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 benefitLimitationOverrideCategory
String benefitLimitationOverrideId benefitLimitationOverrideId
«CS» Code billingUnitOfMeasure billingUnitOfMeasure

"NCPDP standard product billing codes." - NCPDP Telecommunication (Field 600-28, Data Dictionary 201104). Possible values include: Each; Grams; Milliliters.

«CS» Code claimDelayReason 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.

«CS» Code intermediaryAuthorizationCategory 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.

String intermediaryAuthorizationId 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).

«CS» Code levelOfService 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.

PharmacyDispense medicationDispense medicationDispense
«CS» Code pharmacyType pharmacyType
PriorAuthorization priorAuthorization priorAuthorization
ProfessionalServiceProvision serviceProvision 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.

Attributes inherited from FHIM::EnrollEligCOB::BillableService FHIM::EnrollEligCOB::BillableService
account account, associatedTransactionDate associatedTransactionDate, associatedTransactionId associatedTransactionId, billingSequence billingSequence, bodysite bodysite, canBenefitsBeCoordinated canBenefitsBeCoordinated, certificateOfMedicalNecessity certificateOfMedicalNecessity, costCenter costCenter, dateEntered dateEntered, dateOfService dateOfService, definitionCanonical definitionCanonical, definitionUri definitionUri, doesPatientAssignBenefits doesPatientAssignBenefits, doesProviderAcceptAssignment doesProviderAcceptAssignment, eligibilityClarificationCode eligibilityClarificationCode, employmentImpacted employmentImpacted, encounter encounter, enterer enterer, factorOverride factorOverride, hospitalization hospitalization, identifier identifier, location location, medicaidTransactionId medicaidTransactionId, note note, otherCoverageCode otherCoverageCode, overrideReason overrideReason, partOf partOf, patient patient, patientCaseManagement patientCaseManagement, performingOrganization performingOrganization, priceOverride priceOverride, priorAuthorizationRequest priorAuthorizationRequest, product product, productServiceCode productServiceCode, quantity quantity, reason reason, requestingOrganization requestingOrganization, service service, status status, submissionClarificationCode submissionClarificationCode, supportingInformation supportingInformation

Properties:

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

Attribute Details

 benefitLimitationOverrideCategory
Public «CS» Code benefitLimitationOverrideCategory
Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NamebenefitLimitationOverrideCategory
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::benefitLimitationOverrideCategory
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 benefitLimitationOverrideId
Public String benefitLimitationOverrideId
Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NamebenefitLimitationOverrideId
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::benefitLimitationOverrideId
Stereotype
Template Parameter
TypeString
Upper1
Upper Value(1)
VisibilityPublic


 billingUnitOfMeasure
Public «CS» Code billingUnitOfMeasure

"NCPDP standard product billing codes." - NCPDP Telecommunication (Field 600-28, Data Dictionary 201104). Possible values include: Each; Grams; Milliliters.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NamebillingUnitOfMeasure
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::billingUnitOfMeasure
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 claimDelayReason
Public «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.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NameclaimDelayReason
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::claimDelayReason
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 intermediaryAuthorizationCategory
Public «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.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NameintermediaryAuthorizationCategory
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::intermediaryAuthorizationCategory
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 intermediaryAuthorizationId
Public 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).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NameintermediaryAuthorizationId
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::intermediaryAuthorizationId
Stereotype
Template Parameter
TypeString
Upper1
Upper Value(1)
VisibilityPublic


 levelOfService
Public «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.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NamelevelOfService
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::levelOfService
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 medicationDispense
Public PharmacyDispense medicationDispense
Constraints:
Properties:

AggregationNone
Alias
AssociationdrugProvision_medicationDispense
Association End
ClassDrugProvision
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
NamemedicationDispense
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::medicationDispense
Stereotype
Template Parameter
TypePharmacyDispense
Upper1
Upper Value(1)
VisibilityPublic


 pharmacyType
Public «CS» Code pharmacyType
Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassDrugProvision
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
NamepharmacyType
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::pharmacyType
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 priorAuthorization
Public PriorAuthorization priorAuthorization
Constraints:
Properties:

AggregationNone
Alias
AssociationdrugProvision_priorAuthorization
Association End
ClassDrugProvision
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
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::priorAuthorization
Stereotype
Template Parameter
TypePriorAuthorization
Upper*
Upper Value(*)
VisibilityPublic


 serviceProvision
Public 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.

Constraints:
Properties:

AggregationNone
Alias
AssociationdrugProvision_serviceProvision
Association End
ClassDrugProvision
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*
NameserviceProvision
Name Expression
NamespaceDrugProvision
Opposite
OwnerDrugProvision
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::DrugProvision::serviceProvision
Stereotype
Template Parameter
TypeProfessionalServiceProvision
Upper*
Upper Value(*)
VisibilityPublic