EnrollEligCOB
Class PatientCaseManagement

Case Management, in the context of a health insurer or health plan, is defined as: "A method of managing the provision of health care to members with high-cost medical conditions. The goal is to coordinate the care so as to both improve continuity and quality of care and lower costs." This class contains properties needed to identify a Case for the purposes of managing costs associated with that Case. Therefore claims for Billable Services will cite the Case Id contained herein. Note that a Workers' Compensation Claim is not a single claim as the name implies, but a Case, and is modeled as a sub-type of Case Management.

Attributes
«II» Id caseId caseId

A unique identifier assigned to the Patient's Case.
"Identifies the claim number assigned by Worker’s Compensation Program." - NCPDP Telecommunication (Field 435-DZ, Data Dictionary 201104).

«CIMI_EvaluationResultRecorded» ObservationStatement clinicalInformation clinicalInformation

Pointer to a set of clinical observation that indicate the patient's current condition and justify the services needed to treat the patient.

«IVL_TS» Period dateRange dateRange

Represents the time period during which the Patient's case was actively being managed.

DiagnosisListEntry diagnosisList diagnosisList

Pointer to a set of Diagnoses of the Patient's condition that are the subject of the Managed Case.

Boolean isResidentOfCmsQualifiedFacility isResidentOfCmsQualifiedFacility

"Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit." - NCPDP Telecommunication (Field 997-G2, Data Dictionary 201104).

PriorAuthorization priorAuthorization priorAuthorization

"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.


Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NamePatientCaseManagement
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 caseId
Public «II» Id caseId

A unique identifier assigned to the Patient's Case.
"Identifies the claim number assigned by Worker’s Compensation Program." - NCPDP Telecommunication (Field 435-DZ, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPatientCaseManagement
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamecaseId
Name Expression
NamespacePatientCaseManagement
Opposite
OwnerPatientCaseManagement
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement::caseId
Stereotype
Template Parameter
Type«II» Id
Upper1
Upper Value(1)
VisibilityPublic


 clinicalInformation
Public «CIMI_EvaluationResultRecorded» ObservationStatement clinicalInformation

Pointer to a set of clinical observation that indicate the patient's current condition and justify the services needed to treat the patient.

Constraints:
Properties:

AggregationNone
Alias
AssociationpatientCaseManagement_clinicalInformation
Association End
ClassPatientCaseManagement
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NameclinicalInformation
Name Expression
NamespacePatientCaseManagement
Opposite
OwnerPatientCaseManagement
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement::clinicalInformation
Stereotype
Template Parameter
Type«CIMI_EvaluationResultRecorded» ObservationStatement
Upper*
Upper Value(*)
VisibilityPublic


 dateRange
Public «IVL_TS» Period dateRange

Represents the time period during which the Patient's case was actively being managed.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPatientCaseManagement
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamedateRange
Name Expression
NamespacePatientCaseManagement
Opposite
OwnerPatientCaseManagement
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement::dateRange
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 diagnosisList
Public DiagnosisListEntry diagnosisList

Pointer to a set of Diagnoses of the Patient's condition that are the subject of the Managed Case.

Constraints:
Properties:

AggregationNone
Alias
AssociationpatientCaseManagement_diagnosisList
Association End
ClassPatientCaseManagement
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamediagnosisList
Name Expression
NamespacePatientCaseManagement
Opposite
OwnerPatientCaseManagement
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement::diagnosisList
Stereotype
Template Parameter
TypeDiagnosisListEntry
Upper*
Upper Value(*)
VisibilityPublic


 isResidentOfCmsQualifiedFacility
Public Boolean isResidentOfCmsQualifiedFacility

"Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit." - NCPDP Telecommunication (Field 997-G2, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPatientCaseManagement
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameisResidentOfCmsQualifiedFacility
Name Expression
NamespacePatientCaseManagement
Opposite
OwnerPatientCaseManagement
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement::isResidentOfCmsQualifiedFacility
Stereotype
Template Parameter
TypeBoolean
Upper1
Upper Value(1)
VisibilityPublic


 priorAuthorization
Public PriorAuthorization priorAuthorization

"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.

Constraints:
Properties:

AggregationNone
Alias
AssociationpatientCaseManagement_priorAuthorization
Association End
ClassPatientCaseManagement
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamepriorAuthorization
Name Expression
NamespacePatientCaseManagement
Opposite
OwnerPatientCaseManagement
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PatientCaseManagement::priorAuthorization
Stereotype
Template Parameter
TypePriorAuthorization
Upper*
Upper Value(*)
VisibilityPublic