Release 5
This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4
| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, RelatedPerson |
Raw Turtle (+ also see Turtle/RDF Format Specification)
StructureDefinition for coverage
Financial
@prefix fhir: <http://hl7.org/fhir/> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
# - resource -------------------------------------------------------------------
[] a fhir:StructureDefinition ;
fhir:id [ fhir:v "Coverage"] ;
fhir:meta [
fhir:lastUpdated [ fhir:v "2023-03-26T15:21:02.749+11:00" ]
] ;
fhir:text [
fhir:status [ fhir:v "generated" ]
] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-category" ] ;
fhir:value [ fhir:v "Financial.Support" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:value [ fhir:v "trial-use" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm" ] ;
fhir:value [ fhir:v "4" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category" ] ;
fhir:value [ fhir:v "patient" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:value [ fhir:v "fm" ]
] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/Coverage"], [ fhir:v "http://hl7.org/fhir/StructureDefinition/Coverage"] ;
fhir:version [ fhir:v "5.0.0"], [ fhir:v "5.0.0"] ;
fhir:name [ fhir:v "Coverage"], [ fhir:v "Coverage"] ;
fhir:status [ fhir:v "draft"], [ fhir:v "draft"] ;
fhir:experimental [ fhir:v "false"], [ fhir:v "false"] ;
fhir:date [ fhir:v "2023-03-26T15:21:02+11:00"], [ fhir:v "2023-03-26T15:21:02+11:00"] ;
fhir:publisher [ fhir:v "Health Level Seven International (Financial Management)"], [ fhir:v "Health Level Seven International (Financial Management)"] ;
fhir:contact ( [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org/fhir" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm/index.cfm" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org/fhir" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm/index.cfm" ]
] )
] ) ;
fhir:description [ fhir:v "Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment."], [ fhir:v "Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment."] ;
fhir:jurisdiction ( [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] ) ;
fhir:purpose [ fhir:v "Coverage provides a link between covered parties (patients) and the payors of their healthcare costs (both insurance and self-pay)."], [ fhir:v "Coverage provides a link between covered parties (patients) and the payors of their healthcare costs (both insurance and self-pay)."] ;
fhir:fhirVersion [ fhir:v "5.0.0"] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:uri [ fhir:v "http://hl7.org/fhir/workflow" ] ;
fhir:name [ fhir:v "Workflow Pattern" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:uri [ fhir:v "http://hl7.org/fhir/fivews" ] ;
fhir:name [ fhir:v "FiveWs Pattern Mapping" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:uri [ fhir:v "http://hl7.org/v3" ] ;
fhir:name [ fhir:v "RIM Mapping" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:uri [ fhir:v "http://www.cda-adc.ca/en/services/cdanet/" ] ;
fhir:name [ fhir:v "Canadian Dental Association eclaims standard" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:uri [ fhir:v "http://www.pharmacists.ca/" ] ;
fhir:name [ fhir:v "Canadian Pharmacy Association eclaims standard" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:uri [ fhir:v "http://hl7.org/v2" ] ;
fhir:name [ fhir:v "HL7 V2 Mapping" ]
] ) ;
fhir:kind [ fhir:v "resource"] ;
fhir:abstract [ fhir:v "false"] ;
fhir:type [ fhir:v "Coverage"] ;
fhir:baseDefinition [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource"] ;
fhir:derivation [ fhir:v "specialization"] ;
fhir:snapshot [
fhir:element ( [
fhir:id [ fhir:v "Coverage" ] ;
fhir:path [ fhir:v "Coverage" ] ;
fhir:short [ fhir:v "Insurance or medical plan or a payment agreement" ] ;
fhir:definition [ fhir:v "Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment." ] ;
fhir:comment [ fhir:v "The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:constraint ( [
fhir:key [ fhir:v "dom-2" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If the resource is contained in another resource, it SHALL NOT contain nested Resources" ] ;
fhir:expression [ fhir:v "contained.contained.empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:key [ fhir:v "dom-3" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource" ] ;
fhir:expression [ fhir:v "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:key [ fhir:v "dom-4" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" ] ;
fhir:expression [ fhir:v "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:key [ fhir:v "dom-5" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If a resource is contained in another resource, it SHALL NOT have a security label" ] ;
fhir:expression [ fhir:v "contained.meta.security.empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice" ] ;
fhir:value [ fhir:v "true" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation" ] ;
