This page is part of the Da Vinci Payer Data Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions 
3-6-3 US Core Encounter
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Section Guide:
- Implementation...
- - Actors
- - Exchange Interactions
- - Data Payloads
- - Interaction Methods
- - Interaction and Payload Matrix
- - Data Mapping
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An example mapping of Health Plan data for Members to the US Core Encounter profile is shown below:
| Line | PayerSourceRecord | CMS BB 2.0 Field | Data Descriptor | FHIR Profile | Profile Field | ValueSet | Notes |
|---|---|---|---|---|---|---|---|
| 1.5 | Member | BENE_ID | Patientid | US Core Encounter | .subject | Reference(Patient) | |
| 1.1 | Claim | Claim service start date | US Core Encounter | .period.start | |||
| 2.1 | Claim | Claim service end date | US Core Encounter | .period.end | |||
| 5.1 | Claim | Member admission date | US Core Encounter | .period.start | Overrides claim service start date | ||
| 6.1 | Claim | Member discharge date | US Core Encounter | .period.end | Overrides claim service end date | ||
| 7.2 | Claim | Patient account number | US Core Encounter | .subject | Reference(Patient) | ||
| 9.1 | Claim | Claim unique identifier | US Core Encounter | .identifier.id | |||
| 12.1 | Claim | Claim diagnosis related group | US Core Encounter | .diagnosis.id | .diagnosis.use | ||
| 13.1 | Claim | Claim inpatient source admission code | US Core Encounter | .class | http://hl7.org/fhir/R4/v3/ActEncounterCode/vs.html | ||
| 14.1 | Claim | Claim inpatient admission type code | US Core Encounter | .type | http://hl7.org/fhir/us/core/STU3/ValueSet-us-core-encounter-type.html | CPT Coding | |
| 21.1 | Claim | Patient discharge status code | US Core Encounter | .hospitalization.dischargeDisposition | |||
| 2.1 | Claim-Line | Line number | US Core Encounter | .diagnosis.id | |||
| 3.1 | Claim-Line | Service to date | US Core Encounter | .diagnosis.condition.Reference(Procedure).occurence.occurrencePeriod.end | |||
| 4.1 | Claim-Line | Type of service | US Core Encounter | .diagnosis.condition.Reference(Procedure).type | |||
| 5.1 | Claim-Line | Place of service code | US Core Encounter | .location.location.Reference(Location).type | |||
| 1.1 | Diagnosis | Diagnosis code | US Core Encounter | .diagnosis.condition | |||
| 2.1 | Diagnosis | Present on admission | US Core Encounter | .diagnosis.condition | http://hl7.org/fhir/R4/valueset-diagnosis-role.html | .diagnosis.use | |
| 3.1 | Diagnosis | Diagnosis code type | US Core Encounter | .diagnosis.condition.Reference(Condition).code |
Where an entry is provided in the CMS BB2.0 FIELD column the definition of the field can be reviewed using the following URL:
https://bluebutton.cms.gov/resources/variables/{CMS_BB2.0_FIELD}/
Where {CMS_BB2.0_FIELD} is replaced with the Field value in lower case. For example:
https://bluebutton.cms.gov/resources/variables/bene_id/ https://bluebutton.cms.gov/resources/variables/dob_dt/
The minimum fields to be provided in the US Core Encounter resource are:
| R4 Hierarchical Name | R4 Name | Card. | Type | |
|---|---|---|---|---|
| Encounter | Encounter | 0..* | ||
| Encounter.id | id | 0..1 | id | |
| Encounter.identifier | identifier | 0..* | Identifier | |
| Encounter.identifier.system | system | 1..1 | uri | |
| Encounter.identifier.value | value | 1..1 | string | |
| Encounter.status | status | 1..1 | code | |
| Encounter.class | class | 1..1 | Coding | |
| Encounter.type | type | 1..* | CodeableConcept | |
| Encounter.subject | subject | 1..1 | Reference(US Core Patient Profile) | |
| Encounter.participant | participant | 0..* | BackboneElement | |
| Encounter.participant.type | type | 0..* | CodeableConcept | |
| Encounter.participant.period | period | 0..1 | Period | |
| Encounter.participant.individual | individual | 0..1 | Reference(US Core Practitioner Profile) | |
| Encounter.period | period | 0..1 | Period | |
| Encounter.reasonCode | reasonCode | 0..* | CodeableConcept | |
| Encounter.diagnosis | diagnosis | 0..* | BackboneElement | |
| Encounter.diagnosis.condition | condition | 1..1 | Reference(US Core Condition Profile | US Core Procedure Profile) |
| Encounter.diagnosis.rank | rank | 0..1 | positiveInt | |
| Encounter.hospitalization | hospitalization | 0..1 | BackboneElement | |
| Encounter.hospitalization.dischargeDisposition | dischargeDisposition | 0..1 | CodeableConcept | |
| Encounter.location | location | 0..* | BackboneElement | |
| Encounter.location.location | location | 1..1 | Reference(US Core Location Profile) |
3-6-3-1 Example Encounter Resource
An example mapping of an Encounter resource is shown here:
TODO: Add Encounter Resource in JSON format
Refer to the US Core Additional examples of the US Core R4 Implementation Guide for further examples of completed Encounter Profiles .
