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Add prior work from jduteaeu/brettmarquard in new dir, add section/entry #128

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Add prior work from jduteaeu/brettmarquard in new dir, add section/entry
jddamore Jun 6, 2024
1d98d2d
Removing .2 errant on OIDs
jddamore Jun 6, 2024
6ebb63d
Additional human readable content from 6/6 Examples TF dsicussion
jddamore Jun 6, 2024
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184 changes: 184 additions & 0 deletions Payers/Payer Identifiers/Payer_Identifiers.xml
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<section>
<!-- https://confluence.hl7.org/display/SD/Health+Insurance+Information -->
<templateId root="2.16.840.1.113883.10.20.22.2.18" extension="2015-08-01"></templateId>
<templateId root="2.16.840.1.113883.10.20.22.2.18"></templateId>
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payer"></code>
<title>Insurance Providers</title>
<text>
<table>
<thead>
<tr>
<th>Payer / ID</th>
<th>Group ID</th>
<th>Plan Type / ID </th>
<th>Coverage Period</th>
<th>Member's Name / ID</th>
<th>Subscriber's Name / ID</th>
<th>Guarantor</th>
</tr>
</thead>
<tbody>
<tr>
<td ID="payer-1">Good Health Insurance (999999)</td>
<td>XYZ Insurance (330221)</td>
<td>PPO (131)</td>
<td>unknown</td>
<td>Bobby A. Everyman</td>
<td>Robert B. Everyman</td>
<td>Adam Franke Everyman</td>
</tr>
</tbody>
</table>
</text>
<entry>
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.60" extension="2015-08-01" />
<id root="1fe2cdd0-7aad-11db-9fe1-0800200c9a66" />
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment sources" />
<statusCode code="completed" />
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xmlns="urn:hl7-org:v3"
xmlns:sdtc="urn:hl7-org:sdtc">
<templateId root="2.16.840.1.113883.10.20.22.4.61" extension="2015-08-01" />
<!-- Group Identifier - root represents the payer's OID for their group numbers, i.e. Blue Cross, United, etc.; extension represents the actual group identifier -->
<!-- From a practical standpoint, the id records here are not "usable" for defining the id's of the act, discuss with Benjamin Flessner? -->
<id assigningAuthorityName="XYZ Insurance" root="1.1.1.3.4.5" extension="320221" />
<!-- This is the Group # -->

