Da Vinci Payer Data Exchange
2.0.0 - STU2 United States of America flag

This page is part of the Da Vinci Payer Data Exchange (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. 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

Claims information typically represents a particular event, such as a procedure or encounter. The CareTeam resource is intended to represent the parties involved in supporting a subject/patient. Where a claim represents an Episode of Care it may be appropriate to record the parties involved in the claim as members of the CareTeam involved in that EpisodeOfCare. For discrete procedures or encounters it MAY not be appropriate to create a CareTeam record from the claims information.

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

US Core Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
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.role S 1..1 ExplanationOfBenefit.careTeam.role [{“165”:”Care Team Role”}]
- CareTeam.participant.member S 1..1 ExplanationOfBenefit.careTeam.provider [{“Ref (93, 96, 98, 99, 173)”:”Provider attending, PCP, operating,
referring and supervising NPIs”}, {“Ref (166, 169, 182, 171, 174)”:”Provider
attending, PCP, operating, referring 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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