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RoleClass 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 a policy holder of the plan; where the sponsor is the policy holder, who may become a subscriber or a dependent to a policy under the plan; or 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 accepts fiscal responsibility for insurance plans and the policies created under those plans; administers and accepts fiscal responsibility for a program that provides coverage for services to eligible individuals; and/or 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: A health insurer; Medicaid Program; 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 a policy holder of the plan; where the sponsor is the policy holder, who may become a subscriber or a dependent to a policy under the plan; or 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 accepts fiscal responsibility for insurance plans and the policies created under those plans; administers and accepts fiscal responsibility for a program that provides coverage for services to eligible individuals; and/or 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: A health insurer; Medicaid Program; 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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Last Published: 03/27/2006 3:35 AM

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