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  1. CDA Specification Feedback
  2. CDA-20771

References to Coverage periods/effective time conflict.

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • C-CDA R2.1 Companion Guide (CDA)
    • 4.1.1
    • Structured Documents
    • Templates
    • 3.17 Policy Activity and 6.2.7.1 Coverage Status
    • Hide

      Add SHOULD:

      act/effectiveTime to Policy Activity Act

      Add note: 

      This records the policy coverage period, or self-pay period

      Adjust this wording is on the Coverage Activity Act:

      FROM: “The act/effectiveTime@value records the date when you checked the coverage for a patient, and applies for all policies within the coverage activity. If systems choose to include a time they may need multiple Coverage Activity Acts to represent the moment of the eligibility check. Details on a specific Policy coverage period, or self-pay period, systems can record an additional effectiveTime inside the Policy Activity. Systems may prioritize Coverages using the sequenceNumber”

      TO: “The act/effectiveTime@value records the date and time when you checked and possibly updated the coverage for a patient, and applies for all policies within the coverage activity. Multiple Coverage Activity Acts would be needed to convey different times when coverage was checked and possibly updated. Details on a specific Policy coverage period, or self-pay period, systems can record an additional effectiveTime inside the Policy Activity. Systems may prioritize Coverages using the sequenceNumber”

       

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      Add SHOULD: act/effectiveTime to Policy Activity Act Add note:  This records the policy coverage period, or self-pay period Adjust this wording is on the Coverage Activity Act: FROM: “The act/effectiveTime@value records the date when you checked the coverage for a patient, and applies for all policies within the coverage activity. If systems choose to include a time they may need multiple Coverage Activity Acts to represent the moment of the eligibility check. Details on a specific Policy coverage period, or self-pay period, systems can record an additional effectiveTime inside the Policy Activity. Systems may prioritize Coverages using the sequenceNumber” TO: “The act/effectiveTime@value records the date and time when you checked and possibly updated the coverage for a patient, and applies for all policies within the coverage activity. Multiple Coverage Activity Acts would be needed to convey different times when coverage was checked and possibly updated. Details on a specific Policy coverage period, or self-pay period, systems can record an additional effectiveTime inside the Policy Activity. Systems may prioritize Coverages using the sequenceNumber”  
    • Jean Duteau / Benjamin Flessner : 13-0-1
    • Correction
    • Compatible, substantive

    Description

      There is ambiguity on the meaning of Coverage effectiveTime.  It states in 6.2.7.1 that "The act/effectiveTime@value records the date when you checked the coverage for a patient, and applies for all policies within the coverage activity."  I.e., it is when it is observed, but it does not provide a period during which the coverage is actually in effect.  It then states "Details on a specific Policy coverage period, or self-pay period, systems can record an additional effectiveTime inside the Policy Activity." However, when going to Appendix A, 3.17 Policy Activity, there is no effectiveTime attribute capturing the coverage period that would be equivalent to FHIR US Core Coverage.period.  Rather, it seems that /participant/time low and high for participant type "COV" would capture period. This, in combination with Jira CDA-20763, need to be addressed to clarify how one can assert the coverage period and assert whether coverage is present or absent.

      Upon resolving the Jira and considering a clarification along these lines, a separate vote needs to be made to backport the clarification to 4.1.1 to ensure it is properly interpreted and supported for USCDI v3 based certification.

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            Brett.Marquard Brett Marquard
            hbuitendijk Hans Buitendijk
            Hans Buitendijk
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              Updated:
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