ca.infoway.messagebuilder.model.pcs_mr2007_v02_r01.claims.merged
Class AdjudicatedInvoiceElementGroupBean

java.lang.Object
  ca.infoway.messagebuilder.model.MessagePartBean
      ca.infoway.messagebuilder.model.pcs_mr2007_v02_r01.claims.merged.AdjudicatedInvoiceElementGroupBean

All Implemented Interfaces:

NullFlavorSupport, AdjudicatedInvoiceElementChoice, Serializable

public class AdjudicatedInvoiceElementGroupBean
extends MessagePartBean
implements AdjudicatedInvoiceElementChoice

See Also:

Serialized Form

Constructor Summary

AdjudicatedInvoiceElementGroupBean()

Method Summary

AdjudicatedInvoiceAuthorBean	getAuthor() Un-merged Business Name: (no business name specified)
ActInvoiceGroupCode	getCode() Business Name: InvoiceType
List<AdjudicatedInvoiceElementChoice>	getComponentAdjudicatedInvoiceElementChoice() Un-merged Business Name: (no business name specified)
List<AdjudicatedInvoiceCoverageBean>	getCoverage() Un-merged Business Name: (no business name specified)
Identifier	getId() Business Name: AdjudicationResultId
Money	getNetAmt() Business Name: PaidAmount
AdjudicatedResultOutcomeBean	getOutcomeOf() Un-merged Business Name: (no business name specified)
PaymentIntentBean	getReasonPaymentIntent() Un-merged Business Name: (no business name specified)
AdjudicatedInvoiceElementGroupBean	getReferenceAdjudicatedInvoiceElementGroup() Un-merged Business Name: (no business name specified)
AdjudicatedResultsGroupBean	getReferencedByAdjudResultsGroup() Un-merged Business Name: (no business name specified)
ActStatus	getStatusCode() Un-merged Business Name: (no business name specified)
void	setAuthor(AdjudicatedInvoiceAuthorBean author) Un-merged Business Name: (no business name specified)
void	setCode(ActInvoiceGroupCode code) Business Name: InvoiceType
void	setId(Identifier id) Business Name: AdjudicationResultId
void	setNetAmt(Money netAmt) Business Name: PaidAmount
void	setOutcomeOf(AdjudicatedResultOutcomeBean outcomeOf) Un-merged Business Name: (no business name specified)
void	setReasonPaymentIntent(PaymentIntentBean reasonPaymentIntent) Un-merged Business Name: (no business name specified)
void	setReferenceAdjudicatedInvoiceElementGroup(AdjudicatedInvoiceElementGroupBean referenceAdjudicatedInvoiceElementGroup) Un-merged Business Name: (no business name specified)
void	setReferencedByAdjudResultsGroup(AdjudicatedResultsGroupBean referencedByAdjudResultsGroup) Un-merged Business Name: (no business name specified)
void	setStatusCode(ActStatus statusCode) Un-merged Business Name: (no business name specified)

Methods inherited from class ca.infoway.messagebuilder.model.MessagePartBean

getField, getNullFlavor, getNullFlavor, getSpecializationType, hasNullFlavor, hasNullFlavor, setNullFlavor, setNullFlavor, setSpecializationType

Methods inherited from class java.lang.Object

clone, equals, finalize, getClass, hashCode, notify, notifyAll, toString, wait, wait, wait

Constructor Detail

AdjudicatedInvoiceElementGroupBean

public AdjudicatedInvoiceElementGroupBean()

Method Detail

getId

public Identifier getId()

Business Name: AdjudicationResultId

Un-merged Business Name: AdjudicationResultId

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.id

Conformance/Cardinality: MANDATORY (1)

May include data centre and sequence numbers

Adjudication Result Id - Technique to identify that the EOB was not electronic (manual) is through the participation mode code for the adjudicator.

setId

public void setId(Identifier id)

Business Name: AdjudicationResultId

Un-merged Business Name: AdjudicationResultId

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.id

Conformance/Cardinality: MANDATORY (1)

May include data centre and sequence numbers

Adjudication Result Id - Technique to identify that the EOB was not electronic (manual) is through the participation mode code for the adjudicator.

getCode

public ActInvoiceGroupCode getCode()

Business Name: InvoiceType

Un-merged Business Name: InvoiceType

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.code

Conformance/Cardinality: MANDATORY (1)

For Invoice (COB) : Invoice type (for root) cannot be different from submitted invoice. This would be a cause for rejecting the invoice.

