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	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	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	Represents the time period during which the Patient's case was actively being managed.
DiagnosisListEntry	diagnosisList	Pointer to a set of Diagnoses of the Patient's condition that are the subject of the Managed Case.
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).
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.

 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:

Aggregation	None
Alias
Association
Association End
Class	PatientCaseManagement
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	caseId
Name Expression
Namespace	PatientCaseManagement
Opposite
Owner	PatientCaseManagement
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PatientCaseManagement::caseId
Stereotype
Template Parameter
Type	«II» Id
Upper	1
Upper Value	(1)
Visibility	Public

 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:

Aggregation	None
Alias
Association	patientCaseManagement_clinicalInformation
Association End
Class	PatientCaseManagement
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	clinicalInformation
Name Expression
Namespace	PatientCaseManagement
Opposite
Owner	PatientCaseManagement
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PatientCaseManagement::clinicalInformation
Stereotype
Template Parameter
Type	«CIMI_EvaluationResultRecorded» ObservationStatement
Upper	*
Upper Value	(*)
Visibility	Public

 dateRange

Public «IVL_TS» Period dateRange

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

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PatientCaseManagement
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	dateRange
Name Expression
Namespace	PatientCaseManagement
Opposite
Owner	PatientCaseManagement
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PatientCaseManagement::dateRange
Stereotype
Template Parameter
Type	«IVL_TS» Period
Upper	1
Upper Value	(1)
Visibility	Public

 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:

Aggregation	None
Alias
Association	patientCaseManagement_diagnosisList
Association End
Class	PatientCaseManagement
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	diagnosisList
Name Expression
Namespace	PatientCaseManagement
Opposite
Owner	PatientCaseManagement
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PatientCaseManagement::diagnosisList
Stereotype
Template Parameter
Type	DiagnosisListEntry
Upper	*
Upper Value	(*)
Visibility	Public

 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:

Aggregation	None
Alias
Association
Association End
Class	PatientCaseManagement
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	isResidentOfCmsQualifiedFacility
Name Expression
Namespace	PatientCaseManagement
Opposite
Owner	PatientCaseManagement
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PatientCaseManagement::isResidentOfCmsQualifiedFacility
Stereotype
Template Parameter
Type	Boolean
Upper	1
Upper Value	(1)
Visibility	Public

 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:

Aggregation	None
Alias
Association	patientCaseManagement_priorAuthorization
Association End
Class	PatientCaseManagement
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	priorAuthorization
Name Expression
Namespace	PatientCaseManagement
Opposite
Owner	PatientCaseManagement
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::PatientCaseManagement::priorAuthorization
Stereotype
Template Parameter
Type	PriorAuthorization
Upper	*
Upper Value	(*)
Visibility	Public