Da Vinci Payer Data Exchange
1.0.0 - STU1

This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

US Core CareTeam

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Where a Health Plan has access to Information about the CareTeam for a member they SHALL make the information available using the US Core CareTeam resource.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core CareTeam resource are:

R4 Element Name Cardinality Type
CareTeam.status status 0..1 code
CareTeam.subject subject 1..1 Reference(US Core Patient Profile)
CareTeam.participant participant 1..* BackboneElement
CareTeam.role role 1..1 CodeableConcept
CareTeam.member member 1..1 Reference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)

Table Definition

The essential fields to be provided in the CareTeam resource from the CPCDS file are:

US Core Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
- CareTeam.meta.lastUpdated   0..1 ExplanationOfBenefit.meta.lastUpdated [{“163”:”Member Demographics Last Updated Date”}]
CareTeam.status S 0..1   . Note: When generated from claim set to [ active]
CareTeam.subject S 1..1 ExplanationOfBenefit.patient [{“Ref (1)”:”Member id”}
CareTeam.encounter   0..1   . Note: Reference Encounter generated from claim/EOB
CareTeam.period   0..1 ExplanationOfBenefit.item.servicedPeriod | ExplanationOfBenefit.item.servicedDate [{“Ref (177, 178)”:”Statement from date, Statement through date
”}, {“Ref (90,119)”:”Service From date, Service to date”}
CareTeam.participant S 1..* ExplanationOfBenefit.careTeam.provider . Note: Enter practitioner information in sub-elements below
- CareTeam.participant.role S 1..1 ExplanationOfBenefit.careTeam.role [{“165”:”Care Team Role”}]
- CareTeam.participant.member S 1..1 ExplanationOfBenefit.careTeam.member [{“Ref (93, 96, 98, 99, 173)”:”Provider attending, PCP, operating, refering and supervising NPIs”}, {“Ref (166, 169, 182, 171, 174)”:”Provider attending, PCP, operating, refering and supervising names”}, {“Ref (94, 167)”:”Claim Billing Provider NPI, Claim Billing Provider Name”}

Table Definition

Example CareTeam Resource

An example mapping of a CareTeam is shown below:

{
  "resourceType" : "CareTeam",
  "id" : "example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">
Generated Narrative with Details
id: example
meta: 
status: active
name: US-Core example CareTeam
subject: <a href=\"Patient-example.html\">Amy V. Shaw. Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a>
participant
role: Allopathic &amp; Osteopathic Physicians:Internal Medicine:Cardiovascular Disease <span style=\"background: LightGoldenRodYellow\">(Details : {http://nucc.org/provider-taxonomy code '207RC0000X' = 'Cardiovascular Disease', given as 'Allopathic &amp; Osteopathic Physicians:Internal Medicine:Cardiovascular Disease'})</span>
member: <a href=\"Practitioner-practitioner-1.html\">Ronald Bone, MD. Generated Summary: id: practitioner-1; 9941339108, 25456; Ronald Bone </a>
participant
role: Allopathic &amp; Osteopathic Physicians:General Practice <span style=\"background: LightGoldenRodYellow\">(Details : {http://nucc.org/provider-taxonomy code '208D00000X' = 'General Practice', given as 'Allopathic &amp; Osteopathic Physicians:General Practice'})</span>
member: <a href=\"Practitioner-practitioner-2.html\">Kathy Fielding, MD. Generated Summary: id: practitioner-2; 1245319599, 456789; Fielding Kathy </a>
participant
role: Patient (person) <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '116154003' = 'Patient', given as 'Patient (person)'})</span>
member: <a href=\"Patient-example.html\">Amy V. Shaw. Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a>
</div>"
  },
  "status" : "active",
  "name" : "US-Core example CareTeam",
  "subject" : {
    "reference" : "Patient/example",
    "display" : "Amy V. Shaw"
  },
  "participant" : [
    {
      "role" : [
        {
          "coding" : [
            {
              "system" : "http://nucc.org/provider-taxonomy",
              "code" : "207RC0000X",
              "display" : "Allopathic & Osteopathic Physicians:Internal Medicine:Cardiovascular Disease"
            }
          ]
        }
      ],
      "member" : {
        "reference" : "Practitioner/practitioner-1",
        "display" : "Ronald Bone, MD"
      }
    },
    {
      "role" : [
        {
          "coding" : [
            {
              "system" : "http://nucc.org/provider-taxonomy",
              "code" : "208D00000X",
              "display" : "Allopathic & Osteopathic Physicians:General Practice"
            }
          ]
        }
      ],
      "member" : {
        "reference" : "Practitioner/practitioner-2",
        "display" : "Kathy Fielding, MD"
      }
    },
    {
      "role" : [
        {
          "coding" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "116154003",
              "display" : "Patient (person)"
            }
          ]
        }
      ],
      "member" : {
        "reference" : "Patient/example",
        "display" : "Amy V. Shaw"
      }
    }
  ]
}

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