<!-- https://www.tn.gov/content/dam/tn/health/documents/DOR_Manual_2017_P1_1.pdf -->
<code code="PR" displayName="Preferred Provider Organization (PPO)" codeSystemName="Insurance Type Code (x12N-1336)" codeSystem="2.16.840.1.113883.3.88.12.3221.5.2">
<!-- Fixed codeSystem below -->
<translation code="3712" displayName="PPO" codeSystem="2.16.840.1.113883.3.221.5" codeSystemName="Source of Payment Typology (PHDSC)" />
</code>
<statusCode code="completed" />
<!-- Insurance company information -->
<performer typeCode="PRF">
<templateId root="2.16.840.1.113883.10.20.22.4.87" />
<time>
<low nullFlavor="UNK" />
<high nullFlavor="UNK" />
</time>
<assignedEntity>
<!-- Payor Identifier - The root is a KNOWN root/unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority -->
<id assigningAuthorityName="National Association of Insurance Commissioners (NAIC)" root="2.16.840.1.113883.6.300" extension="999999"/>
<!-- Removed HL7 from fix of RoleCode to RoleClass -->
<code code="PAYOR" codeSystem="2.16.840.1.113883.5.110" codeSystemName="RoleClass" displayName="invoice payor" />
<addr use="WP">
<streetAddressLine>123 Insurance Road</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:+(555)555-1515" use="WP" />
<representedOrganization>
<name>Good Health Insurance</name>
<telecom value="tel:+(555)555-1515" use="WP" />
<addr use="WP">
<streetAddressLine>123 Insurance Road</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
<!-- Guarantor information (the person responsible for the final bill) -->
<performer typeCode="PRF">
<templateId root="2.16.840.1.113883.10.20.22.4.88" />
<time>
<low nullFlavor="UNK" />
<high nullFlavor="UNK" />
</time>
<assignedEntity>
<id root="329fcdf0-7ab3-11db-9fe1-0800200c9a66" />
<code code="GUAR" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 RoleCode" />
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+(781)555-1212" use="HP" />
<assignedPerson>
<name>
<prefix>Mr.</prefix>
<given>Adam</given>
<given>Frankie</given>
<family>Everyman</family>
</name>
</assignedPerson>
</assignedEntity>
</performer>
<!-- Covered party -->
<participant typeCode="COV">
<templateId root="2.16.840.1.113883.10.20.22.4.89" />
<time>
<low nullFlavor="UNK" />
<high nullFlavor="UNK" />
</time>
<participantRole classCode="PAT">
<!-- Member Identifier - root represents the payer's OID for member IDs, extension represents the actual member ID -->
<id assigningAuthorityName="XYZ Insurance Covered Member ID #" root="1.1.1.1.1.1.1.1.14" extension="22494935-3" />
<code code="CHILD" codeSystem="2.16.840.1.113883.5.111" displayName="child" />
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<playingEntity>
<name>
<!-- Name is needed if different than the name recorded on the health plan. Birth Date is required if you include this. -->
<given>Bobby</given>
<given>A.</given>
<family>Everyman</family>
</name>
<sdtc:birthTime value="19750501"/>
</playingEntity>
</participantRole>
</participant>
<!-- Policy holder - only present if the holder/subscriber is different from the member, this should not be present if Covered Party role is 'SELF' -->
<participant typeCode="HLD">
<templateId root="2.16.840.1.113883.10.20.22.4.90" />
<participantRole>
<!-- Subscriber Identifier - root represents the payer's OID for subscriber IDs, extension represents the actual subscriber ID -->
<!-- On many insurance plans, the Member ID # is the same subscriber and dependents -->
<id assigningAuthorityName="XYZ Insurance Subscriber ID #" root="1.1.1.1.1.1.1.1.14" extension="22494935-1" />
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<playingEntity>
<name>
<!-- Name is needed if different than the name recorded on the health plan. -->
<given>Robert</given>
<given>B.</given>
<family>Everyman</family>
</name>
</playingEntity>
</participantRole>
</participant>
<!-- typeCode REFR and moodCode DEF mean this is the plan definition -->
<entryRelationship typeCode="REFR">
<act classCode="ACT" moodCode="DEF">
<id assigningAuthorityName="XYZ Insurance" root="2.9.3.4.195" extension="131" />
<!-- This is the Plan id -->
<code nullFlavor="NA"/>
<text>Good Health PPO</text>
</act>
</entryRelationship>
</act>
</entryRelationship>
</act>
</entry>
</section>
39 changes: 39 additions & 0 deletions Payers/Payer Identifiers/Readme.md
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## Approval Status

* Approval Status:
* Example Task Force:
* SDWG:


### C-CDA 2.1 Example:

* Coverage Act 2.16.840.1.113883.10.20.22.4.60:2015-08-01
* Policy Act 2.16.840.1.113883.10.20.22.4.61:2015-08-01

### Reference to full CDA sample:

* TBD

### Validation location

* TBD

### Comments

* This is an example of payer identifier information shown in a payer entry with human readable text. Adapted by John D'Amore / Brett Marquard from original sample proposed by Jean Duteau.

### Custodian

* Jean Duteau [email protected] (Github: jduteau)
* Brett Marquard [email protected] (Github: brettmarquard)
* John D'Amore [email protected] (GitHub: jddamore)

### Keywords

* payer, health plan, insurance

### Permalink


### Links