fhir:value [ fhir:v "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." ]
] ) ;
fhir:key [ fhir:v "dom-6" ] ;
fhir:severity [ fhir:v "warning" ] ;
fhir:human [ fhir:v "A resource should have narrative for robust management" ] ;
fhir:expression [ fhir:v "text.`div`.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Entity, Role, or Act,Coverage" ]
] [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "financial.support" ]
] )
] [
fhir:id [ fhir:v "Coverage.id" ] ;
fhir:path [ fhir:v "Coverage.id" ] ;
fhir:short [ fhir:v "Logical id of this artifact" ] ;
fhir:definition [ fhir:v "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." ] ;
fhir:comment [ fhir:v "Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "id" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.meta" ] ;
fhir:path [ fhir:v "Coverage.meta" ] ;
fhir:short [ fhir:v "Metadata about the resource" ] ;
fhir:definition [ fhir:v "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.meta" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Meta" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.implicitRules" ] ;
fhir:path [ fhir:v "Coverage.implicitRules" ] ;
fhir:short [ fhir:v "A set of rules under which this content was created" ] ;
fhir:definition [ fhir:v "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc." ] ;
fhir:comment [ fhir:v "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.implicitRules" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "uri" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.language" ] ;
fhir:path [ fhir:v "Coverage.language" ] ;
fhir:short [ fhir:v "Language of the resource content" ] ;
fhir:definition [ fhir:v "The base language in which the resource is written." ] ;
fhir:comment [ fhir:v "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.language" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Language" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "IETF language tag for a human language" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/all-languages|5.0.0" ] ;
fhir:additional ( [
fhir:purpose [ fhir:v "starter" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/languages" ]
] )
]
] [
fhir:id [ fhir:v "Coverage.text" ] ;
fhir:path [ fhir:v "Coverage.text" ] ;
fhir:short [ fhir:v "Text summary of the resource, for human interpretation" ] ;
fhir:definition [ fhir:v "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." ] ;
fhir:comment [ fhir:v "Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later." ] ;
fhir:alias ( [ fhir:v "narrative" ] [ fhir:v "html" ] [ fhir:v "xhtml" ] [ fhir:v "display" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.text" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Narrative" ]
] ) ;
fhir:condition ( [ fhir:v "dom-6" ] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Act.text?" ]
] )
] [
fhir:id [ fhir:v "Coverage.contained" ] ;
fhir:path [ fhir:v "Coverage.contained" ] ;
fhir:short [ fhir:v "Contained, inline Resources" ] ;
fhir:definition [ fhir:v "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning." ] ;
fhir:comment [ fhir:v "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels." ] ;
fhir:alias ( [ fhir:v "inline resources" ] [ fhir:v "anonymous resources" ] [ fhir:v "contained resources" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.contained" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Resource" ]
] ) ;
fhir:condition ( [ fhir:v "dom-2" ] [ fhir:v "dom-4" ] [ fhir:v "dom-3" ] [ fhir:v "dom-5" ] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.extension" ] ;
fhir:path [ fhir:v "Coverage.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.modifierExtension" ] ;
fhir:path [ fhir:v "Coverage.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.identifier" ] ;
fhir:path [ fhir:v "Coverage.identifier" ] ;
fhir:short [ fhir:v "Business identifier(s) for this coverage" ] ;
fhir:definition [ fhir:v "The identifier of the coverage as issued by the insurer." ] ;
fhir:comment [ fhir:v "The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant. Note that not all insurers issue unique member IDs therefore searches may result in multiple responses." ] ;
fhir:requirements [ fhir:v "Allows coverages to be distinguished and referenced." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.identifier" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.identifier" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.identifier" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C02" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v ".id" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.32, C.33, C.39" ]
] )
] [
fhir:id [ fhir:v "Coverage.status" ] ;
fhir:path [ fhir:v "Coverage.status" ] ;
fhir:short [ fhir:v "active | cancelled | draft | entered-in-error" ] ;
fhir:definition [ fhir:v "The status of the resource instance." ] ;
fhir:comment [ fhir:v "This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid." ] ;
