Organization: Ontario Association of Community Care Access Centres (oaccac)



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Table of Contents

1.Purchased Service Referral 19

1.1Brief Description 19

High Level Structure of the Service Referral 19

2.Service Referral Elements (version 2.22) 20

2.1ServiceReferral element detail 20

2.2Service element detail 26

2.3Outcome-Based Pathway Assignment element detail 31

2.4Frequency element detail 38

2.5ServiceRecipient element detail 41

2.6Client element detail 41

Address element detail 54

2.7ServicePlanSummary element detail 55

2.8ProviderReportResponse element detail 57

3.Appendix A - Service attribute values 63

3.1Service Type Codes 63

3.2Service Delivery Location 67

3.3Specialty 67

4.Appendix B - Service Delivery Type 69

5.Appendix C - ISO 639-2 Language Codes 96


  1. Purchased Service Referral

    1. Brief Description

Once it is determined that a Client needs to receive a Purchased Service, the CCAC may issue a Service Offer to the chosen Service Provider for them to Accept or Reject. Once the Offer is accepted, a Service Referral is sent to that Provider to more fully describe the details and the context of the service that is required. Should the need occur to change the Service frequency, the CCAC will send another Service Referral (for Frequency Update) to the Provider with a set of Frequency elements containing the appropriate changes.

This document specifies the information and associated format of Service Referral.

High Level Structure of the Service Referral

The Service Referral and Service Referral Update are XML documents that share the following high level element structure:



Figure 1 Service Referral

As the diagram above depicts, a ServiceReferral and ServiceReferralUpdate element contain one Service element, one ServiceRecipient element and possibly one ServicePlanSummary element. The Service element itself contains one to many Frequency and/or Outcome-Based Pathway elements and the ServiceRecipient element contains a single Client element. These are the principal elements that make up a Service Referral and there is a section below to more fully specify each of them.



  1. Service Referral Elements (version 2.22)

The following tables detail the fields contained within the elements that make up a Service Referral as outlined in Figure 2 in a previous section. The Service Referral Update is a subset of the Service Referral and is documented in the following chapter.

    1. ServiceReferral element detail

Name

Field Length (chars)

Type

Mandatory

?


Description

Version (Attribute of ServiceReferral element)

Max 10

Alpha / num

Yes

The version of the schema that this element adheres to. E.g. "1.0". This is required for the receiving provider to correctly interpret the information being provided by the CCAC

MessageTrackingId

36

Alpha/Num (GUID)

Yes

The unique identifier of the message that can be used for tracking

Sender (parent element)

-

-

Yes

A group of elements and attributes identifying the sender of the document.

Destination (parent element)

-

-

Yes

A group of elements and attributes identifying the recipient of the document

Organization (child element of Sender or Destination)

-

-

Yes

Identifies the organization sending or receiving the document

Code (attribute of Organization)

50

Alpha/Num

Yes

Specifies the unique code of the sender or the recipient organization

Type (attribute of Organization)

150

Alpha/Num

Yes

Specifies the type of the sender organization. Valid content is:
“CCAC”
“Provider”
“Vendor”


Name (child of Organization)

250

Alpha

No

The name of the sender or the recipient organization

OwnerOrganization (child of Organization)

-

-

Yes

Specifies the owner organization of the sender or the recipient

Code (attribute of OwnerOrganization)

50

Alpha/Num

Yes

Specifies the unique code of the sender or the recipient owner organization

Type (attribute of OwnerOrganization)

150

Alpha/Num

No

Specifies the type of the sender or the recipient owner organization. Valid content is “CCAC”, “Provider” or “Vendor”. If not provided the “CCAC” type is assumed.

