this context the negationInd defaults to "false".

[1..1] seperatableInd (BL)

This attribute indicates whether or not the source Act is intended to be interpreted independently of the target Act.
If the source act is intended to be interpreted independently the value shall be 'true' otherwise the value shall be 'false'.
The value of seperatableInd shall be evaluated for each usage of the pertinentInformation relationship.
In this context the seperatableInd defaults to "false".

[1..1] pertinentSuppliedLineItemQuantity (SuppliedLineItemQuantity)

A participation that indicates that the supplied quantity of medication is pertinent to the PA line item for which a claim is being made.

This information is mandatory.

SupplyHeaderRef

An act used to carry information the original PA Notification header level information.

Used by: SupplyHeader
[1..1] classCode (CS {CNE:SBADM} ){ Fixed="SBADM " }

A code to indicate introducing or applying a substance to a subject.

  • Fixed value: "SBADM"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] id (II)

The unique identifier of the target act being referred to.  This shall be a DCE UUID carried in the root attribute of the id element.

This is a reference to the original PA event.

SuppliedLineItemRef

An act used to carry the original PA Notification line item level information.

Used by: SuppliedLineItem
[1..1] classCode (CS {CNE:SBADM} ){ Fixed="SBADM " }

A code to indicate introducing or applying a substance to a subject.

  • Fixed value: "SBADM"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] id (II)

The unique identifier of the target act being referred to.  This shall be a DCE UUID carried in the root attribute of the id element.

This is a reference to the original PA line item.

SuppliedLineItemQuantity

Details of the actual medication treatment supplied and administered in this personal administration event.

Used by: SuppliedLineItem
[1..1] classCode (CS {CNE:SPLY} ){ Fixed="SPLY " }

A code to indicate supply.

  • Fixed value: "SPLY"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] code (CD {CNE:SnomedCT-Supply} )

A code from the SnomedCT-Supply UK subset that describes the supply of pharmaceutical products and medical devices.

[1..*] pertinentInformation
A link used to carry information for any endorsements that apply to actual medication quantities dispensed.
[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }

Indicates that this is pertinent information.

  • Fixed value : "PERT"
[1..1] inversionInd (BL)

An indicator specifying that the ActRelationship.typeCode should be interpreted as if the roles of the source and target Acts were reversed. The inversion indicator is used when the meaning of ActRelationship.typeCode must be reversed. In this context the inversionInd defaults to "false".

[1..1] contextConductionInd (BL)

If true, associations in the parent act are conducted across the ActRelationship to the child act.
In this context the contextConductionInd defaults to "true".

[1..1] negationInd (BL)

When "true" allows the sender to specifically state that the relationship does not apply.
In this context the negationInd defaults to "false".

[1..1] seperatableInd (BL)

This attribute indicates whether or not the source Act is intended to be interpreted independently of the target Act.
If the source act is intended to be interpreted independently the value shall be 'true' otherwise the value shall be 'false'.
The value of seperatableInd shall be evaluated for each usage of the pertinentInformation relationship.
In this context the seperatableInd defaults to "false".

[1..1] pertinentDispensingEndorsement (DispensingEndorsement)

A participation that indicates that the dispensing endorsement is pertinent to the supplied quantity of medication.

This information is mandatory.

DispensingEndorsement

Details about the endorsement(s) to support the claim for this medication item. Reference: NPFIT-ETP-PZ-0159-v1.2 Table 4.

Used by: SuppliedLineItemQuantity
[1..1] classCode (CS {CNE:OBS} ){ Fixed="OBS " }

Indicates that this act is an observation

  • Fixed value: "OBS"
[1..1] moodCode (CS {CNE:EVN} ){ Fixed="EVN " }

A code to indicate this is an event.

  • Fixed value: "EVN"
[1..1] code (CV {CNE:PrescriptionAnnotation} )

This act is an observation, this code describes what type of observation it is - it is a prescription annotation, and it has a fixed value to indicate either that the information is about a medication item status.  The value of the status is given in the value attribute. 

  •  Values:  "DE" (Dispensing Endorsement) 
[0..1] text (ST)

Textual (human readable) representation required in support of the reimbursement claim for the medication item.

[1..1] value (CV {CWE:DispensingEndorsement} )

Coded representation of the dispensing endorsement.

The Coded with Code System datatype flavour is used to carry this information as follows:

  • The code attribute will contain a value from the list of codes in the DispensingEndorsement vocabulary;
  • The codeSystem attribute will contain the OID value referenced in the DispensingEndorsement vocabulary.