|
Level
|
Code
|
Display
|
Definition
|
|
1
|
(_AuthorizedParticipationFunction)
Abstract
|
|
This
code
is
used
to
specify
the
exact
function
an
actor
is
authorized
to
have
in
a
service
in
all
necessary
detail.
|
|
2
|
(_AuthorizedReceiverParticipationFunction)
Abstract
|
|
This
code
is
used
to
specify
the
exact
function
an
actor
is
authorized
to
have
as
a
receiver
of
information
that
is
the
subject
of
a
consent
directive
or
consent
override.
|
|
3
|
AUCG
|
caregiver
information
receiver
|
Description:Caregiver
authorized
to
receive
patient
health
information.
|
|
3
|
AULR
|
legitimate
relationship
information
receiver
|
Description:Provider
with
legitimate
relationship
authorized
to
receive
patient
health
information.
|
|
3
|
AUTM
|
care
team
information
receiver
|
Description:Member
of
care
team
authorized
to
receive
patient
health
information.
|
|
3
|
AUWA
|
work
area
information
receiver
|
Description:Entities
within
specified
work
area
authorized
to
receive
patient
health
information.
|
|
2
|
(_ConsenterParticipationFunction)
Abstract
|
|
This
code
is
used
to
specify
the
exact
function
an
actor
is
authorized
to
have
in
authoring
a
consent
directive.
|
|
3
|
GRDCON
|
legal
guardian
consent
author
|
Description:Legal
guardian
of
the
subject
of
consent
authorized
to
author
a
consent
directive
for
the
subject
of
consent.
|
|
3
|
POACON
|
healthcare
power
of
attorney
consent
author
|
Description:Person
authorized
with
healthcare
power
of
attorney
to
author
a
consent
directive
for
the
subject
of
consent.
|
|
3
|
PRCON
|
personal
representative
consent
author
|
Description:Personal
representative
of
the
subject
of
consent
authorized
to
author
a
consent
directive
for
the
subject
of
consent.
|
|
3
|
PROMSK
|
authorized
provider
masking
author
|
Definition:Provider
authorized
to
mask
information
to
protect
the
patient,
a
third
party,
or
to
ensure
that
the
provider
has
consulted
with
the
patient
prior
to
release
of
this
information.
|
|
3
|
SUBCON
|
subject
of
consent
author
|
Description:Subject
of
consent
authorized
to
author
a
consent
directive.
|
|
2
|
(_OverriderParticipationFunction)
Abstract
|
|
This
code
is
used
to
specify
the
exact
function
an
actor
is
authorized
to
have
in
authoring
a
consent
override.
|
|
3
|
AUCOV
|
consent
overrider
|
Description:Entity
authorized
to
override
a
consent
directive.
|
|
3
|
AUEMROV
|
emergency
overrider
|
Description:Entity
authorized
to
override
a
consent
directive
or
privacy
policy
in
an
emergency.
|
|
1
|
(_CoverageParticipationFunction)
Abstract
|
|
Definition:
Set
of
codes
indicating
the
manner
in
which
sponsors,
underwriters,
and
payers
participate
in
a
policy
or
program.
|
|
2
|
(_PayorParticipationFunction)
Abstract
|
|
Definition:
Set
of
codes
indicating
the
manner
in
which
payors
participate
in
a
policy
or
program.</
|
|
3
|
CLMADJ
|
claims
adjudication
|
Definition:
Manages
all
operations
required
to
adjudicate
fee
for
service
claims
or
managed
care
encounter
reports.
|
|
3
|
ENROLL
|
enrollment
broker
|
Definition:
Managing
the
enrollment
of
covered
parties.
|
|
3
|
FFSMGT
|
ffs
management
|
Definition:
Managing
all
operations
required
to
administer
a
fee
for
service
or
indemnity
health
plan
including
enrolling
covered
parties
and
providing
customer
service,
provider
contracting,
claims
payment,
care
management
and
utilization
review.
|
|
3
|
MCMGT
|
managed
care
management
|
Definition:
Managing
all
operations
required
to
administer
a
managed
care
plan
including
enrolling
covered
parties
and
providing
customer
service,,
provider
contracting,
claims
payment,
care
management
and
utilization
review.
|
|
3
|
PROVMGT
|
provider
management
|
Definition:
Managing
provider
contracting,
provider
services,
credentialing,
profiling,
performance
measures,
and
ensuring
network
adequacy.
|
|
3
|
UMGT
|
utilization
management
|
Definition:
Managing
utilization
of
services
by
ensuring
that
providers
adhere
to,
e.g.,
payeraTMs
clinical
protocols
for
medical
appropriateness
and
standards
of
medical
necessity.