Name (child element of OwnerOrganization)

250

Alpha

No

The name of the sender or the recipient owner organization

ProviderAssignmentId

25

Alpha / num

Yes

A CCAC assigned number that uniquely identifies this item

ServiceAssignmentId

25

Alpha / Num (GUID)

Yes

A CCAC assigned number that uniquely identifies service assignment for the referral. This number can be retrieved from the ServiceReferral and ServiceFrequencyUpdate messages

OfferId

Max 25

Alpha / num

No

The unique identifier for the Offer associated with this Referral

OrganizationCode

10

Num

Yes

A unique number assigned to Vendor by local CCAC. Reference may be “provider” or “vendor” organization

TransmissionDateTime

14

Date

Yes

Date and Time (yyyy-mm-ddThh:mm) when the Referral was sent by the CCAC to the Provider

OfferDateTime

10

DateTime

No

Date and time when service was offered

CcacCode

2 - 4

Alpha

Yes

A unique number for the CCAC. Valid values are: "ESC" |"SW" | "WW" | "HNHB" | "CW" | "MH" |"TC" | "CENT"| "CE"| "SE" | "CHAM"| "NSM"| "NE" | "NW"

BillingReferenceNumber

12

Num

Yes

A code that identifies this Referral and quoted by the provider in their Billing Invoice

ContractCode

Max 20

Alpha / num

Yes

Contract Number assigned to Service Provider by the CCAC when the contract was entered into

BillingCodes (element)







No

List of Billing Codes that may be applied to the services provided

BillingCode (element)







No

Billing Code group containing the code and description

Code







Yes

The code assigned based on the contracted service

Description







Yes

The descriptive name of the billing code

ServiceTypeDeliveryType

500

Alpha / Num

No

The Service Type -Service Delivery Type associated to the billing code

[Service_Types].[Service_Type_Desc]

-“



[Ser_Delivery_Types]. [Ser_Delivery_Type]

ReferralType

Max 100

Alpha / num

Yes

Categorizes the referral into "HomeCare", "School", or "Children’s Treatment Network"

RequestType

Max 25

Alpha

Yes

Defines the type of action for the Referral; can be set to one of the following values: "New", "Update", “FrequencyUpdate

NotificationNotes

250

Alpha / num

No

Additional information the CCAC would like the provider to know about the Service Referral

ServiceInstructions (element)

-

Element

Yes

Contains all of the fields that provide instructions for this service

(The elements should be in this order)

FocusOfIntervention

250

Alpha / num

Yes

Ensures that the CCAC and the provider have a common understanding of the needs of the client. For clients who have been assessed using the RAI-HC instrument, the focus of intervention will have been informed by the CAPS output of the assessment.

In the absence of client / referral level service planning documentation, the client’s needs are documented for each service, and are shared with the assigned provider.

ServicePlanGoals

250

Alpha / num

Yes

A list of specific, measurable, acceptable (to client/family), realistic, time limited goals, to be achieved through the service provider’s intervention(s)

Treatment Orders

250

Alpha / num

Yes

Reference to any medical referral(s) that relate to the required treatment(s)

Should also include references to a prescription, if a prescription is being sent as part of the referral package

ProviderInstructions

250

Alpha

No

Specific instructions to the provider from the CCAC.

ProviderReportResponse

--

element

No

See ProviderReportResponse element detail

ContentUpdateClientEvents

-

Element

No

Contains all of the client events that occurred since the last service referral notification transmission

ContentUpdateClientEvent

-

Element

No

Represnts an individual client event that occurred since the last service referral notification transmission

ClientEventTypeCode

50

Alpha / num

No

A unique code representing the client event type

ClientEventTypeDescription

500

Alpha / num

No

A description of the client event type

NotificationFlag

50

Alpha / num

No

One of the following:

  • New

  • Discharge

  • On/Off Hold

  • Service Updates

  • Other Updates



    1. Service element detail



Name

Field Length (chars)

Type

Mandatory?

Description

ServiceTypeCode

Max 30

Alpha

Yes

Identifies the general service to be delivered to the client; See Description of Service Type Codes in Appendix A for list of valid values. The code that represents the service type

ServiceDeliveryType

Max 50

Alpha

Yes

Identifies a more specific service within the general ServiceType to be delivered to the client; See Service Delivery Type Code in Appendix B for list of valid values

UnitOfService

Max 10

Alpha

Yes

Code assigned by CCAC for the units in which the service is to be delivered (e.g., HOUR, VISIT)

SpecialtyCode

Max 50

Alpha

No

Optional information that identifies a specialty associated with the Service Type; See Appendix A for list of valid values

ServiceDeliveryLocationCode

Max 50

Alpha

No

The location where the service is to be delivered; See Service Location in Appendix B for list of valid values

DateServiceRequiredBy

10

Date

No

Date (yyyy-mm-dd) that the service must be started by

RequiredFirstVisitDate

10

Date

No

Date (yyyy-mm-dd) that first visit must occur on

LocalDistinction

250

Alpha / num

No

In addition to geographic areas, contracts can be further defined by other locally defined distinctions.