fhir:requirements [ fhir:v "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.status" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageStatus" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "A code specifying the state of the resource instance." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/fm-status|5.0.0" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.status" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.status" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Act.status" ]
] )
] [
fhir:id [ fhir:v "Coverage.kind" ] ;
fhir:path [ fhir:v "Coverage.kind" ] ;
fhir:short [ fhir:v "insurance | self-pay | other" ] ;
fhir:definition [ fhir:v "The nature of the coverage be it insurance, or cash payment such as self-pay." ] ;
fhir:requirements [ fhir:v "This is used to implement conformance on other elements." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.kind" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageKind" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0" ]
]
] [
fhir:id [ fhir:v "Coverage.paymentBy" ] ;
fhir:path [ fhir:v "Coverage.paymentBy" ] ;
fhir:short [ fhir:v "Self-pay parties and responsibility" ] ;
fhir:definition [ fhir:v "Link to the paying party and optionally what specifically they will be responsible to pay." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.paymentBy" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.paymentBy.id" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.paymentBy.extension" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.paymentBy.modifierExtension" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.paymentBy.party" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.party" ] ;
fhir:short [ fhir:v "Parties performing self-payment" ] ;
fhir:definition [ fhir:v "The list of parties providing non-insurance payment for the treatment costs." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.paymentBy.party" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.paymentBy.responsibility" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.responsibility" ] ;
fhir:short [ fhir:v "Party's responsibility" ] ;
fhir:definition [ fhir:v " Description of the financial responsibility." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.paymentBy.responsibility" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.type" ] ;
fhir:path [ fhir:v "Coverage.type" ] ;
fhir:short [ fhir:v "Coverage category such as medical or accident" ] ;
fhir:definition [ fhir:v "The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization." ] ;
fhir:requirements [ fhir:v "The order of application of coverages is dependent on the types of coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.type" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageType" ]
] ) ;
fhir:strength [ fhir:v "preferred" ] ;
fhir:description [ fhir:v "The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-type" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-15" ]
] )
] [
fhir:id [ fhir:v "Coverage.policyHolder" ] ;
fhir:path [ fhir:v "Coverage.policyHolder" ] ;
fhir:short [ fhir:v "Owner of the policy" ] ;
fhir:definition [ fhir:v "The party who 'owns' the insurance policy." ] ;
fhir:comment [ fhir:v "For example: may be an individual, corporation or the subscriber's employer." ] ;
fhir:requirements [ fhir:v "This provides employer information in the case of Worker's Compensation and other policies." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.policyHolder" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.subscriber" ] ;
fhir:path [ fhir:v "Coverage.subscriber" ] ;
fhir:short [ fhir:v "Subscriber to the policy" ] ;
fhir:definition [ fhir:v "The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due." ] ;
fhir:comment [ fhir:v "May be self or a parent in the case of dependants. A subscriber is only required on certain types of policies not all policies and that it is appropriate to have just a policyholder and a beneficiary when not other party can join that policy instance." ] ;
fhir:requirements [ fhir:v "This is the party who is entitled to the benfits under the policy." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.subscriber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.subscriberId" ] ;
fhir:path [ fhir:v "Coverage.subscriberId" ] ;
fhir:short [ fhir:v "ID assigned to the subscriber" ] ;
fhir:definition [ fhir:v "The insurer assigned ID for the Subscriber." ] ;
fhir:requirements [ fhir:v "The insurer requires this identifier on correspondance and claims (digital and otherwise)." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.subscriberId" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.beneficiary" ] ;
fhir:path [ fhir:v "Coverage.beneficiary" ] ;
fhir:short [ fhir:v "Plan beneficiary" ] ;
fhir:definition [ fhir:v "The party who benefits from the insurance coverage; the patient when products and/or services are provided." ] ;