May
include
management
of
authorizations
for
services
and
referrals.
|
|
2
|
(_SponsorParticipationFunction)
Abstract
|
|
Definition:
Set
of
codes
indicating
the
manner
in
which
sponsors
participate
in
a
policy
or
program.
NOTE:
use
only
when
the
Sponsor
is
not
further
specified
with
a
SponsorRoleType
as
being
either
a
fully
insured
sponsor
or
a
self
insured
sponsor.
|
|
3
|
FULINRD
|
fully
insured
|
Definition:
Responsibility
taken
by
a
sponsor
to
contract
with
one
or
more
underwriters
for
the
assumption
of
full
responsibility
for
the
risk
and
administration
of
a
policy
or
program.
|
|
3
|
SELFINRD
|
self
insured
|
Definition:
Responsibility
taken
by
a
sponsor
to
organize
the
underwriting
of
risk
and
administration
of
a
policy
or
program.
|
|
2
|
(_UnderwriterParticipationFunction)
Abstract
|
|
Definition:
Set
of
codes
indicating
the
manner
in
which
underwriters
participate
in
a
policy
or
program.
|
|
3
|
PAYORCNTR
|
payor
contracting
|
Definition:
Contracting
for
the
provision
and
administration
of
health
services
to
payors
while
retaining
the
risk
for
coverage.
Contracting
may
be
for
all
provision
and
administration;
or
for
provision
of
certain
types
of
services;
for
provision
of
services
by
region;
and
by
types
of
administration,
e.g.,
claims
adjudication,
enrollment,
provider
management,
and
utilization
management.
Typically
done
by
underwriters
for
sponsors
who
need
coverage
provided
to
covered
parties
in
multiple
regions.
The
underwriter
may
act
as
the
payor
in
some,
but
not
all
of
the
regions
in
which
coverage
is
provided.
|
|
3
|
REINS
|
reinsures
|
Definition:
Underwriting
reinsurance
for
another
underwriter
for
the
policy
or
program.
|
|
3
|
RETROCES
|
retrocessionaires
|
Definition:
Underwriting
reinsurance
for
another
reinsurer.
|
|
3
|
SUBCTRT
|
subcontracting
risk
|
Definition:
Delegating
risk
for
a
policy
or
program
to
one
or
more
subcontracting
underwriters,
e.g.,
a
major
health
insurer
may
delegate
risk
for
provision
of
coverage
under
a
national
health
plan
to
other
underwriters
by
region
.
|
|
3
|
UNDERWRTNG
|
underwriting
|
Definition:
Provision
of
underwriting
analysis
for
another
underwriter
without
assumption
of
risk.
|
|
1
|
ADMPHYS
|
admitting
physician
|
A
physician
who
admitted
a
patient
to
a
hospital
or
other
care
unit
that
is
the
context
of
this
service.
|
|
1
|
ANEST
|
anesthesist
|
In
a
typical
anesthesia
setting
an
anesthesiologist
or
anesthesia
resident
in
charge
of
the
anesthesia
and
life
support,
but
only
a
witness
to
the
surgical
procedure
itself.
To
clarify
responsibilities
anesthesia
should
always
be
represented
as
a
separate
service
related
to
the
surgery.
|
|
1
|
ANRS
|
anesthesia
nurse
|
In
a
typical
anesthesia
setting
the
nurse
principally
assisting
the
anesthesiologist
during
the
critical
periods.
|
|
1
|
ASSEMBLER
|
assembly
software
|
A
device
that
operates
independently
of
an
author
on
custodian's
algorithms
for
data
extraction
of
existing
information
for
purpose
of
generating
a
new
artifact.