For Adjudication Results: code must match to the corresponding invoice element that was submitted.

For Invoice Nullify Results: this is the identifier of the EOB that was previously messaged to the Provider.

Modifiers for the codes are taken from the same domain (i.e ActInvoiceGroupCode).

Invoice Type e.g. Healthcare Services, Rx Dispense, Rx Compound

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.code

Conformance/Cardinality: MANDATORY (1)

(Invoice Type e.g. Healthcare Services, Rx Dispense, Rx Compound, Healthcare Goods, Preferred Accomodation

setCode

public void setCode(ActInvoiceGroupCode code)

Business Name: InvoiceType

Un-merged Business Name: InvoiceType

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.code

Conformance/Cardinality: MANDATORY (1)

For Invoice (COB) : Invoice type (for root) cannot be different from submitted invoice. This would be a cause for rejecting the invoice.

For Adjudication Results: code must match to the corresponding invoice element that was submitted.

For Invoice Nullify Results: this is the identifier of the EOB that was previously messaged to the Provider.

Modifiers for the codes are taken from the same domain (i.e ActInvoiceGroupCode).

Invoice Type e.g. Healthcare Services, Rx Dispense, Rx Compound

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.code

Conformance/Cardinality: MANDATORY (1)

(Invoice Type e.g. Healthcare Services, Rx Dispense, Rx Compound, Healthcare Goods, Preferred Accomodation

getStatusCode

public ActStatus getStatusCode()

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.statusCode

Conformance/Cardinality: MANDATORY (1)

Active EOBs are used to convey interim or preliminary adjudication results. They can also be used, with information codes, to indicate that the invoice grouping is held for manual review by the adjudicator, waiting for other third party information (e.g. from another provider, employer, etc.).

Suspended EOBs are used to convey adjudication results that are awaiting additional information from the submitting Provider.

Complete EOBs are used to convey final adjudication results, with an associated intent to pay.

For Invoice (COB): Status code must be complete in order for EOB to be sent to downstream Adjudicators. If a Provider receives a non-complete EOB, this cannot be forwarded to a downstream Adjudicator.

Field cannot be made mandatory, as it is not included in Payment Advice Detail messages (only completed EOBs can be included in a Payment Advice).

Invoice Status - Completed when done, Suspended if waiting for external information, Active if delayed by Adjudicator

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.statusCode

Conformance/Cardinality: MANDATORY (1)

(Completed when done, Suspended if waiting for external )(information, Active if delayed by Adjudicator or the EOB is an estimate

setStatusCode

public void setStatusCode(ActStatus statusCode)

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.statusCode

Conformance/Cardinality: MANDATORY (1)

Active EOBs are used to convey interim or preliminary adjudication results. They can also be used, with information codes, to indicate that the invoice grouping is held for manual review by the adjudicator, waiting for other third party information (e.g. from another provider, employer, etc.).

Suspended EOBs are used to convey adjudication results that are awaiting additional information from the submitting Provider.

Complete EOBs are used to convey final adjudication results, with an associated intent to pay.

For Invoice (COB): Status code must be complete in order for EOB to be sent to downstream Adjudicators. If a Provider receives a non-complete EOB, this cannot be forwarded to a downstream Adjudicator.

Field cannot be made mandatory, as it is not included in Payment Advice Detail messages (only completed EOBs can be included in a Payment Advice).

