EnrollEligCOB
Class CertificateOfMedicalNecessity

A Certificate of Medical Necessity is a document required by Centers for Medicare and Medicaid Services to substantiate the medical necessity of an item (e.g., a durable medical equipment) or service furnished to a Medicare beneficiary. Medical necessity is a legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. By statute, Medicare may only pay for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member", unless there is another statutory authorization for payment. - adapted from wikipedia.

Attributes
Answer assessmentResponse assessmentResponse

Pointer to a set of questions and answers. The FHIM reuses a structure built for this purpose from the Assessment domain. This association to the assessment response/question corresponds to the following fields in the NCPDP Telecommunication standard: 378-4B, Question Number/Letter; 379-4D, Question Percent Response; 379-4D, Question Date Response; 381-4H, Question Dollar Amount Response; 382-4J, Question Numeric Response; 383-4K, Question Alphanumeric Response.

«CS» Code category category

"Unique identifier for the data being submitted." - NCPDP Telecommunication (Field 369-2Q, Data Dictionary 201104). Possible values include: Hospital Beds; Support Surfaces; Motorized Wheel Chair; Manual Wheelchair; Continuous Positive Airway Pressure (CPAP); Lymphedema Pumps; Osteogenesis Stimulator; Transcutaneous Electrical Nerve Stimulator TENS); Seat Lift Mechanisms; Power Operated Vehicles (POV); Immunosuppressive Drugs; Infusion Pump; Parenteral Nutrition; Enteral Nutrition; Oxygen.

«TS» PointInTime dateBegin dateBegin

"The beginning date of need." - NCPDP Telecommunication (Field 374-2V, Data Dictionary 201104).

«TS» PointInTime dateRevisedOrRecertified dateRevisedOrRecertified

"The effective date of the revision or re-certification provided by the certifying physician." - NCPDP Telecommunication (Field 375-2W, Data Dictionary 201104).

«TS» PointInTime dateSigned dateSigned

"The date the form was completed and signed by the ordering physician." - NCPDP Telecommunication (Field 372-2T, Data Dictionary 201104).

«PQ» TimeQuantity lengthOfNeed lengthOfNeed

"Length of time the physician expects the patient to require use of the ordered item." - NCPDP Telecommunication (Field 370-2R, Data Dictionary 201104). Note that the NCPDP Telecommunication structure uses a separate "qualifier" field (371-2S) to provide the units of measure for the time quantity represented in 370-2R. Possible values include: Hours; Days; Weeks; Months; Years; Lifetime; Not Specified. Note that each of these units, except for "Lifetime" are handled in the TimeQuantity datatype.

String narrative narrative

"Free text message" - NCPDP Telecommunication (Field 376-2X, Data Dictionary 201104).

Integer questionCount questionCount

"Count of Question Number/Letter occurrences." - NCPDP Telecommunication (Field 377-2Z, Data Dictionary 201104). Note that this is modeled as a derived property as it may potentially be calculated based on the number of Assessment Instrument Response instances.

«CS» Code requestStatus requestStatus

"Code identifying type of request." - NCPDP Telecommunication (Field 373-2U, Data Dictionary 201104). Possible values include: Initial; Revision; Recertification; Not Specified.


Properties:

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

Attribute Details

 assessmentResponse
Public Answer assessmentResponse

Pointer to a set of questions and answers. The FHIM reuses a structure built for this purpose from the Assessment domain. This association to the assessment response/question corresponds to the following fields in the NCPDP Telecommunication standard: 378-4B, Question Number/Letter; 379-4D, Question Percent Response; 379-4D, Question Date Response; 381-4H, Question Dollar Amount Response; 382-4J, Question Numeric Response; 383-4K, Question Alphanumeric Response.

Constraints:
Properties:

AggregationNone
Alias
AssociationcertificateOfMedicalNecessity_assessmentResponse
Association End
ClassCertificateOfMedicalNecessity
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*
NameassessmentResponse
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::assessmentResponse
Stereotype
Template Parameter
TypeAnswer
Upper*
Upper Value(*)
VisibilityPublic


 category
Public «CS» Code category

"Unique identifier for the data being submitted." - NCPDP Telecommunication (Field 369-2Q, Data Dictionary 201104). Possible values include: Hospital Beds; Support Surfaces; Motorized Wheel Chair; Manual Wheelchair; Continuous Positive Airway Pressure (CPAP); Lymphedema Pumps; Osteogenesis Stimulator; Transcutaneous Electrical Nerve Stimulator TENS); Seat Lift Mechanisms; Power Operated Vehicles (POV); Immunosuppressive Drugs; Infusion Pump; Parenteral Nutrition; Enteral Nutrition; Oxygen.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
Namecategory
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::category
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 dateBegin
Public «TS» PointInTime dateBegin

"The beginning date of need." - NCPDP Telecommunication (Field 374-2V, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
NamedateBegin
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::dateBegin
Stereotype
Template Parameter
Type«TS» PointInTime
Upper1
Upper Value(1)
VisibilityPublic


 dateRevisedOrRecertified
Public «TS» PointInTime dateRevisedOrRecertified

"The effective date of the revision or re-certification provided by the certifying physician." - NCPDP Telecommunication (Field 375-2W, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
NamedateRevisedOrRecertified
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::dateRevisedOrRecertified
Stereotype
Template Parameter
Type«TS» PointInTime
Upper1
Upper Value(1)
VisibilityPublic


 dateSigned
Public «TS» PointInTime dateSigned

"The date the form was completed and signed by the ordering physician." - NCPDP Telecommunication (Field 372-2T, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
NamedateSigned
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::dateSigned
Stereotype
Template Parameter
Type«TS» PointInTime
Upper1
Upper Value(1)
VisibilityPublic


 lengthOfNeed
Public «PQ» TimeQuantity lengthOfNeed

"Length of time the physician expects the patient to require use of the ordered item." - NCPDP Telecommunication (Field 370-2R, Data Dictionary 201104). Note that the NCPDP Telecommunication structure uses a separate "qualifier" field (371-2S) to provide the units of measure for the time quantity represented in 370-2R. Possible values include: Hours; Days; Weeks; Months; Years; Lifetime; Not Specified. Note that each of these units, except for "Lifetime" are handled in the TimeQuantity datatype.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
NamelengthOfNeed
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::lengthOfNeed
Stereotype
Template Parameter
Type«PQ» TimeQuantity
Upper1
Upper Value(1)
VisibilityPublic


 narrative
Public String narrative

"Free text message" - NCPDP Telecommunication (Field 376-2X, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
Namenarrative
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::narrative
Stereotype
Template Parameter
TypeString
Upper1
Upper Value(1)
VisibilityPublic


 questionCount
Public Integer questionCount

"Count of Question Number/Letter occurrences." - NCPDP Telecommunication (Field 377-2Z, Data Dictionary 201104). Note that this is modeled as a derived property as it may potentially be calculated based on the number of Assessment Instrument Response instances.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
NamequestionCount
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::questionCount
Stereotype
Template Parameter
TypeInteger
Upper1
Upper Value(1)
VisibilityPublic


 requestStatus
Public «CS» Code requestStatus

"Code identifying type of request." - NCPDP Telecommunication (Field 373-2U, Data Dictionary 201104). Possible values include: Initial; Revision; Recertification; Not Specified.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCertificateOfMedicalNecessity
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
NamerequestStatus
Name Expression
NamespaceCertificateOfMedicalNecessity
Opposite
OwnerCertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::CertificateOfMedicalNecessity::requestStatus
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic