PA Reimbursement Rejection Tabular View

PA Reimbursement Rejection - tabular view

No Current Link To Vocabulary

Coded With Extensions

Coded No Extensions

This message is used by the Reimbursement Authority to inform a claimant that a request for a PA Reimbursement has been rejected

Reference: W5-13.4.8.1

Used by:

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

A code indicating that the ReimbursementClaimReject focal act is for payment adjudication

Fixed value: "ADJUD"

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

A code to indicate this is an event.

Fixed value: "EVN"

[1..1] id (II)

UUID identifying this instance of a service request. This identifier is universally unique across all records. It is in the form of a UUID.

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

[1..1] effectiveTime (TS)

Date and time stamp for the PA Reimbursement Rejection message.

[1..1] author

A participation used to provide a link from an act to a role in this case used to convey that the Reimbursement Authority is the author of this message.


[1..1] typeCode (CS {CNE:AUT} ){ Fixed="AUT " }		Indicates that the role is the author of this rejection message. Fixed value: "AUT"

[1..1] participant [CMET: UKCT_MT120401UK02]		NPfIT CMET fulfilling the specific role of an organisation, in this instance the payor organisation (which may be the PPA) to whom the claim is presented. 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.name (Name of organisation)

[1..1] primaryInformationRecipient

A participation used to provide information about the receiver of this rejection message


[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 (UKCT_MT120401UK02)		NPfIT CMET to identify the person to whom this message is addressed. This person was the legal authenticator of the Reimbursement Claim that has been rejected. This information is optional and may be omitted. The following CMET data elements are required and must be provided: Organization.id (Organisation SDS identifier) Organization.name (Name of organisation)

[0..*] pertinentInformation3

A participation used to provide information on the reasons for rejection


[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }		Indicates that this is pertinent information. Fixed value: "PERT"

[1..1] pertinentRejectionReason (RejectionReason)		Indicates that SupplyInstructions are pertinent to SuppliedLineItemQuantity. This information is mandatory

[1..1] pertinentInformation1

An act relationship which provides a link to the PA Notification with Claim Information or PA Notification message for which the claim is being rejected.


[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }		Indicates that this is pertinent information. Fixed value : "PERT"

[1..1] pertinentPANotificationRef (PANotificationRef)		A link to the details of the PA Notification with Claim Information or PA Notification message for which the claim is being rejected.

[1..1] pertinentInformation2

An act relationship which provides a link between this rejection message and the original PANotificationWithClaim or PA ClaimInfo message which has been rejected.


[1..1] typeCode (CS {CNE:PERT} ){ Fixed="PERT " }		Indicates that this is pertinent information. Fixed value : "PERT"

[1..1] pertinentSupplyHeaderRef (SupplyHeaderRef)		A link to the details of the PA Claim message which has been rejected.

RejectionReason

Details of the Reason used to Reject the Reimbursement Claim

Used by: ReimbursementClaimReject

[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 " }

Indicates that this is an event

Fixed value: "EVN"

[1..1] code (CV {CNE:PrescriptionAnnotation} )

Indicates that this is representation of the Rejection Reason.

Fixed value: "RJ"

[0..1] text (ST)

The Reason for Rejecting the Reimbursement Claim.

This information is optional and may be omitted.

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

Coded representation of the Rejection Reason.

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 ReimbursementRejectionReason vocabulary;
The codeSystem attribute will contain the OID value referenced in the ReimbursementRejectionReason vocabulary.

PANotificationRef

Details of the PA Notification with Claim Information or PA Notification message for which the claim is being rejected.

Used by: ReimbursementClaimReject

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

A code indicating that the PANotificationRef is for information purposes only

Fixed value: "INFO"

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

Indicates that this is an event

Fixed value: "EVN"

[1..1] id (II)

The UUID identifying the PA Notification with Claim Information or PA Notification message for which the claim is being rejected.

SupplyHeaderRef

Details of the PANotificationWithClaim Info or PAClaimInfo message which has caused this rejection

Used by: ReimbursementClaimReject

[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 " }

Indicates that this is an event

Fixed value: "EVN"

[1..1] id (II)

The UUID identifying either the PANotificationWithClaimInfo message or the PAClaimInfo message which has caused this rejection.