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RoleClass    NormativeStandard1

This table includes codes for the Role class hierarchy. The values in this hierarchy, represent a Role which is an association or relationship between two entities - the entity that plays the role and the entity that scopes the role. Roles names are derived from the name of the playing entity in that role.

The role hierarchy stems from three core concepts, or abstract domains:

  • RoleClassOntological is an abstract domain that collects roles in which the playing entity is defined or specified by the scoping entity.

  • RoleClassPartitive collects roles in which the playing entity is in some sense a "part" of the scoping entity.

  • RoleClassAssociative collects all of the remaining forms of association between the playing entity and the scoping entity. This set of roles is further partitioned between:

    • RoleClassPassive which are roles in which the playing entity is used, known, treated, handled, built, or destroyed, etc. under the auspices of the scoping entity. The playing entity is passive in these roles in that the role exists without an agreement from the playing entity.

    • RoleClassMutualRelationship which are relationships based on mutual behavior of the two entities. The basis of these relationship may be formal agreements or they may be de facto behavior. Thus, this sub-domain is further divided into:

      • RoleClassRelationshipFormal in which the relationship is formally defined, frequently by a contract or agreement.

      • Personal relationship which inks two people in a personal relationship.

The hierarchy discussed above is represented In the current vocabulary tables as a set of abstract domains, with the exception of the "Personal relationship" which is a leaf concept.

This table controls values for structural elements of the HL7 Reference Information Model. Therefore, it is part of the Normative Ballot for the RIM.

Lvl Type, Domain name and/or Mnemonic code Concept ID Mnemonic Print Name Definition/Description
1 S: RoleClassRoot (ROL) S13940 ROL role

Corresponds to the Role class

2   A: RoleClassAssociative A19313

A general association between two entities that is neither partitive nor ontological.

3     A: RoleClassMutualRelationship A19316

A relationship that is based on mutual behavior of the two Entities as being related. The basis of such relationship may be agreements (e.g., spouses, contract parties) or they may be de facto behavior (e.g. friends) or may be an incidental involvement with each other (e.g. parties over a dispute, siblings, children).

4       A: RoleClassRelationshipFormal A10416

A relationship between two entities that is formally recognized, frequently by a contract or similar agreement.

5         S: LicensedEntityRole (LIC) S16773 LIC licensed entity

A relationship in which the scoper certifies the player ( e. g. a medical care giver, a medical device or a provider organization) to perform certain activities that fall under the jurisdiction of the scoper (e.g., a health authority licensing healthcare prlviders, a medical quality authority certifying healthcare professionals,)

6           L:  (PROV) C11599 PROV healthcare provider

An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).

6           L:  (NOT) C11576 NOT notary public
5         S: RoleClassAgent (AGNT) S14006 AGNT agent

An entity (player) that acts or is authorized to act on behalf of another entity (scoper).

6           S: RoleClassAssignedEntity (ASSIGNED) S11595 ASSIGNED assigned entity

An agent role in which the agent is an Entity acting in the employ of an organization. The focus is on functional role on behalf of the organization, unlike the Employee role where the focus is on the 'Human Resources' relationship between the employee and the organization.

7             S: RoleClassContact (CON) S12205 CON contact

A person or an organization (player) which provides or receives information regarding another entity (scoper). Examples; patient NOK and emergency contacts; guarantor contact; employer contact.

8               L:  (ECON) C19140 ECON emergency contact

An entity to be contacted in the event of an emergency.

8               L:  (NOK) C19141 NOK next of kin

An individual designated for notification as the next of kin for a given entity.

7             L:  (COMPAR) C21303 COMPAR commissioning party

An Entity that is authorized to issue or instantiate permissions, privileges, credentials or other formal/legal authorizations.

7             L:  (SGNOFF) C14007 SGNOFF signing authority or officer

The role of a person (player) who is the officer or signature authority for of a scoping entity, usually an organization (scoper).

6           L:  (GUARD) C16324 GUARD guardian

Guardian of a ward

5         S: RoleClassEmployee (EMP) S11569 EMP employee

A relationship between a person or organization and a person or organization formed for the purpose of exchanging work for compensation. The purpose of the role is to identify the type of relationship the employee has to the employer, rather than the nature of the work actually performed. (Contrast with AssignedEntity.)

6           L:  (MIL) C11570 MIL military person

A role played by a member of a military service. Scoper is the military service (e.g. Army, Navy, Air Force, etc.) or, more specifically, the unit (e.g. Company C, 3rd Battalion, 4th Division, etc.)

