PS Reimbursement Rejection Tabular View

PS Reimbursement Rejection - tabular view

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Coded With Extensions

Coded No Extensions

This message is used by the Reimbursement Organisation to notify a dispensing contractor that a request for reimbursement for a Protocol Supply has been rejected, giving the reason(s) for the rejection.

Reference: W5-14.4.8.2

Used by:

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

A code indicating that the PS Reimbursement Rejection is concerned with the claim adjudication process

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 PS Reimbursement Rejection message.

[1..1] author

This participation provides a link to the (payor) organisation that has rejected the reimbursement claim.


[1..1] typeCode (CS {CNE:AUT} ){ Fixed="AUT " }		Indicates that the role is the author of the request. 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 was presented to. 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

This participation provides a link to the dispensing organisation (claimant) that submitted the reimbursement claim.


[1..1] typeCode (CS {CNE:PRCP} ){ Fixed="PRCP " }		A code indicating that the dispensing organisation is the primary recipient Fixed value: "PRCP"

[1..1] participant (UKCT_MT120401UK02)		NPfIT CMET fulfilling the specific role of an organisation, in this instance the claiming organisation (which is the dispensing organisation) that presented the reimbursement claim. 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)

[0..*] pertinentInformation3

An act relationship to provide the reason(s) describing why reimbursement cannot be made for the medication item.


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

[1..1] pertinentRejectionReason (RejectionReason)		Indicates that RejectionReason is pertinent to ReimbursementClaimReject. This is information is mandatory, and 1 or more reasons may be provided.

[1..1] pertinentInformation1

An act relationship to identify the original PS Notification with Claim Information or PS 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] pertinentPSNotificationRef (PSNotificationRef)		Indicates that PSNotificationRef is pertinent to ReimbursementClaimReject. This information is mandatory.

[1..1] pertinentInformation2

An act relationship to identify the original PS Notification with Claim Information message or the PS Claim Information message which is being rejected


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

[1..1] pertinentSupplyHeaderRef (SupplyHeaderRef)		Indicates that SupplyHeaderRef is pertinent to ReimbursementClaimReject. This information is mandatory.

RejectionReason

Reason(s) supporting the Reimbursement Claim Rejection. Reference: NPFIT-ETP-PZ-0159-v1.2 Table 12.

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} )

Code representation for prescription charge exemption status.

Fixed value: "RJ"

[0..1] text (ST)

Additional textual (human readbable) information describing why reimbursement cannot be made for this item. This is free-form text that supplements the textual information already provided in the value field.

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

Coded information describing why reimbursement cannot be made for this item.

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.

Supporting textual (human readable) information as to why reimbursement cannot be made for this item, e.g. Dispensing endorsement required.

PSNotificationRef

Details of the original PS Notification with Claim Information or PS 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 PS Reimbursement Rejection 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)

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

In this instance, this is the unique number to identify the original PS Notification with Claim Information or PS Notification message for which the claim is being rejected.

SupplyHeaderRef

Details of the original PS Notification with Claim Information message or the PS Claim Information message that has now been rejected.

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 a request or order for a service.

Fixed value: "RQO" (Request or Order)

[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.

In this instance, this is the unique number to identify the PS Notification with Claim Information or PS Claim Information message.