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

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

All Implemented Interfaces:

NullFlavorSupport, AdjudicatedInvoiceElementChoice, Serializable

public class AdjudicationResultIdentifierBean
extends MessagePartBean
implements AdjudicatedInvoiceElementChoice

FICR_MT610201CA.AdjudicatedInvoiceElementGroup: Adjudicated Invoice

For the root AdjududicatedInvoiceElementGroup, the Coverage, Author and OutcomeOf relationships are Mandatory.

All Relationships to the AdjudicatedInvoiceElementGroup can only be associated with the root level instance

A.K.A. the result.

QUCR_MT830201CA.AdjudicatedInvoiceElementGroup: Adjudication Result Identifier

May include data centre and sequence numbers

Adjudication Result Identifier

See Also:

Serialized Form

Constructor Summary

AdjudicationResultIdentifierBean()

Method Summary

AdjudicatorBean	getAuthor() Un-merged Business Name: (no business name specified)
ActInvoiceGroupCode	getCode() Business Name: InvoiceType
List<ComponentInvoiceElementBean>	getComponent() Un-merged Business Name: (no business name specified)
List<AdjudicatedInvoiceCoverageBean>	getCoverage() Un-merged Business Name: (no business name specified)
Identifier	getId() Business Name: AdjudicatedResultsIdentifier
Money	getNetAmt() Business Name: PaidAmount
AdjudicatedResultOutcomeBean	getOutcomeOf() Un-merged Business Name: (no business name specified)
AdjudicationResultIdentifierBean	getPredecessorAdjudicatedInvoiceElementGroup() Un-merged Business Name: (no business name specified)
AllowableBean	getReference1Allowable() Un-merged Business Name: (no business name specified)
List<AdjudicatedInvoiceElementGroupBean>	getReferenceAdjudicatedInvoiceElementGroup() Un-merged Business Name: (no business name specified)
AdjudicatedResultsGroupBean	getReferencedByAdjudResultsGroup() Un-merged Business Name: (no business name specified)
ActStatus	getStatusCode() Business Name: StatusOfTheAdjudicatedInvoice
void	setAuthor(AdjudicatorBean author) Un-merged Business Name: (no business name specified)
void	setCode(ActInvoiceGroupCode code) Business Name: InvoiceType
void	setId(Identifier id) Business Name: AdjudicatedResultsIdentifier
void	setNetAmt(Money netAmt) Business Name: PaidAmount
void	setOutcomeOf(AdjudicatedResultOutcomeBean outcomeOf) Un-merged Business Name: (no business name specified)
void	setPredecessorAdjudicatedInvoiceElementGroup(AdjudicationResultIdentifierBean predecessorAdjudicatedInvoiceElementGroup) Un-merged Business Name: (no business name specified)
void	setReference1Allowable(AllowableBean reference1Allowable) Un-merged Business Name: (no business name specified)
void	setReferencedByAdjudResultsGroup(AdjudicatedResultsGroupBean referencedByAdjudResultsGroup) Un-merged Business Name: (no business name specified)
void	setStatusCode(ActStatus statusCode) Business Name: StatusOfTheAdjudicatedInvoice

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

AdjudicationResultIdentifierBean

public AdjudicationResultIdentifierBean()

Method Detail

getReference1Allowable

public AllowableBean getReference1Allowable()

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

Relationship: FICR_MT610201CA.Reference4.allowable

Conformance/Cardinality: POPULATED (1)

Specified by:

getReference1Allowable in interface AdjudicatedInvoiceElementChoice

setReference1Allowable

public void setReference1Allowable(AllowableBean reference1Allowable)

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

Relationship: FICR_MT610201CA.Reference4.allowable

Conformance/Cardinality: POPULATED (1)

Specified by:

setReference1Allowable in interface AdjudicatedInvoiceElementChoice

getId

public Identifier getId()

Business Name: AdjudicatedResultsIdentifier

Un-merged Business Name: AdjudicatedResultsIdentifier

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.id

Conformance/Cardinality: MANDATORY (1)

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

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

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

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.id

Conformance/Cardinality: MANDATORY (1)

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

May include data centre and sequence numbers

setId

public void setId(Identifier id)

Business Name: AdjudicatedResultsIdentifier

Un-merged Business Name: AdjudicatedResultsIdentifier

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.id

Conformance/Cardinality: MANDATORY (1)

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

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

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

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.id

Conformance/Cardinality: MANDATORY (1)

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

May include data centre and sequence numbers

getCode

public ActInvoiceGroupCode getCode()

Business Name: InvoiceType

Un-merged Business Name: InvoiceType

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.code

Conformance/Cardinality: MANDATORY (1)

RXDINV, RXCINV, CSINV, CPINV only.

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).

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, Healthcare Goods, Preferred Accomodation

Un-merged Business Name: InvoiceType

Relationship: QUCR_MT830201CA.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, Healthcare Goods, Preferred Accomodation

setCode

public void setCode(ActInvoiceGroupCode code)

Business Name: InvoiceType

Un-merged Business Name: InvoiceType

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.code

Conformance/Cardinality: MANDATORY (1)

RXDINV, RXCINV, CSINV, CPINV only.

