PolicyActivity

Policy Activity

draftC-CDA Templates4.0.0logical34 key elements

A policy activity represents the policy or program providing the coverage. The person for whom payment is being provided (i.e., the patient) is the covered party. The subscriber of the policy or program is represented as a participant that is the holder of the coverage. The payer is represented as the performer of the policy activity. Note that the absence of a Policy Activity Act is not confirmation the patient does not have coverage. A Patient's coverage may not have been documented yet or not known to the healthcare provider.

  • Absence of a Policy Activity Act may mean that the patient has no coverage or the healthcare provider may not know it.
  • A self pay payer type MAY be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs.

#### Templates Used Although open templates may contain any valid CDA content, the following templates are specifically called out by this template:

Optional EntryRelationships: AuthorizationActivity

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/cda/us/ccda/StructureDefinition/PolicyActivity
ID
PolicyActivity
Type
Base Definition
Act
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
templateId
1+
:policy-activity1..1
1+
templateId.root
1+
templateId.extension
1+
id
1+
𝗨𝗦𝗖𝗗𝗜: Group Identifier: This is the identifier (sent in the @extension attribute) used to uniquely refer to a specific health insurance plan.
statusCode
1+
statusCode.code
1+
performer
1+
:payer1..1
1+
This performer represents the Payer.
performer.templateId1..1
1+
performer.templateId.root
1+
performer.typeCode
1+
performer.assignedEntity.code.code
1+
performer.templateId1..1
1+
performer.templateId.root
1+
performer.typeCode
1+
performer.assignedEntity.code
1+
performer.assignedEntity.code.code
1+
performer.assignedEntity.code.codeSystem
1+
participant
1+
:coverage-target1..1
1+
participant
participant.templateId1..1
1+
participant.templateId.root
1+
participant.participantRole.id
1+
𝗨𝗦𝗖𝗗𝗜: Member Identifier: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
participant.participantRole.code
1+
𝗨𝗦𝗖𝗗𝗜: Relationship to Subscriber: Records the relationship of a patient to the primary insured person.
participant.participantRole.playingEntity.name1..1
1+
participant.participantRole.playingEntity.sdtcBirthTime
1+
sdtc:birthTime
participant.templateId1..1
1+
participant.templateId.root
1+
participant.participantRole.id
1+
𝗨𝗦𝗖𝗗𝗜: Subscriber Id: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
entryRelationship.act
http://hl7.org/cda/stds/core/StructureDefinition/Act
1+
entryRelationship.act
1+
entryRelationship.act.id
1+
Plan identifier
entryRelationship.act.text
1+
Name of the plan