DaVinci PDEX Plan Net
1.1.0 - STU 1.1 US

This page is part of the DaVinci PDEX Plan Net (v1.1.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: Plan-Net Network

Official URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-Network Version: 1.1.0
Active as of 2022-04-04 Computable Name: PlannetNetwork

A Network refers to a healthcare provider insurance network. A healthcare provider insurance network is an aggregation of organizations and individuals that deliver a set of services across a geography through health insurance products/plans. A network is typically owned by a payer.

In the PlanNet IG, individuals and organizations are represented as participants in a PLan-Net Network through the practitionerRole and Plan-Net-organizationAffiliation resources, respectively.

Implementation Guidance

  • The Network profile is based on USCore Organization, since there was no contradiction between the USCore profile and the Plan-Net requirements. However, the NPI and CLIA identifier types, which are Must-Support, are clearly intended for provider organizations only and are not expected to be populated for other organization types.
  • The Plan-Net Network and Organization profiles are both based on the Organization profile. To selectively query only Network profiles, search for type = 'ntwk'. To selectively query only Organization profiles, search for type = 'fac,bus,prvgrp,payer,atyprv'.
  • When the contact is a department name, rather than a human (e.g., patient help line), include a blank family and given name, and provide the department name in contact.name.text.
  • Note that the relationship between InsurancePlans and Networks is many-to-many. A plan may be associated with multiple networks, and a network may be associated with many plans. In this IG, this is modeled by having InsurancePlans reference networks (directionality of relationship supports this).
  • To use the location-reference extension to indicate a network coverage area, the preferred form of reference is to create a Location instance with the State or region specified, and possibly provide a GeoJSON.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from USCoreOrganizationProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization 0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... meta
.... lastUpdated 1..1instantWhen the resource version last changed
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
.... type S0..1CodeableConceptDescription of identifier
... active 1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type S1..1CodeableConceptKind of organization
Binding: Network Type VS (required)
... telecom 0..0
... partOf S1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-availabletime 0..*(Complex)Contactpoint Availabletime
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization I0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣI0..*IdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:NPI SΣI0..1IdentifierNational Provider Identifier (NPI)

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:CLIA ΣI0..1IdentifierClinical Laboratory Improvement Amendments (CLIA) Number for laboratories

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!SΣ1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type SΣ1..1CodeableConceptKind of organization
Binding: Network Type VS (required)
... name SΣI1..1stringName used for the organization
... alias 0..*stringA list of alternate names that the organization is known as, or was known as in the past
... address SI0..*AddressAn address for the organization
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district Σ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23","end":"2010-07-01"}
... partOf SΣ1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... contactpoint-availabletime 0..*(Complex)Contactpoint Availabletime
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system SΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization I0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... location-reference 0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
... Slices for identifier ΣI0..*IdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ0..1uriThe namespace for the identifier value
..... value Σ0..1stringThe value that is unique
.... identifier:NPI ΣI0..1IdentifierNational Provider Identifier (NPI)

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
... active ?!Σ1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... name ΣI1..1stringName used for the organization
... address I0..*AddressAn address for the organization
.... line Σ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
.... city Σ0..1stringName of city, town etc.
.... state Σ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode Σ0..1stringUS Zip Codes
.... country Σ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
... partOf Σ1..1Reference(Plan-Net Organization)The organization that manages this network
... contact 0..*BackboneElementContact for the organization for a certain purpose
.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
..... system ΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value Σ0..1stringThe actual contact point details
... endpoint 0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

Differential View

This structure is derived from USCoreOrganizationProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization 0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... meta
.... lastUpdated 1..1instantWhen the resource version last changed
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
.... type S0..1CodeableConceptDescription of identifier
... active 1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type S1..1CodeableConceptKind of organization
Binding: Network Type VS (required)
... telecom 0..0
... partOf S1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... contactpoint-availabletime 0..*(Complex)Contactpoint Availabletime
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system S0..1codephone | fax | email | pager | url | sms | other
..... value S0..1stringThe actual contact point details
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization I0..*USCoreOrganizationProfileA grouping of people or organizations with a common purpose
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... location-reference S0..*Reference(Plan-Net Location)Network coverage area
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/location-reference
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣI0..*IdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:NPI SΣI0..1IdentifierNational Provider Identifier (NPI)

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:CLIA ΣI0..1IdentifierClinical Laboratory Improvement Amendments (CLIA) Number for laboratories

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!SΣ1..1booleanWhether the organization's record is still in active use
Fixed Value: true
... type SΣ1..1CodeableConceptKind of organization
Binding: Network Type VS (required)
... name SΣI1..1stringName used for the organization
... alias 0..*stringA list of alternate names that the organization is known as, or was known as in the past
... address SI0..*AddressAn address for the organization
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district Σ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23","end":"2010-07-01"}
... partOf SΣ1..1Reference(Plan-Net Organization)The organization that manages this network
... contact S0..*BackboneElementContact for the organization for a certain purpose
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S0..1HumanNameA name associated with the contact
.... telecom S0..*ContactPointContact details (telephone, email, etc.) for a contact
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... contactpoint-availabletime 0..*(Complex)Contactpoint Availabletime
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/contactpoint-availabletime
..... via-intermediary 0..*Reference(Plan-Net PractitionerRole | Plan-Net OrganizationAffiliation | Plan-Net Location | Plan-Net Organization)Via Intermediary
URL: http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/via-intermediary
..... system SΣI0..1codephone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ0..1stringThe actual contact point details
..... use ?!Σ0..1codehome | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank Σ0..1positiveIntSpecify preferred order of use (1 = highest)
..... period Σ0..1PeriodTime period when the contact point was/is in use
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint S0..*Reference(Plan-Net Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Organization.meta.securityextensibleAll Security Labels
Organization.meta.tagexampleCommonTags
Organization.languagepreferredCommonLanguages
Max Binding: AllLanguages
Organization.identifier.userequiredIdentifierUse
Organization.identifier.typeextensibleIdentifier Type Codes
Organization.typerequiredNetworkTypeVS
Organization.address.userequiredAddressUse
Organization.address.typerequiredAddressType
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes
Organization.contact.purposeextensibleContactEntityType
Organization.contact.telecom.systemrequiredContactPointSystem
Organization.contact.telecom.userequiredContactPointUse