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).

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, Healthcare Goods, Preferred Accomodation

Un-merged Business Name: InvoiceType

Relationship: QUCR_MT830201CA.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, Healthcare Goods, Preferred Accomodation

getStatusCode

public ActStatus getStatusCode()

Business Name: StatusOfTheAdjudicatedInvoice

Un-merged Business Name: StatusOfTheAdjudicatedInvoice

Relationship: FICR_MT610201CA.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 Pharmacy dispense Invoices & Pre-Determinations (RXDINV, RXCINV), only completed EOBs are permitted to facilitate real-time processing.

For Pharmacy clinical product (CPINV) and clinical service (CSINV) Invoices & Pre-Determinations, status may be active, suspended or complete.

For all Coverage Extension Requests, status may be active, suspended or complete. 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).

Status of the Adjudicated Invoice

setStatusCode

public void setStatusCode(ActStatus statusCode)

Business Name: StatusOfTheAdjudicatedInvoice

Un-merged Business Name: StatusOfTheAdjudicatedInvoice

Relationship: FICR_MT610201CA.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 Pharmacy dispense Invoices & Pre-Determinations (RXDINV, RXCINV), only completed EOBs are permitted to facilitate real-time processing.

For Pharmacy clinical product (CPINV) and clinical service (CSINV) Invoices & Pre-Determinations, status may be active, suspended or complete.

For all Coverage Extension Requests, status may be active, suspended or complete. 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).

Status of the Adjudicated Invoice

getNetAmt

public Money getNetAmt()

Business Name: PaidAmount

Un-merged Business Name: PaidAmount

Relationship: FICR_MT610201CA.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: PaidAmount

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.netAmt

Conformance/Cardinality: MANDATORY (1)

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

Grand total of all SOFA observations contained in this summary

setNetAmt

public void setNetAmt(Money netAmt)

Business Name: PaidAmount

Un-merged Business Name: PaidAmount

Relationship: FICR_MT610201CA.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: PaidAmount

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.netAmt

Conformance/Cardinality: MANDATORY (1)

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

Grand total of all SOFA observations contained in this summary

getAuthor

public AdjudicatorBean getAuthor()

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

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.author

Conformance/Cardinality: REQUIRED (0-1)

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

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.author

Conformance/Cardinality: REQUIRED (0-1)

setAuthor

public void setAuthor(AdjudicatorBean author)

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

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.author

Conformance/Cardinality: REQUIRED (0-1)

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

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.author

Conformance/Cardinality: REQUIRED (0-1)

getPredecessorAdjudicatedInvoiceElementGroup

public AdjudicationResultIdentifierBean getPredecessorAdjudicatedInvoiceElementGroup()

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

Relationship: FICR_MT610201CA.AdjudicatedInvoicePredecessor.adjudicatedInvoiceElementGroup

Conformance/Cardinality: POPULATED (1)

setPredecessorAdjudicatedInvoiceElementGroup

public void setPredecessorAdjudicatedInvoiceElementGroup(AdjudicationResultIdentifierBean predecessorAdjudicatedInvoiceElementGroup)

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

Relationship: FICR_MT610201CA.AdjudicatedInvoicePredecessor.adjudicatedInvoiceElementGroup

Conformance/Cardinality: POPULATED (1)

getReferenceAdjudicatedInvoiceElementGroup

public List<AdjudicatedInvoiceElementGroupBean> getReferenceAdjudicatedInvoiceElementGroup()

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

Relationship: FICR_MT610201CA.Reference2.adjudicatedInvoiceElementGroup

Conformance/Cardinality: POPULATED (1)

getCoverage

public List<AdjudicatedInvoiceCoverageBean> getCoverage()

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

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.coverage

Conformance/Cardinality: REQUIRED (0-10)

getComponent

public List<ComponentInvoiceElementBean> getComponent()

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

Relationship: FICR_MT610201CA.AdjudicatedInvoiceElementGroup.component

Conformance/Cardinality: POPULATED (1-5)

getReferencedByAdjudResultsGroup

public AdjudicatedResultsGroupBean getReferencedByAdjudResultsGroup()

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

Relationship: FICR_MT610201CA.AdjudResultsRef.adjudResultsGroup

Conformance/Cardinality: POPULATED (1)

setReferencedByAdjudResultsGroup

public void setReferencedByAdjudResultsGroup(AdjudicatedResultsGroupBean referencedByAdjudResultsGroup)

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

Relationship: FICR_MT610201CA.AdjudResultsRef.adjudResultsGroup

Conformance/Cardinality: POPULATED (1)

getOutcomeOf

public AdjudicatedResultOutcomeBean getOutcomeOf()

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

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.outcomeOf

Conformance/Cardinality: POPULATED (1)

setOutcomeOf

public void setOutcomeOf(AdjudicatedResultOutcomeBean outcomeOf)

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

Relationship: QUCR_MT830201CA.AdjudicatedInvoiceElementGroup.outcomeOf

Conformance/Cardinality: POPULATED (1)