R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.1.6 Resource Coverage - Mappings

Financial Management Work GroupMaturity Level: N/ABallot Status: Informative Compartments: Patient, RelatedPerson

Mappings:

FiveWs Pattern

Workflow Pattern

HL7 v2 Mapping

RIM Mapping

Canadian Dental Association eclaims standard

Canadian Pharmacy Associaiton eclaims standard

Mappings for the coverage resource.

13.1.6.1 Mappings for FiveWs Pattern (http://hl7.org/fhir/fivews)

Coverage
    identifierFiveWs.identifier
    statusFiveWs.status
    typeFiveWs.class
    policyHolderFiveWs.subject[x]
    subscriberFiveWs.subject[x]
    subscriberIdFiveWs.subject[x]
    beneficiaryFiveWs.subject[x]
    periodFiveWs.done[x]
    payorFiveWs.author

13.1.6.2 Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

CoverageEvent
    identifierEvent.identifier
    statusEvent.status
    beneficiaryEvent.subject
    periodEvent.occurrence[x]

13.1.6.3 Mappings for HL7 v2 Mapping (http://hl7.org/v2)

Coverage
    identifierIN1-2
    status
    typeIN1-15
    policyHolderIN1-16, 18, 19-name of insured, address, date of birth
    subscriberIN1-16, 18, 19-name of insured, address, date of birth
    subscriberIdIN1-16, 18, 19-name of insured, address, date of birth
    beneficiaryIN1-16, 18, 19-name of insured, address, date of birth
    dependent- No exact HL7 v2 equivalent concept seems to exist;
    relationship
    periodIN1-12 / IN1-13
    payorIN1-3
    class
        type
        valueIN1-8
        nameIN1-8
    grouping
        groupIN1-8
        groupDisplayIN1-8
        subGroupIN1-8
        subGroupDisplayIN1-8
        planIN1-35
        planDisplayIN1-35
        subPlanIN1-10
        subPlanDisplayIN1-10
        classIN1-35
        classDisplayIN1-35
        subClassIN1-35
        subClassDisplayIN1-35
    sequenceNo HL7 v2 equivalent concept seems to exist
    order- No exact HL7 v2 equivalent concept seems to exist;
    network
    copay
        type
        valueIN1-8
    contractIN1-16, 18, 19

13.1.6.4 Mappings for RIM Mapping (http://hl7.org/v3)

CoverageCoverage
    identifier.id
    statusAct.status
    periodAct.effectiveTime
    contractn/a

13.1.6.5 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

Coverage
    identifierC02
    status
    type
    policyHolderD01 through D09
    subscriberD01 through D09
    subscriberIdD01 through D09
    beneficiaryD01 through D09
    dependentC17
    relationshipC03
    period
    payorA05
    class
        type
        valueC11 (Division,Section)
        nameC11 (Division,Section)
    grouping
        groupC11 (Division,Section)
        groupDisplayC11 (Division,Section)
        subGroup
        subGroupDisplay
        planC01
        planDisplayC01
        subPlan
        subPlanDisplay
        classC01
        classDisplayC01
        subClassC01
        subClassDisplayC01
    sequenceD11
    order
    networkD10
    copay
        type
        valueC11 (Division,Section)
    contractD01 through D09

13.1.6.6 Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

Coverage
    identifierC.32, C.33, C.39
    status
    type
    policyHolderC.35
    subscriberC.35
    subscriberIdC.35
    beneficiaryC.35
    dependent
    relationship
    period
    payorC.30
    class
        type
        valueC.31
        nameC.31
    grouping
        groupC.31
        groupDisplayC.31
        subGroup
        subGroupDisplay
        plan
        planDisplay
        subPlan
        subPlanDisplay
        class
        classDisplay
        subClass
        subClassDisplay
    sequence
    order
    network
    copay
        type
        valueC.31
    contractC.35