Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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

13.1.8 Resource Coverage - Mappings

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeSecurity Category: Patient Compartments: Patient, RelatedPerson

Mappings:

FiveWs Pattern Mapping

Workflow Pattern

HL7 v2 Mapping

RIM Mapping

Canadian Dental Association eclaims standard

Canadian Pharmacy Association eclaims standard

Mappings for the coverage resource (see Mappings to Other Standards for further information & status).

13.1.8.1 FiveWs Pattern Mapping (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]

13.1.8.2 Workflow Pattern (http://hl7.org/fhir/workflow )

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

13.1.8.3 HL7 v2 Mapping (http://hl7.org/v2 )

Coverage
    identifier
    status
    kind
    paymentBy
        party
        responsibility
    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
    insurer
    class
        type
        valueIN1-2
        nameIN1-8
    order
    network
    costToBeneficiary
        type
        category
        network
        unit
        term
        value[x]IN1-8
        exception
            type
            period
    subrogation
    contractIN1-16, 18, 19
    insurancePlan

13.1.8.4 RIM Mapping (http://hl7.org/v3 )

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

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

Coverage
    identifierC02
    status
    kind
    paymentBy
        party
        responsibility
    type
    policyHolderD01 through D09
    subscriberD01 through D09
    subscriberIdD01 through D09
    beneficiaryD01 through D09
    dependentC17
    relationshipC03
    period
    insurer
    class
        type
        valueC11 (Division,Section)
        nameC11 (Division,Section)
    order
    networkD10
    costToBeneficiary
        type
        category
        network
        unit
        term
        value[x]C11 (Division,Section)
        exception
            type
            period
    subrogation
    contractD01 through D09
    insurancePlan

13.1.8.6 Canadian Pharmacy Association eclaims standard (http://www.pharmacists.ca/ )

Coverage
    identifierC.32, C.33, C.39
    status
    kind
    paymentBy
        party
        responsibility
    type
    policyHolderC.35
    subscriberC.35
    subscriberIdC.35
    beneficiaryC.35
    dependent
    relationship
    period
    insurer
    class
        type
        valueC.31
        nameC.31
    order
    network
    costToBeneficiary
        type
        category
        network
        unit
        term
        value[x]C.31
        exception
            type
            period
    subrogation
    contractC.35
    insurancePlan