5         S: RoleClassInvestigationSubject (INVSBJ) S21464 INVSBJ Investigation Subject

An entity that is the subject of an investigation. This role is scoped by the party responsible for the investigation.

6           L:  (CASEBJ) C21465 CASEBJ Case Subject

A person, non-person living subject, or place that is the subject of an investigation related to a notifiable condition (health circumstance that is reportable within the applicable public health jurisdiction)

6           L:  (RESBJ) C19166 RESBJ research subject

Definition:Specifies the administrative functionality within a formal experimental design for which the ResearchSubject role was established.

Examples: Screening - role is used for pre-enrollment evaluation portion of the design; enrolled - role is used for subjects admitted to the experimental portion of the design.

5         L:  (AFFL) C21438 AFFL affiliate

Player of the Affiliate role has a business/professional relationship with scoper. Player and scoper may be persons or organization. The Affiliate relationship does not imply membership in a group, nor does it exist for resource scheduling purposes.

Example: A healthcare provider is affiliated with another provider as a business associate.

5         L:  (CIT) C11568 CIT citizen

Citizen of apolitical entity

5         L:  (CRINV) C19164 CRINV clinical research investigator

A role played by a provider, always a person, who has agency authority from a Clinical Research Sponsor to direct the conduct of a clinical research trial or study on behalf of the sponsor.

5         L:  (CRSPNSR) C19165 CRSPNSR clinical research sponsor

A role played by an entity, usually an organization, that is the sponsor of a clinical research trial or study. The sponsor commissions the study, bears the expenses, is responsible for satisfying all legal requirements concerning subject safety and privacy, and is generally responsible for collection, storage and analysis of the data generated during the trial. No scoper is necessary, as a clinical research sponsor undertakes the role on its own authority and declaration. Clinical research sponsors are usually educational or other research organizations, government agencies or biopharmaceutical companies.

5         L:  (SPNSR) C14012 SPNSR coverage sponsor

A role played by an entity, usually an organization that is the sponsor of an insurance plan or a health program. A sponsor is the party that is ultimately accountable for the coverage by employment contract or by law. A sponsor can be an employer, union, government agency, or association. Fully insured sponsors establish the terms of the plan and contract with health insurance plans to assume the risk and to administer the plan. Self-insured sponsors delegate coverage administration, but not risk, to third-party administrators. Program sponsors designate services to be covered in accordance with statute. Program sponsors may administer the coverage themselves, delegate coverage administration, but not risk to third-party administrators, or contract with health insurance plans to assume the risk and administrator a program. Sponsors qualify individuals who may become

  1. a policy holder of the plan;

  2. where the sponsor is the policy holder, who may become a subscriber or a dependent to a policy under the plan; or

  3. where the sponsor is a government agency, who may become program eligibles under a program.

The sponsor role may be further qualified by the SponsorRole.code. Entities playing the sponsor role may also play the role of a Coverage Administrator.

Example: An employer, union, government agency, or association.

5         L:  (COVPTY) C14011 COVPTY covered party

A role class played by a person who receives benefit coverage under the terms of a particular insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy.

Discussion:This reason for coverage is captured in 'Role.code' and a relationship link with type code of indirect authority should be included using the policy holder role as the source, and the covered party role as the target.

Note that a particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.

5         L:  (GUAR) C13941 GUAR guarantor

A person or organization (player) that serves as a financial guarantor for another person or organization (scoper).

5         L:  (PAYOR) C14014 PAYOR invoice payor

The role of an organization that undertakes to accept claims invoices, assess the coverage or payments due for those invoices and pay to the designated payees for those invoices. This role may be either the underwriter or a third-party organization authorized by the underwriter. The scoping entity is the organization that underwrites the claimed coverage.

5         L:  (PAT) C11577 PAT patient

Scoped by a provider

5         L:  (PAYEE) C14015 PAYEE payee

The role of an organization or individual designated to receive payment for a claim against a particular coverage. The scoping entity is the organization that is the submitter of the invoice in question.

5         L:  (POLHOLD) C14010 POLHOLD policy holder

A role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.

Discussion:The identifier of the policy is captured in 'Role.id' when the Role is a policy holder.

A particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.

5         L:  (QUAL) C11619 QUAL qualified entity

An entity (player) that has been recognized as having certain training/experience or other characteristics that would make said entity an appropriate performer for a certain activity. The scoper is an organization that educates or qualifies entities.

