EnrollEligCOB
Class CoordinationOfBenefits

This class represents the results of prior Billing Events, including previous payments, which are used in part to determine the liability of the Payer and of the Patient for the current Billing Event.

Attributes
BenefitStage benefitStage benefitStage

Pointer to a record of the number and dollar amount of payments made in each Medicare Part D stage.

Integer benefitStageCount benefitStageCount

"Count of Benefit Stage Amount occurrences." - NCPDP Telecommunication (Field 392-MU, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Benefit Stage class instances.

BillingSequence billingSequence billingSequence

Pointer to the Billing Event(s) for which Health Plans have previously made payments for the Billable Service.

«TS» PointInTime dateAdjudicated dateAdjudicated

"Payment or denial date of the claim submitted to the other payer. Used for coordination of benefits." - NCPDP Telecommunication (Field 443-E8, Data Dictionary 201104).

String internalControlId internalControlId

"Number assigned by the processor to identify an adjudicated claim when supplied in payer-to-payer coordination of benefits only." - NCPDP Telecommunication (Field 993-A7, Data Dictionary 201104).

«II» Id otherPayerId otherPayerId

"ID assigned to the payer." - NCPDP Telecommunication (Field 340-7C, Data Dictionary 201104). Note that the NCPDP Telecommunication structure uses a separate "qualifier" field (339-6C) to identify what kind of id is being used here (i.e., who issued the id). Possible values include: National Provider Identifier (NPI); Medicare; Medicaid; Health Industry Number (HIN); Bank Information Number (BIN); National Association of Insurance Commissioners (NAIC); Medicare Carrier Number; Other. The FHIM does not model this concept separately, as it is built-in to the the Id data type structure.

PreviousPatientResponsibility previousPatientResponsibility previousPatientResponsibility

Pointer to a set of amounts previously determined by other payers to be the responsibility of the Patient.

Integer previousPatientResponsibilityCount previousPatientResponsibilityCount

"Count of Other Payer-Patient Responsibility Amount and Other Payer-Patient Responsibility Amount Qualifier occurrences." - NCPDP Telecommunication (Field 353-NR, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Previous Patient Responsibility class instances.

PreviousPayment previousPayment previousPayment

Pointer to a set of amounts and categories of any payment(s) known by the pharmacy from other sources.

Integer previousPaymentCount previousPaymentCount

"Count of the payer amount paid occurrences." - NCPDP Telecommunication (Field 341-HB, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Previous Payment class instances.

PreviousRejection previousRejection previousRejection

Pointer to a set of rejections previously made by other payers.

Integer previousRejectionCount previousRejectionCount

"Count of Other Payer Reject Code occurrences." - NCPDP Telecommunication (Field 471-5E, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Previous Rejection class instances.


Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NameCoordinationOfBenefits
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 benefitStage
Public BenefitStage benefitStage

Pointer to a record of the number and dollar amount of payments made in each Medicare Part D stage.

Constraints:
Properties:

AggregationNone
Alias
AssociationcoordinationOfBenefits_benefitStage
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamebenefitStage
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::benefitStage
Stereotype
Template Parameter
TypeBenefitStage
Upper*
Upper Value(*)
VisibilityPublic


 benefitStageCount
Public Integer benefitStageCount

"Count of Benefit Stage Amount occurrences." - NCPDP Telecommunication (Field 392-MU, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Benefit Stage class instances.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedtrue
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamebenefitStageCount
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::benefitStageCount
Stereotype
Template Parameter
TypeInteger
Upper1
Upper Value(1)
VisibilityPublic


 billingSequence
Public BillingSequence billingSequence

Pointer to the Billing Event(s) for which Health Plans have previously made payments for the Billable Service.

