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| EnrollEligCOB UML Documentation |
EnrollEligCOB
Class DrugProvision
This class represents the billable aspects of a pharmacy dispense. It serves to link the clinical data related to a dispense to the administrative data needed to bill for the dispense. As a sub-type of Billable Service, it inherits all of the data related to billing and Coodination Of Benefits, adds some data elements specifically needed to bill for the pharmacy dispense, and points to the Pharmacy Dispense clinical data for any remaining data needed for billing. Note that this class also points to Professional Service Provision to handle any professional servies charges related to the dispense, such as patient counseling. Note that this class contains some properties that are clearly billing oriented, which are modeled here rather than in Billable Service, because they're only needed for the billing of Drug Provision.
| Attributes |
| «CS» Code |  benefitLimitationOverrideCategory | |
| String | benefitLimitationOverrideId | |
| «CS» Code | billingUnitOfMeasure |
"NCPDP standard product billing codes." - NCPDP Telecommunication (Field 600-28, Data Dictionary 201104). Possible values include: Each; Grams; Milliliters.
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| «CS» Code | claimDelayReason |
"Code to specify the reason that submission of the transactions has been delayed." - NCPDP Telecommunication (Field 357-NV, Data Dictionary 201104). Possible values include: Proof of eligibility unknown or unavailable; Litigation; Authorization delays; Delay in certifying provider; Delay in supplying billing forms; Delay in delivery of custom-made appliances; Third party processing delay; Delay in eligibility determination; Original claims rejected or denied due to a reason unrelated to the billing limitation rules; Administration delay in the prior approval process; Received late with no exceptions; Substantial damage by fire, etc to provider records; Theft, sabotage/other willful acts by employee; Other.
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| «CS» Code | intermediaryAuthorizationCategory |
This property, in conjunction with intermediaryAuthorizationId, is used to inform an intermediary (i.e., a switch) to override edit(s) that they normally perform on the claim due to some special circumstance, which has been pre-arranged with the intermediary or the Payer."Value indicating that authorization occurred for intermediary processing." - NCPDP Telecommunication (Field 463-EW, Data Dictionary 201104). Possible values include: Intermediary Authorization; Other Override; Not Specified.
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| String | intermediaryAuthorizationId |
This property, in conjunction with intermediaryAuthorizationCategory, is used to inform an intermediary (i.e., a switch) to override edit(s) that they normally perform on the claim due to some special circumstance, which has been pre-arranged with the intermediary or the Payer."Value indicating intermediary authorization occurred." - NCPDP Telecommunication (Field 464-EX, Data Dictionary 201104).
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| «CS» Code | levelOfService |
"Coding indicating the type of service the provider rendered." - NCPDP Telecommunication (Field 418-DI, Data Dictionary 201104). Possible values include: Patient consultation; Home delivery; Emergency; 24 hour service; Patient consultation regarding generic product selection; In-Home Service; Not Specified.
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| PharmacyDispense | medicationDispense | |
| «CS» Code | pharmacyType | |
| PriorAuthorization | priorAuthorization | |
| ProfessionalServiceProvision | serviceProvision |
Pointer to the billable aspects of the provision of professional services. This class will link the clinical data related to professional services to the administrative data needed to bill for the services.
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Attributes inherited from  FHIM::EnrollEligCOB::BillableService |
| account, associatedTransactionDate, associatedTransactionId, billingSequence, bodysite, canBenefitsBeCoordinated, certificateOfMedicalNecessity, costCenter, dateEntered, dateOfService, definitionCanonical, definitionUri, doesPatientAssignBenefits, doesProviderAcceptAssignment, eligibilityClarificationCode, employmentImpacted, encounter, enterer, factorOverride, hospitalization, identifier, location, medicaidTransactionId, note, otherCoverageCode, overrideReason, partOf, patient, patientCaseManagement, performingOrganization, priceOverride, priorAuthorizationRequest, product, productServiceCode, quantity, reason, requestingOrganization, service, status, submissionClarificationCode, supportingInformation |
Properties:
| Alias | |
| Classifier Behavior | |
| Is Abstract | false |
| Is Active | false |
| Is Leaf | false |
| Keywords | |
| Name | DrugProvision |
| Name Expression | |
| Namespace | EnrollEligCOB |
| Owned Template Signature | |
| Owner | EnrollEligCOB |
| Owning Template Parameter | |
| Package | EnrollEligCOB |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision |
| Representation | |
| Stereotype | |
| Template Parameter | |
| Visibility | Public |
benefitLimitationOverrideCategory
Public «CS» Code benefitLimitationOverrideCategory
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | benefitLimitationOverrideCategory |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::benefitLimitationOverrideCategory |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
benefitLimitationOverrideId
Public String benefitLimitationOverrideId
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | benefitLimitationOverrideId |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::benefitLimitationOverrideId |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
billingUnitOfMeasure
Public «CS» Code billingUnitOfMeasure
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"NCPDP standard product billing codes." - NCPDP Telecommunication (Field 600-28, Data Dictionary 201104). Possible values include: Each; Grams; Milliliters.