Invoice Status - Completed when done, Suspended if waiting for external information, Active if delayed by Adjudicator

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.statusCode

Conformance/Cardinality: MANDATORY (1)

(Completed when done, Suspended if waiting for external )(information, Active if delayed by Adjudicator or the EOB is an estimate

getNetAmt

public Money getNetAmt()

Business Name: PaidAmount

Un-merged Business Name: PaidAmount

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.netAmt

Conformance/Cardinality: MANDATORY (1)

For Coverage Extension Results, this is typically not specified, as dollar limits are noted as information codes

Paid Amount

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.netAmt

Conformance/Cardinality: MANDATORY (1)

Identifies the total monetary amount billed for the invoice element. = unit_qty * unit_price_amt * factor_nbr * points_nbr. E.g. $150 CAD

setNetAmt

public void setNetAmt(Money netAmt)

Business Name: PaidAmount

Un-merged Business Name: PaidAmount

Relationship: FICR_MT630000CA.AdjudicatedInvoiceElementGroup.netAmt

Conformance/Cardinality: MANDATORY (1)

For Coverage Extension Results, this is typically not specified, as dollar limits are noted as information codes

Paid Amount

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.netAmt

Conformance/Cardinality: MANDATORY (1)

Identifies the total monetary amount billed for the invoice element. = unit_qty * unit_price_amt * factor_nbr * points_nbr. E.g. $150 CAD

getReasonPaymentIntent

public PaymentIntentBean getReasonPaymentIntent()

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.PaymentIntentReason.paymentIntent

Conformance/Cardinality: POPULATED (1)

setReasonPaymentIntent

public void setReasonPaymentIntent(PaymentIntentBean reasonPaymentIntent)

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.PaymentIntentReason.paymentIntent

Conformance/Cardinality: POPULATED (1)

getReferenceAdjudicatedInvoiceElementGroup

public AdjudicatedInvoiceElementGroupBean getReferenceAdjudicatedInvoiceElementGroup()

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.Reference.adjudicatedInvoiceElementGroup

Conformance/Cardinality: POPULATED (1)

setReferenceAdjudicatedInvoiceElementGroup

public void setReferenceAdjudicatedInvoiceElementGroup(AdjudicatedInvoiceElementGroupBean referenceAdjudicatedInvoiceElementGroup)

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.Reference.adjudicatedInvoiceElementGroup

Conformance/Cardinality: POPULATED (1)

getReferencedByAdjudResultsGroup

public AdjudicatedResultsGroupBean getReferencedByAdjudResultsGroup()

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.AdjudResultsRef.adjudResultsGroup

Conformance/Cardinality: POPULATED (1)

setReferencedByAdjudResultsGroup

public void setReferencedByAdjudResultsGroup(AdjudicatedResultsGroupBean referencedByAdjudResultsGroup)

Un-merged Business Name: (no business name specified)

Relationship: FICR_MT630000CA.AdjudResultsRef.adjudResultsGroup

Conformance/Cardinality: POPULATED (1)

getOutcomeOf

public AdjudicatedResultOutcomeBean getOutcomeOf()

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementChoice.outcomeOf

Conformance/Cardinality: POPULATED (1)

Specified by:

getOutcomeOf in interface AdjudicatedInvoiceElementChoice

setOutcomeOf

public void setOutcomeOf(AdjudicatedResultOutcomeBean outcomeOf)

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementChoice.outcomeOf

Conformance/Cardinality: POPULATED (1)

Specified by:

setOutcomeOf in interface AdjudicatedInvoiceElementChoice

getAuthor

public AdjudicatedInvoiceAuthorBean getAuthor()

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.author

Conformance/Cardinality: MANDATORY (1)

setAuthor

public void setAuthor(AdjudicatedInvoiceAuthorBean author)

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.author

Conformance/Cardinality: MANDATORY (1)

getCoverage

public List<AdjudicatedInvoiceCoverageBean> getCoverage()

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementGroup.coverage

Conformance/Cardinality: POPULATED (1-10)

getComponentAdjudicatedInvoiceElementChoice

public List<AdjudicatedInvoiceElementChoice> getComponentAdjudicatedInvoiceElementChoice()

Un-merged Business Name: (no business name specified)

Relationship: COCT_MT680000CA.AdjudicatedInvoiceElementComponent.adjudicatedInvoiceElementChoice

Conformance/Cardinality: POPULATED (1)