Constraints:
Properties:

AggregationNone
Alias
AssociationcoordinationOfBenefits_billingSequence
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamebillingSequence
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::billingSequence
Stereotype
Template Parameter
TypeBillingSequence
Upper*
Upper Value(*)
VisibilityPublic


 dateAdjudicated
Public «TS» PointInTime dateAdjudicated

"Payment or denial date of the claim submitted to the other payer. Used for coordination of benefits." - NCPDP Telecommunication (Field 443-E8, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamedateAdjudicated
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::dateAdjudicated
Stereotype
Template Parameter
Type«TS» PointInTime
Upper1
Upper Value(1)
VisibilityPublic


 internalControlId
Public String internalControlId

"Number assigned by the processor to identify an adjudicated claim when supplied in payer-to-payer coordination of benefits only." - NCPDP Telecommunication (Field 993-A7, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NameinternalControlId
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::internalControlId
Stereotype
Template Parameter
TypeString
Upper1
Upper Value(1)
VisibilityPublic


 otherPayerId
Public «II» Id otherPayerId

"ID assigned to the payer." - NCPDP Telecommunication (Field 340-7C, Data Dictionary 201104). Note that the NCPDP Telecommunication structure uses a separate "qualifier" field (339-6C) to identify what kind of id is being used here (i.e., who issued the id). Possible values include: National Provider Identifier (NPI); Medicare; Medicaid; Health Industry Number (HIN); Bank Information Number (BIN); National Association of Insurance Commissioners (NAIC); Medicare Carrier Number; Other. The FHIM does not model this concept separately, as it is built-in to the the Id data type structure.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameotherPayerId
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::otherPayerId
Stereotype
Template Parameter
Type«II» Id
Upper1
Upper Value(1)
VisibilityPublic


 previousPatientResponsibility
Public PreviousPatientResponsibility previousPatientResponsibility

Pointer to a set of amounts previously determined by other payers to be the responsibility of the Patient.

Constraints:
Properties:

AggregationNone
Alias
AssociationcoordinationOfBenefits_previousPatientResponsibility
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamepreviousPatientResponsibility
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::previousPatientResponsibility
Stereotype
Template Parameter
TypePreviousPatientResponsibility
Upper*
Upper Value(*)
VisibilityPublic


 previousPatientResponsibilityCount
Public Integer previousPatientResponsibilityCount

"Count of Other Payer-Patient Responsibility Amount and Other Payer-Patient Responsibility Amount Qualifier occurrences." - NCPDP Telecommunication (Field 353-NR, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Previous Patient Responsibility class instances.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedtrue
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamepreviousPatientResponsibilityCount
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::previousPatientResponsibilityCount
Stereotype
Template Parameter
TypeInteger
Upper1
Upper Value(1)
VisibilityPublic


 previousPayment
Public PreviousPayment previousPayment

Pointer to a set of amounts and categories of any payment(s) known by the pharmacy from other sources.

Constraints:
Properties:

AggregationNone
Alias
AssociationcoordinationOfBenefits_previousPayment
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamepreviousPayment
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::previousPayment
Stereotype
Template Parameter
TypePreviousPayment
Upper*
Upper Value(*)
VisibilityPublic


 previousPaymentCount
Public Integer previousPaymentCount

"Count of the payer amount paid occurrences." - NCPDP Telecommunication (Field 341-HB, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Previous Payment class instances.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedtrue
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamepreviousPaymentCount
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::previousPaymentCount
Stereotype
Template Parameter
TypeInteger
Upper1
Upper Value(1)
VisibilityPublic


 previousRejection
Public PreviousRejection previousRejection

Pointer to a set of rejections previously made by other payers.

Constraints:
Properties:

AggregationNone
Alias
AssociationcoordinationOfBenefits_previousRejection
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamepreviousRejection
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::previousRejection
Stereotype
Template Parameter
TypePreviousRejection
Upper*
Upper Value(*)
VisibilityPublic


 previousRejectionCount
Public Integer previousRejectionCount

"Count of Other Payer Reject Code occurrences." - NCPDP Telecommunication (Field 471-5E, Data Dictionary 201104). Note that this property is marked as derived, since this number can be calculated from the number of Previous Rejection class instances.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoordinationOfBenefits
Datatype
Default
Default Value
Is Compositefalse
Is Derivedtrue
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamepreviousRejectionCount
Name Expression
NamespaceCoordinationOfBenefits
Opposite
OwnerCoordinationOfBenefits
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CoordinationOfBenefits::previousRejectionCount
Stereotype
Template Parameter
TypeInteger
Upper1
Upper Value(1)
VisibilityPublic