The local distinction will be used by CCACs who have separate contracts for specific client groups, such as Children / Adults / ABI distinctions for OT.



GeographicArea

250

Alpha / num

No

CCACs can further define contracts specific to a geographic area, or a local contract distinction.

A geographic area is a named area that represents some part of the whole area serviced by the CCAC. A CCAC may define this area in terms of North / South / East / West or cities and towns within the geographical boundaries of the CCAC. Alternately, the geographic area may be defined as the area services by one branch of the CCAC.



Where providers are contracted for specific parts of the geographic area of the whole CCAC, this geographic area distinction is used.

Authorization (element)

-

element

Yes

This element defines the service dates and amounts that have been authorized by the CCAC case manager; it contains the following fields ...

AuthorizingCaseManagerName

50

Alpha

Yes

The name of the Case Manager that authorized this service

InitialOfferContactName

50

Alpha

No

The name of the person responsible for this offer

ReferralTeam

50

Alpha

No

Team name responsible for the Client (referral).

ReferralCaseload

20

Alpha

No

Caseload name responsible for the Client (referral).

CaseloadStaff




element

No

Collection of employee names responsible for the caseload. Typically this is a one or two item collection.

Employee




element

No

Employee responsible for the Caseload.

Name

50

Alpha

No

Employee name responsible for the Caseload.

Sender




element

No

The name of the sender of this referral or person who sent the original Offer

Name

50

Alpha

No

For new referral, it is the name of person who sent the original Offer. For update referral, it is the name of the person who update the referral

CarePathways




Element

Yes




CarePathwayAssignment




Element

No

See Outcome-Based Pathway Assignment element details

A collection of Outcome-Based Pathway Assignments for the Service

Frequencies

-

element

No

The Frequency for the Service

Frequency

-

element

No

Frequency for the Service (see Frequency element below for details)

FrequencyPeriodCancellations

-

element

No

Frequency cancelled for the Service

StartDate

10

Date

Yes

The date (yyyy-mm-dd) when the cancelled Frequency starts

EndDate

10

Date

No

The expected date (yyyy-mm-dd) when the cancelled Frequency ends

ServiceDeliveryUnit

6

Alpha

Yes

Unit of Service Delivered in Visits or Hours

CancellationReason

50

Alpha

No

Reason for the cancellation

Quantity

5

Num

Yes

Number of Visits or Hours cancelled

LastUpdateDate

10

Date

No

Date of the last update for the Cancellation

FrequencyId

36

Alpha / Num

(GUID)


Yes

The unique identifier of the frequency. The field must match one of the existing frequency identifier used in CCAC system.

ServiceType

250

Alpha / num

No

Description of the Service Type

ServiceDeliveryType

50

Alpha / num

No

Name of the Service Delivery Type

ServiceDeliveryTypeCode

20

Alpha / num

No

Code of the Service Delivery Type

DisplayDate

10

DateTime

No

Cancelled visit date displayed on the Frequency Change/Service Referral report

ServicePriorityRating

50

Alpha

Yes

Service Priority
e.g. High, Moderate



AssignedStaffName

50

Alpha

No

Name of the Assigned Staff member

AssignedStaffPhoneNumber

-

element

No

Phone number for the assigned staff member

TelephoneNumber

15

Alpha / Num

Yes

Telephone number

Extension

10

Alpha / Num

No

Extension of the Telephone Number

ProviderEndDate

14

Date

No

Date and time when the Provider assignment will end (Used mostly on FrequencyUpdates)

CMReassessmentDate

10

Date

No

Date when CM Reassessment is due (Used mostly on FrequencyUpdates)