5         L:  (STD) C12248 STD student

A role played by an individual who is a student of a school, which is the scoping entity.

5         L:  (UNDWRT) C14009 UNDWRT underwriter

A role played by a person or an organization. It is the party that

  1. accepts fiscal responsibility for insurance plans and the policies created under those plans;

  2. administers and accepts fiscal responsibility for a program that provides coverage for services to eligible individuals; and/or

  3. has the responsibility to assess the merits of each risk and decide a suitable premium for accepting all or part of the risk. If played by an organization, this role may be further specified by an appropriate RoleCode.

Example:

  1. A health insurer;

  2. Medicaid Program;

  3. Lloyd's of London

4       L:  (CAREGIVER) C21355 CAREGIVER caregiver

A person responsible for the primary care of a patient at home.

4       L:  (PRS) C19167 PRS personal relationship

Links two people in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.

3     A: RoleClassPassive A19105

An association for a playing Entity that is used, known, treated, handled, built, or destroyed, etc. under the auspices of the scoping Entity. The playing Entity is passive in these roles (even though it may be active in other roles), in the sense that the kinds of things done to it in this role happen without an agreement from the playing Entity.

4       L:  (ADMM) C21435 ADMM Administerable Material

A material (player) that can be administered to an Entity (scoper).

4       S: RoleClassDistributedMaterial (DST) S10418 DST distributed material

A material (player) distributed by a distributor (scoper) who functions between a manufacturer and a buyer or retailer.

5         L:  (RET) C10419 RET retailed material

Material (player) sold by a retailer (scoper), who also give advice to prospective buyers.

4       S: RoleClassManufacturedProduct (MANU) S11580 MANU manufactured product

Scoped by the manufacturer

5         L:  (THER) C11581 THER therapeutic agent

A manufactured material (player) that is used for its therapeutic properties. The manufacturer is the scoper.

4       S: RoleClassServiceDeliveryLocation (SDLOC) S16927 SDLOC service delivery location

A role played by a place at which services may be provided.

5         L:  (DSDLOC) C11600 DSDLOC dedicated service delivery location

A role of a place (player) that is intended to house the provision of services. Scoper is the Entity (typically Organization) that provides these services. This is not synonymous with "ownership."

5         L:  (ISDLOC) C16929 ISDLOC incidental service delivery location

A role played by a place at which health care services may be provided without prior designation or authorization.

4       L:  (ACCESS) C11592 ACCESS access

A role in which the playing entity (material) provides access to another entity. The principal use case is intravenous (or other bodily) access lines that preexist and need to be referred to for medication routing instructions.

4       L:  (BIRTHPL) C11589 BIRTHPL birthplace

Relates a place (playing Entity) as the location where a living subject (scoping Entity) was born.

4       L:  (EXPR) C19131 EXPR exposed entity

A role played by an entity that has been exposed to a person or animal suffering a contagious disease, or with a location from which a toxin has been distributed. The player of the role is normally a person or animal, but it is possible that other entity types could become exposed. The role is scoped by the source of the exposure, and it is quite possible for a person playing the role of exposed party to also become the scoper a role played by another person. That is to say, once a person has become infected, it is possible, perhaps likely, for that person to infect others.

Management of exposures and tracking exposed parties is a key function within public health, and within most public health contexts - exposed parties are known as "contacts."

4       L:  (HLTHCHRT) C11618 HLTHCHRT health chart

The role of a material (player) that is the physical health chart belonging to an organization (scoper).

4       L:  (HLD) C10422 HLD held entity

Entity that is currently in the possession of a holder (scoper), who holds, or uses it, usually based on some agreement with the owner.

4       L:  (IDENT) C16721 IDENT identified entity

Roles played by entities and scoped by entities that identify them for various purposes.

4       L:  (MNT) C10427 MNT maintained entity

An entity (player) that is maintained by another entity (scoper). This is typical role held by durable equipment. The scoper assumes responsibility for proper operation, quality, and safety.

4       L:  (OWN) C10421 OWN owned entity

An Entity (player) for which someone (scoper) is granted by law the right to call the material (player) his own. This entitles the scoper to make decisions about the disposition of that material.

4       L:  (RGPR) C19132 RGPR regulated product

A product regulated by some governmentatl orgnization. The role is played by Material and scoped by Organization.