UsageConstraint:
ASSEMBLER
ParticipationFunction
should
be
used
with
DEV
(device)
ParticipationType.
|
|
1
|
ATTPHYS
|
attending
physician
|
A
physician
who
is
primarily
responsible
for
a
patient
during
the
hospitalization,
which
is
the
context
of
the
service.
|
|
1
|
COMPOSER
|
composer
software
|
A
device
used
by
an
author
to
record
new
information,
which
may
also
be
used
by
the
author
to
select
existing
information
for
aggregation
with
newly
recorded
information
for
the
purpose
of
generating
a
new
artifact.
UsageConstraint:
COMPOSER
ParticipationFunction
should
be
used
with
DEV
(device)
ParticipationType.
Usage
Note:
This
code
will
enable
implementers
to
more
specifically
represent
the
manner
in
which
a
Device
participated
in
and
facilitated
the
generation
of
a
CDA
Clinical
Document
or
a
CDA
Entry
by
the
responsible
Author,
which
is
comprised
of
the
Author's
newly
entered
content,
and
may
include
the
pre-existing
content
selected
by
the
Author,
for
the
purpose
of
establishing
the
provenance
and
accountability
for
these
acts.
|
|
1
|
DISPHYS
|
discharging
physician
|
A
physician
who
discharged
a
patient
from
a
hospital
or
other
care
unit
that
is
the
context
of
this
service.
|
|
1
|
FASST
|
first
assistant
surgeon
|
In
a
typical
surgery
setting
the
assistant
facing
the
primary
surgeon.
The
first
assistant
performs
parts
of
the
operation
and
assists
in
others
(e.g.,
incision,
approach,
electrocoutering,
ligatures,
sutures).
|
|
1
|
MDWF
|
midwife
|
A
person
(usually
female)
helping
a
woman
deliver
a
baby.
Responsibilities
vary
locally,
ranging
from
a
mere
optional
assistant
to
a
full
required
participant,
responsible
for
(normal)
births
and
pre-
and
post-natal
care
for
both
mother
and
baby.
|
|
1
|
NASST
|
nurse
assistant
|
In
a
typical
surgery
setting
the
non-sterile
nurse
handles
material
supply
from
the
stock,
forwards
specimen
to
pathology,
and
helps
with
other
non-sterile
tasks
(e.g.,
phone
calls,
etc.).
|
|
1
|
PCP
|
primary
care
physician
|
The
healthcare
provider
that
holds
primary
responsibility
for
the
overall
care
of
a
patient.
|
|
1
|
PRISURG
|
primary
surgeon
|
In
a
typical
surgery
setting
the
primary
performing
surgeon.
|
|
1
|
REVIEWER
|
reviewer
|
A
verifier
who
is
accountable
for
reviewing
and
asserting
that
the
verification
of
an
Act
complies
with
jurisdictional
or
organizational
policy.
UsageConstraint:
UsageConstraint:
Specifies
the
exact
function
that
an
actor
is
authorized
to
have
as
a
verifier
of
an
Act.
Connotes
that
a
specialized
verifier
asserts
compliance
for
veracity
of
the
review
per
jurisdictional
or
organizational
policy.
E.g.,
The
Provider
who
takes
responsibility
for
authenticity
of
a
record
submitted
to
a
payer.
REVIEW
ParticipationFunction
should
be
used
with
VFR
(verifier)
|
|
1
|
RNDPHYS
|
rounding
physician
|
A
physician
who
made
rounds
on
a
patient
in
a
hospital
or
other
care
center.
|
|
1
|
SASST
|
second
assistant
surgeon
|
In
a
typical
surgery
setting
the
assistant
who
primarily
holds
the
hooks.
|
|
1
|
SNRS
|
scrub
nurse
|
In
a
typical
surgery
setting
the
nurse
in
charge
of
the
instrumentation.
|
|
1
|
TASST
|
third
assistant
|
In
a
typical
surgery
setting
there
is
rarely
a
third
assistant
(e.g.,
in
some
Hip
operations
the
third
assistant
postures
the
affected
leg).
|
.
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