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | billingUnitOfMeasure |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::billingUnitOfMeasure |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
claimDelayReason
Public «CS» Code claimDelayReason
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"Code to specify the reason that submission of the transactions has been delayed." - NCPDP Telecommunication (Field 357-NV, Data Dictionary 201104). Possible values include: Proof of eligibility unknown or unavailable; Litigation; Authorization delays; Delay in certifying provider; Delay in supplying billing forms; Delay in delivery of custom-made appliances; Third party processing delay; Delay in eligibility determination; Original claims rejected or denied due to a reason unrelated to the billing limitation rules; Administration delay in the prior approval process; Received late with no exceptions; Substantial damage by fire, etc to provider records; Theft, sabotage/other willful acts by employee; Other.
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | claimDelayReason |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::claimDelayReason |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
intermediaryAuthorizationCategory
Public «CS» Code intermediaryAuthorizationCategory
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This property, in conjunction with intermediaryAuthorizationId, is used to inform an intermediary (i.e., a switch) to override edit(s) that they normally perform on the claim due to some special circumstance, which has been pre-arranged with the intermediary or the Payer."Value indicating that authorization occurred for intermediary processing." - NCPDP Telecommunication (Field 463-EW, Data Dictionary 201104). Possible values include: Intermediary Authorization; Other Override; Not Specified.
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | intermediaryAuthorizationCategory |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::intermediaryAuthorizationCategory |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
intermediaryAuthorizationId
Public String intermediaryAuthorizationId
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This property, in conjunction with intermediaryAuthorizationCategory, is used to inform an intermediary (i.e., a switch) to override edit(s) that they normally perform on the claim due to some special circumstance, which has been pre-arranged with the intermediary or the Payer."Value indicating intermediary authorization occurred." - NCPDP Telecommunication (Field 464-EX, Data Dictionary 201104).
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | intermediaryAuthorizationId |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::intermediaryAuthorizationId |
| Stereotype | |
| Template Parameter | |
| Type | String |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
levelOfService
Public «CS» Code levelOfService
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"Coding indicating the type of service the provider rendered." - NCPDP Telecommunication (Field 418-DI, Data Dictionary 201104). Possible values include: Patient consultation; Home delivery; Emergency; 24 hour service; Patient consultation regarding generic product selection; In-Home Service; Not Specified.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | levelOfService |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::levelOfService |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
medicationDispense
Public PharmacyDispense medicationDispense
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | drugProvision_medicationDispense |
| Association End | |
| Class | DrugProvision |
| 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 | medicationDispense |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::medicationDispense |
| Stereotype | |
| Template Parameter | |
| Type | PharmacyDispense |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
pharmacyType
Public «CS» Code pharmacyType
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | |
| Association End | |
| Class | DrugProvision |
| 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 | pharmacyType |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::pharmacyType |
| Stereotype | |
| Template Parameter | |
| Type | «CS» Code |
| Upper | 1 |
| Upper Value | (1) |
| Visibility | Public |
priorAuthorization
Public PriorAuthorization priorAuthorization
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Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | drugProvision_priorAuthorization |
| Association End | |
| Class | DrugProvision |
| 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 | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::priorAuthorization |
| Stereotype | |
| Template Parameter | |
| Type | PriorAuthorization |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
serviceProvision
Public ProfessionalServiceProvision serviceProvision
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Pointer to the billable aspects of the provision of professional services. This class will link the clinical data related to professional services to the administrative data needed to bill for the services.
-
Constraints:
-
Properties:
-
| Aggregation | None |
| Alias | |
| Association | drugProvision_serviceProvision |
| Association End | |
| Class | DrugProvision |
| 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 | serviceProvision |
| Name Expression | |
| Namespace | DrugProvision |
| Opposite | |
| Owner | DrugProvision |
| Owning Association | |
| Owning Template Parameter | |
| Qualified Name | FHIM::EnrollEligCOB::DrugProvision::serviceProvision |
| Stereotype | |
| Template Parameter | |
| Type | ProfessionalServiceProvision |
| Upper | * |
| Upper Value | (*) |
| Visibility | Public |
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| EnrollEligCOB UML Documentation |