Rationale: To support an entity clone used to identify the NDC number for a drug product.

4       L:  (TERR) C11583 TERR territory of authority

Relates a place entity (player) as the region over which the scoper (typically an Organization) has certain authority (jurisdiction). For example, the Calgary Regional Health Authority (scoper) has authority over the territory "Region 4 of Alberta" (player) in matters of health.

4       L:  (WRTE) C16300 WRTE warranted product

A role a product plays when a guarantee is given to the purchaser by the seller (scoping entity) stating that the product is reliable and free from known defects and that the seller will repair or replace defective parts within a given time limit and under certain conditions.

2   A: RoleClassOntological A10428

A relationship in which the scoping Entity defines or specifies what the playing Entity is. Thus, the player's "being" (Greek: ontos) is specified.

3     S: RoleClassIsSpeciesEntity (GEN) S10441 GEN has generalization

Relates a specialized material concept (player) to its generalization (scoper).

4       L:  (GRIC) C10442 GRIC has generic

A special link between pharmaceuticals indicating that the target (scoper) is a generic for the source (player).

3     L:  (INST) C10443 INST instance

An individual piece of material (player) instantiating a class of material (scoper).

3     L:  (SAME) C21488 SAME same

The "same" roleclass asserts an identity between playing and scoping entities: that they are in fact instances of the same entity and, in the case of discrepancies (e.g different DOB, gender), that one or both are in error.

Usage:

playing and scoping entities must have same classcode, but need not have identical attributes or values.

Example:

a provider registry maintains sets of conflicting demographic data for what is reported to be the same individual.

3     L:  (SUBY) C20070 SUBY subsumed by

Relates a prevailing record of an Entity (scoper) with another record (player) that it subsumes.

Examples: Show a correct new Person object (scoper) that subsumes one or more duplicate Person objects that had accidentally been created for the same physical person.

Constraints: Both the player and scoper must have the same classCode.

3     L:  (SUBS) C16241 SUBS subsumer

An entity that subsumes the identity of another. Used in the context of merging documented entity instances. Both the player and scoper must have the same classCode.

The use of this code is deprecated in favor of the term SUBY which is its inverse and is more ontologically correct.

2   A: RoleClassPartitive A10429

An association between two Entities where the playing Entity is considered in some way "part" of the scoping Entity, e.g., as a member, component, ingredient, or content. Being "part" in the broadest sense of the word can mean anything from being an integral structural component to a mere incidental temporary association of a playing Entity with a (generally larger) scoping Entity.

3     S: RoleClassIngredientEntity (INGR) S10430 INGR ingredient

Relates a component (player) to a mixture (scoper). E.g., Glucose and Water are ingredients of D5W, latex may be an ingredient in a tracheal tube.

4       S: RoleClassInactiveIngredient (IACT) S19089 IACT inactive ingredient
5         L:  (COLR) C10437 COLR color additive

A substance (player) influencing the optical aspect of material (scoper).

5         L:  (FLVR) C10436 FLVR flavor additive

A substance (player) added to a mixture (scoper) to make it taste a certain way. In food the use is obvious, in pharmaceuticals flavors can hide disgusting taste of the active ingredient (important in pediatric treatments).

5         L:  (PRSV) C10435 PRSV preservative

A substance (player) added to a mixture (scoper) to prevent microorganisms (fungi, bacteria) to spoil the mixture.

5         L:  (STBL) C10434 STBL stabilizer

A stabilizer (player) added to a mixture (scoper) in order to prevent the molecular disintegration of the main substance.

4       L:  (ACTI) C10433 ACTI active ingredient

A therapeutically active ingredient (player) in a mixture (scoper), where the mixture is typically a manufactured pharmaceutical.

4       L:  (ACTM) C19088 ACTM active moiety

The molecule or ion that is responsible for the intended pharmacological action of the drug substance, excluding those appended or associated parts of the molecule that make the molecule an ester, salt (including a salt with hydrogen or coordination bonds), or other noncovalent derivative (such as a complex, chelate, or clathrate).

Examples: heparin-sodium and heparin-potassium have the same active moiety, heparin; the active moiety of morphine-hydrochloride is morphine.

4       L:  (ADTV) C10432 ADTV additive

An ingredient (player) that is added to a base (scoper), that amounts to a minor part of the overall mixture.