IsClusterCare

5

Boolean

No

If present and true indicates that this service referral is a cluster care service referral

ProviderDischargeDate

10

Date

No

Provider’s actual discharge date

DischargeDispositionCode

10

Alpha / num

No

The provider discharge disposition code

DischargeDispositionDescription

100

Alpha / num

No

The provider discharge disposition description

AuthorizationScheduleTypeName

100

Alpha / num

No

Name of the Service Authorization Schedule Type

PatientAvailableDate

-

DateTime

No

Final Service Authorization Date

ServiceType

250

Alpha / num

No

Service Type description



    1. Outcome-Based Pathway Assignment element detail

      Name

      Field Length (bytes)

      Type

      Mandatory?

      Description

      CarePathwayTitle

      100

      Alpha / num

      Yes

      Title of the Outcome-Based Pathway

      [ICC_Care_Paths].[Title]

      CarePathwayDocumentURL

      255

      Alpha / num

      No

      URL of the published Outcome-Based Pathway Best Practices document for this Outcome-Based Pathway

      [ICC_Care_Paths].[Document_Url]

      CarePathwayDescription

      255

      Alpha / num

      No

      Description of the Outcome-Based Pathway

      [ICC_Care_Paths].[Description]

      CarePathwayCode

      20

      Alpha / num

      No

      Code identifying the Outcome-Based Pathway

      [ICC_Care_Paths].[Care_Path_Code]

      CarePathwayStartDate

      10

      Date

      Yes

      The date (yyyy-mm-dd) when the Client is first available for this Outcome-Based Pathway

      [ICC_Care_Path_Assignments].[Start_Date]



      OR

      For a Service Offer

      [Service_Offers].[Care_Path_Start_Date]

      CarePathwayEndDate

      10

      Date

      No

      The date (yyyy-mm-dd) when the Outcome-Based Pathway is ended

      [ICC_Care_Path_Assignments].[End_Date]

      CarePathwayComments

      250

      Alpha / num

      No

      User entered Outcome-Based Pathway comments

      [ICC_Care_Path_Assignments].[Comments]

      OR

      For a Service Offer

      [Service_Offers].[Care_Path_Comments]

      AuthorizingCMName

      50

      Alpha

      Yes

      The name of the Case Manager that authorized this Outcome-Based Pathway

      [ICC_Care_Path_Assignments].[Authorizing_CM_Employee_Id]

      OR

      For a Service Offer the name of the Case Manager that Authorized this Service

      DischargeDisposition

      100

      Alpha / num

      No

      The description of the reason for discharging

      [Discharge_Dispositions].[Description]

      Based on:

      [ICC_Care_Path_Assignments].[Discharge_Disposition_Id]

      DischargeComment

      250

      Alpha / num

      No

      Comments associated with the Discharge

      [ICC_Care_Path_Assignments].[Discharge_Comment]

      LastUpdateDate




      DateTime

      No

      Date and time of the last update for the Outcome-Based Pathway Assignment

      [ICC_Care_Path_Assignments].[Last_Update_Date]

      CarePathwayAssignmentGuid




      Unique identifier

      No

      Unique identifier of the Outcome-Based Pathway Assignment

      [ICC_Care_Path_Assignments].[RowGuid]

      CarePathwayAssignmentCurrentStatusCode

      10

      Alpha / num

      No

      Code of the current Outcome-Based Pathway assignment status

      CarePathwayAssignmentCurrentStatusName

      50

      Alpha / num

      No

      Name of the current Outcome-Based Pathway assignment status

      CarePathwayAssignmentMilestones




      Element

      No

      A collection of Milestones for the Outcome-Based Pathway Assignment – Service Referral and Frequency changes only

      CarePathwayAssignmentMilestone




      Element

      No




      Code

      50

      Alpha / num

      No

      Milestone title code

      [ICC_Care_Path_Events].[Event_Code]

      Title

      100

      Alpha / num

      No

      Milestone title

      [ICC_Care_Path_Events].[Title]

      Description

      500

      Alpha / num

      No

      Milestone description

      [ICC_Care_Path_Events].[Description]

