Dispense Reimbursement Claim - tabular view

No Current Link To VocabularyCoded With ExtensionsCoded No Extensions
PORX_RM142006UK31
ReimbursmentClaim

This is the message sent from the ETP component to the Reimbursement Authority. It consists of various received messages 'wrapped' together and precursored by a reimbursement claim.

Reference: W5 2.4.6.1

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

A code indicating that the ReimbursementClaim 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 globally unique identifier for this instance of a Dispense Reimbursement Claim. 

The Identifier Global datatype flavour is used to carry this information as follows:

  • the root attribute will contain a UUID .
[1..1] effectiveTime (TS)

The date and timestamp of this message.

The date-timestamp must be given with the following precision:

  • YYYYMMDDHHMMSS
[1..1] component1

A link to the component Parent Prescription message for which this claim is being made.

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

Indicates that this is a component.

  • Fixed value: "COMP"
[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] 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] templateId (II)

Identifier used to define the set of allowable types and versions of component Parent Prescription message.

The External Identifier datatype flavour is used to hold this information as follows:

[1..1] abstractParentPrescription (AbstractParentPrescription)

The component Parent Prescription.

[0..1] component2

A link to the component Dispense Claim Information message.

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

Indicates that this is a component.

  • Fixed value: "COMP"
[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] 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] templateId (II)

Identifier used to define the set of allowable types and versions of component Dispense Claim Information message.

The External Identifier datatype flavour is used to hold this information as follows:

  • the root attribute shall contain the value of the OID value referenced in the DispenseClaimMessageType vocabulary
  • the extension attribute shall contain a value from the list of coded identifiers in the DispenseClaimMessageType vocabulary
[1..1] abstractDispenseClaim (AbstractDispenseClaim)

The component Dispense Claim Information message.

[0..1] component4

A link to the component Dispense Notification message.

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

Indicates that this is a component.

  • Fixed value: "COMP"
[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] 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] templateId (II)

Identifier used to define the set of allowable types and versions of component Dispense Notification message.

The External Identifier datatype flavour is used to hold this information as follows:

[1..1] abstractDispenseNotification (AbstractDispenseNotification)

The component Dispense Notification message.

[0..1] component3

A link to the component Dispense Notification with Claim Information message.

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

Indicates that this is a component.

  • Fixed value : "COMP"
[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] 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] templateId (II)

Identifier used to define the set of allowable types and versions of component Dispense Notification with Claim Information message.

The External Identifier datatype flavour is used to hold this information as follows:

[1..1] abstractDispenseNotificationWithClaim (AbstractDispenseNotificationWithClaim)

The component Dispense Notification with Claim Information message.

[1..1] pertinentInformation

A link to information that indicates to the PPA whether or not this message replaces a previously submitted claim.

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

Indicates pertinent information.

  • Fixed value
[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 "tue".

[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] pertinentReplacementInd (ReplacementInd)

The replacement indicator pertinent to this message.

AbstractParentPrescription

Abstract placeholder for a Parent Prescription message payload. 

The placeholder and its contents are never instantiated, but are instead replaced by an actual Parent Prescription message from the following set of allowable types and versions:  

The type and version of the replacement message is indicated by the typeId attribute and must match the value of the templateId of the component link.

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

A code indicating that the Parent Prescription message 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 an 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 act that identifies the payload of the message.

[0..1] typeId (II)

Identifier used to define the set of allowable types and versions of Parent Prescription message.

The External Identifier datatype flavour is used to hold this information as follows:

  • the root attribute shall contain the value of the Type Identifiers OID = 2.16.840.1.113883.2.1.3.2.4.18.7
  • the extension attribute shall contain a type identifier value that is equal to the artifact id of the Parent Prescription message. 
AbstractDispenseClaim

Abstract placeholder for a Dispense Claim message payload. 

The placeholder and its contents are never instantiated, but are instead replaced by an actual Dispense Claim message from the following set of allowable types and versions:  

The type and version of the replacement message is indicated by the typeId attribute and must match the value of the templateId of the component link.

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

A code indicating that the Dispense Claim Information message 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 an 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 act that identifies the payload of the message.

[0..1] typeId (II)

Identifier used to define the set of allowable types and versions of Dispense Claim Information message.

The External Identifier datatype flavour is used to hold this information as follows:

  • the root attribute shall contain the value of the Type Identifiers OID = 2.16.840.1.113883.2.1.3.2.4.18.7
  • the extension attribute shall contain a type identifier value that is equal to the artifact id of the Dispense Claim Information message. 
AbstractDispenseNotification

Abstract placeholder for a Dispense Notification message payload. 

The placeholder and its contents are never instantiated, but are instead replaced by an actual Dispense Notification message from the following set of allowable types and versions:  

The type and version of the replacement message is indicated by the typeId attribute and must match the value of the templateId of the component link.

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

A code indicating that the Dispense Notification message 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 an 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 act that identifies the payload of the message.

[0..1] typeId (II)

Identifier used to define the set of allowable types and versions of Dispense Notification message.

The External Identifier datatype flavour is used to hold this information as follows:

  • the root attribute shall contain the value of the Type Identifiers OID = 2.16.840.1.113883.2.1.3.2.4.18.7
  • the extension attribute shall contain a type identifier value that is equal to the artifact id of the Dispense Notification message. 
AbstractDispenseNotificationWithClaim

Abstract placeholder for a Dispense Notification with Claim Information message payload. 

The placeholder and its contents are never instantiated, but are instead replaced by an actual Dispense Notification With Claim Information message from the following set of allowable types and versions:  

The type and version of the replacement message is indicated by the typeId attribute and must match the value of the templateId of the component link.

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

A code indicating that the Dispense Notification with Claim Information message 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 an 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 act that identifies the payload of the message.

[0..1] typeId (II)

Identifier used to define the set of allowable types and versions of Dispense Notification with Claim message.

The External Identifier datatype flavour is used to hold this information as follows:

  • the root attribute shall contain the value of the Type Identifiers OID = 2.16.840.1.113883.2.1.3.2.4.18.7
  • the extension attribute shall contain a type identifier value that is equal to the artifact id of the Dispense Notification with Claim message. 
ReplacementInd

An indicator of whether or not the message replaces a previously submitted claim.

Used by: ReimbursmentClaim
[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 the information is about a replacement claim.  

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

  • The code attribute will contain the fixed value "RPL" from the list of codes in the PrescriptionAnnotation vocabulary;
  • The codeSystem attribute will contain the OID value referenced in the PrescriptionAnnotation vocabulary.
[1..1] value (BL)

Value indicating whether or not the message replaces a previously submitted claim.

  • "true" => message replaces previously submitted claim
  • "false" => message does not replace previously submitted claim

In this instance the value defaults to "false"