For AI agents: the documentation index is at /docs/payerbox/llms.txt. A Markdown version of this page is available at /docs/payerbox/data-integration/uscdi/encounters.md or by requesting it with the Accept: text/markdown header.
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Encounter Information

Datasets

US Core 6.1.0 maps each USCDI data element onto a FHIR element.

DatasetUS Core 6.1.0 target profile(s)
encountersUS Core Encounter
locationsUS Core Location

encounters

One row per encounter. Several diagnoses or participants stay one row: list the keys ;-separated.

ColumnRequiredFormat / valuesExample
encounter_idYesyour stable key for this encounter; other datasets reference itENC-9912
encounter_id_systemYesURI of the identifier system; a URL you control or an OIDurn:oid:2.16.840.1.113883.3.99.2
patient_identifierYespatient keyMRN-4471903
statusYesplanned, arrived, triaged, in-progress, onleave, finished, cancelled, entered-in-error, unknown encounter-statusfinished
classYesAMB ambulatory, IMP inpatient, EMER emergency, OBSENC observation v3-ActEncounterCodeAMB
type_codeYesCPT or SNOMED CT code(s), ;-separated, with type_system; CPT if omitted US Core Encounter Type99213
period_startRecommendeddatetime2026-04-18T09:00:00-04:00
period_endRecommendeddatetime2026-04-18T09:30:00-04:00
reason_codeIf availableSNOMED CT or ICD-10-CM code(s), ;-separated, with reason_system; SNOMED CT if omitted encounter-reason29857009 chest pain
location_idRecommendedlocations keyLOC-221
diagnosis_condition_idIf availablerecord_id of the conditions row(s), ;-separatedCND-4501
participant_npiIf available10 digits, Luhn-valid over the 80840 prefix, ;-separated9999999995
participant_type_codeIf availableATND attender, ADM admitter, DIS discharger, CON consultant, REF referrer, with participant_type_system; v3-ParticipationType if omitted encounter-participant-typeATND
discharge_disposition_codeIf applicableNUBC patient discharge status code, as carried in UB-04 field 17, with discharge_disposition_system AHA NUBC Patient Discharge Status01 discharged to home or self-care
service_provider_npiIf available10 digits, Luhn-valid over the 80840 prefix9999999979
is_deletedIf retractingtrue retracts this rowtrue
  • reason_code is the presenting complaint, not the diagnosis (diagnosis_condition_id). Its binding is preferred, so an ICD-10-CM code off the claim is accepted.
  • participant_type_code is each clinician's role at the visit. Send one per participant_npi, in the same order.
  • NUBC is a billing code set, not clinical terminology: send the discharge status off the claim. AHA licenses the codes, so the linked page cannot list them.

locations

One row per physical location: a clinic, a hospital ward, a lab draw station.

If you already send the Provider Directory feed, list here only the locations missing from it, such as a facility outside your network where a member was treated.

ColumnRequiredFormat / valuesExample
record_idYesyour stable key for this location; encounters and practitioners reference itLOC-221
location_nameYestextAnytown Family Practice
managing_org_npiRecommended10 digits, Luhn-valid over the 80840 prefix9999999979
address_line1Recommendedtext123 Main St
cityRecommendedtextAnytown
stateRecommended2-letter USPS USPS statesNY
zipRecommended5 or 9 digits, as a string12345
is_deletedIf retractingtrue retracts this rowtrue
  • location_name is the one mandatory field: a row without it cannot become a Location.
  • managing_org_npi must match a row in your organizations dataset.

These resources are served by Patient Access, Provider Access, Payer-to-Payer, and Prior Auth.

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