4       L:  (BASE) C10431 BASE base

A base ingredient (player) is what comprises the major part of a mixture (scoper). E.g., Water in most i.v. solutions, or Vaseline in salves. Among all ingredients of a material, there should be only one base. A base substance can, in turn, be a mixture.

3     S: RoleClassLocatedEntity (LOCE) S16815 LOCE located entity

Relates an entity (player) to a location (scoper) at which it is present in some way. This presence may be limited in time.

4       L:  (STOR) C16817 STOR stored entity

Relates an entity (player) (e.g. a device) to a location (scoper) at which it is normally found or stored when not used.

3     S: RoleClassSpecimen (SPEC) S11591 SPEC specimen

A role played by a material entity that is a specimen for an act. It is scoped by the source of the specimen.

4       L:  (ALQT) C14026 ALQT aliquot

A portion (player) of an original or source specimen (scoper) used for testing or transportation.

4       L:  (ISLT) C16302 ISLT isolate

A microorganism that has been isolated from other microorganisms or a source matrix.

3     L:  (CONT) C10438 CONT content

Relates a material as the content (player) to a container (scoper). Unlike ingredients, the content and a container remain separate (not mixed) and the content can be removed from the container. A content is not part of an empty container.

3     L:  (MBR) C12204 MBR member

A role played by an entity that is a member of a group. The group provides the scope for this role.

Among other uses, groups as used in insurance (groups of covered individuals) and in scheduling where resources may be grouped for scheduling and logistical purposes.

3     L:  (PART) C19102 PART part

An association between two Entities where the playing Entity is considered in some way "part" of the scoping Entity, e.g., as a member, component, ingredient, or content. Being "part" in the broadest sense of the word can mean anything from being an integral structural component to a mere incidental temporary association of a playing Entity with a (generally larger) scoping Entity.

2   A: x_AccommodationRequestorRole A19352
3     L:  (AGNT) C14006 AGNT agent

An entity (player) that acts or is authorized to act on behalf of another entity (scoper).

3     L:  (PROV) C11599 PROV healthcare provider

An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).

3     L:  (PAT) C11577 PAT patient

Scoped by a provider

3     L:  (PRS) C19167 PRS personal relationship

Links two people in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.

2   A: x_DocumentEntrySubject A19367

Used to represent the role(s) of those who can serve as subjects of the contents of a clinical document.

3     L:  (PAT) C11577 PAT patient

Scoped by a provider

3     L:  (PRS) C19167 PRS personal relationship

Links two people in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.

3     L:  (SPEC) C11591 SPEC specimen

A role played by a material entity that is a specimen for an act. It is scoped by the source of the specimen.

2   A: x_DocumentSubject A19368
3     L:  (PAT) C11577 PAT patient

Scoped by a provider

3     L:  (PRS) C19167 PRS personal relationship

Links two people in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.

2   A: x_InformationRecipientRole A16772

Used to represent the role(s) of those who should receive a copy of a document.

3     L:  (ASSIGNED) C11595 ASSIGNED assigned entity

An agent role in which the agent is an Entity acting in the employ of an organization. The focus is on functional role on behalf of the organization, unlike the Employee role where the focus is on the 'Human Resources' relationship between the employee and the organization.

3     L:  (HLTHCHRT) C11618 HLTHCHRT health chart

The role of a material (player) that is the physical health chart belonging to an organization (scoper).

2   A: x_RoleClassAccommodationRequestor A19382

The requestor for the accommodation. Steward is Financial Management Technical Committee

3     L:  (AGNT) C14006 AGNT agent

An entity (player) that acts or is authorized to act on behalf of another entity (scoper).

3     L:  (PROV) C11599 PROV healthcare provider

An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).

3     L:  (PAT) C11577 PAT patient

Scoped by a provider

3     L:  (PRS) C19167 PRS personal relationship

Links two people in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.

2   A: x_RoleClassCoverage A14008

An abstract domain that encompasses the roles that arise in the context of providing, purchasing, and managing health care coverage and insurance.

3     L:  (SPNSR) C14012 SPNSR coverage sponsor

A role played by an entity, usually an organization that is the sponsor of an insurance plan or a health program. A sponsor is the party that is ultimately accountable for the coverage by employment contract or by law. A sponsor can be an employer, union, government agency, or association. Fully insured sponsors establish the terms of the plan and contract with health insurance plans to assume the risk and to administer the plan. Self-insured sponsors delegate coverage administration, but not risk, to third-party administrators. Program sponsors designate services to be covered in accordance with statute. Program sponsors may administer the coverage themselves, delegate coverage administration, but not risk to third-party administrators, or contract with health insurance plans to assume the risk and administrator a program. Sponsors qualify individuals who may become

  1. a policy holder of the plan;

  2. where the sponsor is the policy holder, who may become a subscriber or a dependent to a policy under the plan; or

  3. where the sponsor is a government agency, who may become program eligibles under a program.