      MilestoneDate

      10

      Date

      No

      Milestone date

      [ICC_Care_Path_Assignment_Milestones].[Milestone_Date]

      MilestoneReviewDate

      10

      Date

      No

      Milestone date

      [ICC_Care_Path_Assignment_Milestones].[Milestone_Review_Date]

      ResponsibleActorTypeCode

      10

      Alpha / num

      No

      Derived from [ICC_Care_Path_Events].[ICC_Care_Path_Actor_Type_Id]

      ResponsibleActorTypeName

      100

      Alpha / num

      No

      Derived from [ICC_Care_Path_Events].[ICC_Care_Path_Actor_Type_Id]

      LastUpdateDate




      DateTime

      No

      Date and time of the last update for the Milestone

      [ICC_Care_Path_Assignment_Milestones].[Last_Update_Date]

      CarePathwayAssignmentReimbursementModelAssignments




      Element

      No

      A collection of service assignment reimbursement model assignments for the Outcome-Based Pathway Assignment

      CarePathwayAssignmentReimbursementModelAssignment




      Element

      No

      Service assignment reimbursement model assignment for the Outcome-Based Pathway Assignment

      The detailed business rules of retrieving Care Pathway Reimbursement Model Assignment can be found in FA-WS-30 Get Care Path Assignments – Specifications.

      ReimbursementModelCode

      10

      Alpha / num

      Yes

      Code of the service assignment reimbursement model assignment

      [Service_Assignment_Reimbursement_Models].[Code]

      ReimbursementModelTitle

      100

      Alpha / num

      Yes

      Title of the service assignment reimbursement model assignment

      [Service_Assignment_Reimbursement_Models].[Title]

      ReimbursementModelAssignmentStartDate

      10

      Date

      Yes

      Start date of the service assignment reimbursement model assignment

      [Service_Assignment_Reimbursement_Model_Assignment].[Start_Date_Inclusive]

      ReimbursementModelAssignmentEndDate

      10

      Date

      No

      Start date of the service assignment reimbursement model assignment

      [Service_Assignment_Reimbursement_Model_Assignment].[End_Date_Inclusive]

      ControllingReimbursementModelCarePathwayAssignmentGuid




      Unique identifier

      No

      Unique identifier of the Outcome-Based Pathway Assignment that controls the reimbursement model

      [ICC_Care_Path_Assignments].[RowGUID] based on [Service_Assignment_Reimbursement_Model_Assignment].[ICC_Care_Path_Assignment_Id]=[ICC_Care_Path_Assignments].[ICC_Care_Path_Assignment_Id]

      ControllingReimbursementModelCarePathwayCode

      20

      Alpha / num

      No

      Type code of the Outcome-Based Pathway Assignment that controls the reimbursement model

      [ICC_Care_Paths].[Care_Path_Code]

      ControllingReimbursementModelCarePathwayName

      100

      Alpha / num

      No

      Type name of the Outcome-Based Pathway Assignment that controls the reimbursement model

      [ICC_Care_Paths].[Title]

      CarePathwayAssignmentActorAssignments




      Element

      No

      A collection of actor assignments for the Outcome-Based Pathway Assignment

      CarePathwayAssignmentActorAssignment




      Element

      No

      Actor assignment for the Outcome-Based Pathway Assignment

      ActorTypeCode

      10

      Alpha / num

      Yes

      Code of the actor type

      [ICC_Care_Path_Actor_Types].[Actor_Code]

      ActorTypeName

      100

      Alpha / num

      Yes

      Name of the actor type

      [ICC_Care_Path_Actor_Types].[Actor_Name]

      ActorAssignmentStartDate

      10

      Date

      Yes

      Start date of the actor assignment

      [ICC_Care_Path_Assignment_Actor_Assignments].[Start_Date]

      ActorAssignmentDiscontinueDate

      10

      Date

      No

      Discontinue date of the actor assignment

      [ICC_Care_Path_Assignment_Actor_Assignments].[Discontinue_Date]

      ActorAssignmentStatusCode

      10

      Alpha / num

      No

      Code of the actor assignment status

      [ICC_Care_Path_Assignment_Actor_Assignment_Status].[Status_Code]

      ActorAssignmentStatusName

      50

      Alpha / num

      No

      Name of the actor assignment status

      [ICC_Care_Path_Assignment_Actor_Assignment_Status].[Status_Title]

      ExternalSystemId

      50

      Alpha / num

      No

      External system ID of the Outcome-Based Pathway Assignment

    2. Frequency element detail



Name

Field Length (chars)

Type

Mandatory?

