Table of Contents 1 1.1 Revision History 1.2 Acknowledgements 2 2.1 Audience 2.2 Purpose 2.3 Scope 2.4 History 2.5 Approach 3 3.1 Essential Reference Material 3.2 Understanding C-CDA 3.2.1 Clinical Document Architecture (CDA) 3.3 ISO Object Identifiers (OID’s) 3.4 Structured/Unstructured Content 3.4.1 Structured Content 3.4.2 Unstructured Content 3.5 Content Types 3.6 Base 64 Encoding Content 3.6.1 Standard for Base 64 Encoding 3.6.2 Uses of Base 64 Encoding 3.6.3 Base 64 Encoding Examples 4 -- 4.1 Attachment Exchange 4.1.1 Solicited and Unsolicited Attachments 4.1.2 Request Attachment Activity 4.1.3 Response Attachment Activity 4.1.4 Understanding Attachment Activities 4.1.5 Attachment Request/Response Re-Association using 4.2 Standards to Accomplish Information Exchange of The Request and Response
Phone call, US Postal Service, Patient request, etc After claim receipt and review Payer request and Rules Based At time of claims submital claim and Prior Authorization Standard After prior receipt and review Payer request and Phone call, US Postal Service, Patient request, etc After prior receipt and review Payer request and Rules Based At time of prior request Prior request and Referral Standard After referral receipt and review Payer request and provide provide submit provide provide
Phone call, US Postal Service, Patient request, etc) After referral receipt and review Payer request and Rules Based At time of referral request referral request and Notification Rules Based At the time of or service, actual or approval for Health Services Review or Post Adjudicated Claim Standard After claim Payer request and Response Attachment Activity The act of exchanging Attachments from an information source to an information receiver is considered a response. The information source is considered the entity that creates provide
To better understand the relationship of the row values for each attachment activity, a “table interpretation template” was developed: Table interpretation template: Activity “Activity ID” represents the information exchange for the “Healthcare Administrative Activity” “Solicited / Unsolicited” “Originator Activity Type” for Attachments from the “Originator” to the “receiver”. By substituting the row values found for each of the heading columns identified in “BOLD” type, a high level use case description can be created. The following examples are derived from the table using the template above: Claim Attachment Scenarios () Activity #1 represents the information exchange for the Claims Attachment solicited request from the payer to the provider. Activity #2 represents the information exchange for the Claims Attachment solicited response from the provider to the payer. Activity #3 represents the information exchange for the Claims unsolicited Attachment submission from the provider to the payer. Prior Authorization Attachment Scenarios () Activity #4 represents the information exchange for the rior uthorization Attachment solicited request from the payer to the provider. Activity #5 represents the information exchange for the rior uthorization solicited response from the provider to the payer. Activity #6 represents the information exchange for the rior uthorization unsolicited Attachment submission from the provider to the payer. Referral Attachment Scenarios () Activity #7 represents the information exchange for the Referral Attachment solicited request from the payer/referred to provider to the referring provider. Activity #8 represents the information exchange for the Referral Attachment solicited response from the referring provider to the payer/referred to provider. Activity #9 represents the information exchange for the eferral unsolicited Attachment submission from the referring provider to the payer/referred to provider. Notification Attachment Scenarios () Activity #10, represents the information exchange for the otification unsolicited Attachment submissions from the facility provider to the primary care provider.
R2 R2 Diagnostic Imaging Report (DIR) 61004-n CCDAR2: Diagnostic Imaging Report R2 Discharge Summary 61005-n CCDAR2: Discharge Summary R2 History and Physical 61006-n CCDAR2: History and Physicial R2 Operative Note 61007-n CCDAR2: Operative Note R2 Procedure Note 61008-n CCDAR2: Procedure Note R2 Progress Note 61009-n CCDAR2: Progress Note R2 Care Plan urn:oid:2.16.840.1.113883.10.20.22.1.15 61010-n CCDAR2: Care Plan R2 Referral Note urn:oid:2.16.840.1.113883.10.20.22.1.14 61011-n CCDAR2: Referral Note R2 Transfer Summary urn:oid:2.16.840.1.113883.10.20.22.1.13 61012-n CCDAR2: Transfer Summary CDP1 Enhanced Encouner Document urn:oid:2.16.840.1.113883.10.20.35.1.1 62001-n CDP1: Enhanced Encouner Document CDP1 Enhanced Discharge Document urn:oid:2.16.840.1.113883.10.20.35.1.2 62002-n CDP1: Enhanced Discharge Document CDP1 Enhanced Operative Note Document urn:oid:2.16.840.1.113883.10.20.35.1.3 62003-n CDP1: Enhanced Operative Note CDP1 Enhanced Procedure Document urn:oid:2.16.840.1.113883.10.20.35.1.4 62004-n CDP1: Enhanced Procedure Note CDP1 Interval Document 62005-n CDP1: Interval Note
History and Physical 34117-2 History and Physical note Table #41 HPDocumentType Interval 77600-5 Interval LOINC code for Interval Document Operative Note 11504-8 Operation Note Table #44 Procedure Note 28570-0 Procedure Note Table #48 Progress Note 11506-3 Progress Note Table# 51 ProgressNoteDocumentTypeCode Referral Note 57133-1 Referral Note Table# 54 ReferralDocumentType Transfer Summary 18761-7 Transfer Summary Table# 57 TransferDocumentType What are C-CDA Document Types? C-CDA Implementaiton Gudes define clinical information in a format based on CDA, constrained by conformance statements consistent with industry best practices for specific types of clinical documents. Some broadly used clinical document types have been more fully developed in CDA than others. Examples of those clinical document types are: In the C-CDA R2 Continuity of Care Document (CCD) Consultation Note Diagnostic Imaging Report (DIR) Discharge Summary History and Physical Operative Note Procedure Note Progress Note Care Plan
R2 Diagnostic Imaging Report (DIR) 61004-n CCDAR2: Diagnostic Imaging Report R2 Discharge Summary 61005-n CCDAR2: Discharge Summary R2 History and Physical 61006-n CCDAR2: History and Physicial R2 Operative Note 61007-n CCDAR2: Operative Note R2 Procedure Note 61008-n CCDAR2: Procedure Note R2 Progress Note 61009-n CCDAR2: Progress Note R2 Care Plan urn:oid:2.16.840.1.113883.10.20.22.1.15 61010-n CCDAR2: Care Plan R2 Referral Note urn:oid:2.16.840.1.113883.10.20.22.1.14 61011-n CCDAR2: Referral Note R2 Transfer Summary urn:oid:2.16.840.1.113883.10.20.22.1.13 61012-n CCDAR2: Transfer Summary CDP1 Enhanced Encouner Document urn:oid:2.16.840.1.113883.10.20.35.1.1 62001-n CDP1: Enhanced Encouner Document CDP1 Enhanced Discharge Document urn:oid:2.16.840.1.113883.10.20.35.1.2 62002-n CDP1: Enhanced Discharge Document CDP1 Enhanced Operative Note Document urn:oid:2.16.840.1.113883.10.20.35.1.3 62003-n CDP1: Enhanced Operative Note CDP1 Enhanced Procedure Document urn:oid:2.16.840.1.113883.10.20.35.1.4 62004-n CDP1: Enhanced Procedure Note CDP1 Interval Document urn:oid:2.16.840.1.113883.10.20.35.1.5 62005-n CDP1: Interval Note