The sponsor role may be further qualified by the SponsorRole.code. Entities playing the sponsor role may also play the role of a Coverage Administrator.

Example: An employer, union, government agency, or association.

3     L:  (COVPTY) C14011 COVPTY covered party

A role class played by a person who receives benefit coverage under the terms of a particular insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy.

Discussion:This reason for coverage is captured in 'Role.code' and a relationship link with type code of indirect authority should be included using the policy holder role as the source, and the covered party role as the target.

Note that a particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.

3     L:  (POLHOLD) C14010 POLHOLD policy holder

A role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.

Discussion:The identifier of the policy is captured in 'Role.id' when the Role is a policy holder.

A particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.

3     L:  (UNDWRT) C14009 UNDWRT underwriter

A role played by a person or an organization. It is the party that

  1. accepts fiscal responsibility for insurance plans and the policies created under those plans;

  2. administers and accepts fiscal responsibility for a program that provides coverage for services to eligible individuals; and/or

  3. has the responsibility to assess the merits of each risk and decide a suitable premium for accepting all or part of the risk. If played by an organization, this role may be further specified by an appropriate RoleCode.

Example:

  1. A health insurer;

  2. Medicaid Program;

  3. Lloyd's of London

2   A: x_RoleClassCoverageInvoice A14013

An abstract domain that encompasses the roles involved in submitting, responding to and managing invoices or claims for health care coverage.

3     L:  (PAYOR) C14014 PAYOR invoice payor

The role of an organization that undertakes to accept claims invoices, assess the coverage or payments due for those invoices and pay to the designated payees for those invoices. This role may be either the underwriter or a third-party organization authorized by the underwriter. The scoping entity is the organization that underwrites the claimed coverage.

3     L:  (PAYEE) C14015 PAYEE payee

The role of an organization or individual designated to receive payment for a claim against a particular coverage. The scoping entity is the organization that is the submitter of the invoice in question.

2   A: x_RoleClassCredentialedEntity A16930

A role played by an entity that receives credentials from the scoping entity.

3     S: LicensedEntityRole (LIC) S16773 LIC licensed entity

A relationship in which the scoper certifies the player ( e. g. a medical care giver, a medical device or a provider organization) to perform certain activities that fall under the jurisdiction of the scoper (e.g., a health authority licensing healthcare prlviders, a medical quality authority certifying healthcare professionals,)

4       L:  (PROV) C11599 PROV healthcare provider

An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).

4       L:  (NOT) C11576 NOT notary public
3     L:  (ASSIGNED) C11595 ASSIGNED assigned entity

An agent role in which the agent is an Entity acting in the employ of an organization. The focus is on functional role on behalf of the organization, unlike the Employee role where the focus is on the 'Human Resources' relationship between the employee and the organization.

3     L:  (QUAL) C11619 QUAL qualified entity

An entity (player) that has been recognized as having certain training/experience or other characteristics that would make said entity an appropriate performer for a certain activity. The scoper is an organization that educates or qualifies entities.

2   A: x_RoleClassPayeePolicyRelationship A19395

The specification of the relationship of the Payee to the invoice. Can be used in cases when an insurer is not directly paying the healthcare provider (as payee) but reimbursing the party that paid the invoice/claim.

3     L:  (COVPTY) C14011 COVPTY covered party

A role class played by a person who receives benefit coverage under the terms of a particular insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy.

Discussion:This reason for coverage is captured in 'Role.code' and a relationship link with type code of indirect authority should be included using the policy holder role as the source, and the covered party role as the target.

Note that a particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.

3     L:  (GUAR) C13941 GUAR guarantor

A person or organization (player) that serves as a financial guarantor for another person or organization (scoper).

3     L:  (PROV) C11599 PROV healthcare provider

An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).

3     L:  (PRS) C19167 PRS personal relationship

Links two people in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.

3     L:  (POLHOLD) C14010 POLHOLD policy holder

A role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.

Discussion:The identifier of the policy is captured in 'Role.id' when the Role is a policy holder.

A particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.


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