Description

FrequencyId (attribute)

36

Alpha / Num

(GUID)

Yes

The unique identifier of the frequency. The field must match one of the existing frequency identifier used in CCAC system.

Type

15

Alpha

Yes

The type of frequency which the case manager has authorized for the selected service / provider
The frequency type defines the frequency period as follows:

One-time = no fixed period

Daily = 1 day

Weekly = 1 week (Monday to Sunday)

Monthly = 1 calendar month

Custom = no fixed period

Block = no fixed period

Summary

250

Alpha

Yes

An English description of the frequency element

UnitOfService

Max 6

Alpha

Yes

Code assigned by CCAC for the units in which the service is to be delivered (e.g., HOUR, VISIT);

QuantityOfService

6

Num(6,2)

No

Number of hours or visits authorized

PreferredTime

20

Alpha

No

Time of day that visit is preferred by the client

StartDate

10

Date

Yes

The date (yyyy-mm-dd) when this Frequency starts

EndDate

10

Date

No

The expected date (yyyy-mm-dd) when this Frequency ends

ReccurenceTimes

4

Num

No

Weekly frequency (e.g. Two visits per day = 2)

Interval

4

Num

No

No. of repeats (e.g. Every two days = 2)

RecurrenceNumber

4

Num

No

Current not in use. Value = 0

RecurrencePeriod

4

Num

No

Current not in use. Value = 0

Weekday1

4

Num

No

Number of visits on Monday.

Weekday2

4

Num

No

Number of visits on Tuesday.

Weekday3

4

Num

No

Number of visits on Wednesday.

Weekday4

4

Num

No

Number of visits on Thursday.

Weekday5

4

Num

No

Number of visits on Friday.

Weekday6

4

Num

No

Number of visits on Saturday.

Weekday7

4

Num

No

Number of visits on Sunday.

NumberOfHoursPerVisit

6

Num(6,2)

No

Number of hours per visit.

AdditionalDetails

250

Alpha / num

No

Any details not captured by the above fields in this frequency

Service Pathway Name

100

Alpha / num

No

Name of the Service Pathway Template that this Frequency is part of

Service Pathway Description

250

Alpha / num

No

Description of the Service Pathway template that this Frequency is part of

Service Pathway Document URL

200

Alpha / num

No

URL of the published Service Pathway instruction document for this Service Pathway

ServiceType

250

Alpha / num

No

Description of the Service Type

ServiceDeliveryType

50

Alpha / num

No

Name of the Service Delivery Type

ServiceDeliveryTypeCode

20

Alpha / num

No

Code of the Service Delivery Type

ExternalSystemId

50

Alpha / num

No

Identification of the external system

AuthorizingCaseManagerName

50

Alpha

Yes

The name of the Case Manager that authorized this frequency




    1. ServiceRecipient element detail

The role of the ServiceRecipient element is to specify the entity that will be receiving the Service. Initially this element will only contain a single Client element, Code and Description.

In the future it is envisioned that different types of recipients will need to be supported. For example, allow for the specification of groups of people to be served by a single service (e.g. people located in a specific building, service that is targeted towards serving the fluctuating needs of a community within a retirement home etc).



Although not strictly required today, the ServiceRecipient element is being included in the specification to avoid having to make basic changes to the format in the future once multiple recipient types are supported.

Name

Field Length (chars)

Type

Mandatory?

Description

Code

10

Alpha/Num

No

The MIS Standards code pertaining to the service recipient

Description

250

Alpha/Num

No

The descriptive name of the code

StartDate

-

DateTime

No

The start date of the active service recipient code
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