fhir:requirements [ fhir:v "This is the party who receives treatment for which the costs are reimbursed under the coverage." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.beneficiary" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.subject" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.dependent" ] ;
fhir:path [ fhir:v "Coverage.dependent" ] ;
fhir:short [ fhir:v "Dependent number" ] ;
fhir:definition [ fhir:v "A designator for a dependent under the coverage." ] ;
fhir:comment [ fhir:v "Sometimes the member number is constructed from the subscriberId and the dependant number." ] ;
fhir:requirements [ fhir:v "For some coverages a single identifier is issued to the Subscriber and then an additional dependent number is issued to each beneficiary." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.dependent" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C17" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "- No exact HL7 V2 equivalent concept seems to exist;" ]
] )
] [
fhir:id [ fhir:v "Coverage.relationship" ] ;
fhir:path [ fhir:v "Coverage.relationship" ] ;
fhir:short [ fhir:v "Beneficiary relationship to the subscriber" ] ;
fhir:definition [ fhir:v "The relationship of beneficiary (patient) to the subscriber." ] ;
fhir:comment [ fhir:v "Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others." ] ;
fhir:requirements [ fhir:v "The relationship between the patient and the subscriber to determine coordination of benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.relationship" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Relationship" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The relationship between the Subscriber and the Beneficiary (insured/covered party/patient)." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/subscriber-relationship" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C03" ]
] )
] [
fhir:id [ fhir:v "Coverage.period" ] ;
fhir:path [ fhir:v "Coverage.period" ] ;
fhir:short [ fhir:v "Coverage start and end dates" ] ;
fhir:definition [ fhir:v "Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force." ] ;
fhir:requirements [ fhir:v "Some insurers require the submission of the coverage term." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.period" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.occurrence[x]" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.done[x]" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-12 / IN1-13" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Act.effectiveTime" ]
] )
] [
fhir:id [ fhir:v "Coverage.insurer" ] ;
fhir:path [ fhir:v "Coverage.insurer" ] ;
fhir:short [ fhir:v "Issuer of the policy" ] ;
fhir:definition [ fhir:v "The program or plan underwriter, payor, insurance company." ] ;
fhir:comment [ fhir:v "May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)." ] ;
fhir:requirements [ fhir:v "Need to identify the issuer to target for claim processing and for coordination of benefit processing." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.insurer" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.class" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Class" ]
] ) ;
fhir:path [ fhir:v "Coverage.class" ] ;
fhir:short [ fhir:v "Additional coverage classifications" ] ;
fhir:definition [ fhir:v "A suite of underwriter specific classifiers." ] ;
fhir:comment [ fhir:v "For example, class may be used to identify a class of coverage or employer group, policy, or plan." ] ;
fhir:requirements [ fhir:v "The codes provided on the health card which identify or confirm the specific policy for the insurer." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.class" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.class.id" ] ;
fhir:path [ fhir:v "Coverage.class.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.class.extension" ] ;
fhir:path [ fhir:v "Coverage.class.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.class.modifierExtension" ] ;
fhir:path [ fhir:v "Coverage.class.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.class.type" ] ;
fhir:path [ fhir:v "Coverage.class.type" ] ;
fhir:short [ fhir:v "Type of class such as 'group' or 'plan'" ] ;
fhir:definition [ fhir:v "The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan." ] ;
fhir:requirements [ fhir:v "The insurer issued label for a specific health card value." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.class.type" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageClass" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The policy classifications, e.g. Group, Plan, Class, etc." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-class" ]
]
] [
fhir:id [ fhir:v "Coverage.class.value" ] ;
fhir:path [ fhir:v "Coverage.class.value" ] ;
fhir:short [ fhir:v "Value associated with the type" ] ;
fhir:definition [ fhir:v "The alphanumeric identifier associated with the insurer issued label." ] ;
fhir:comment [ fhir:v "For example, the Group or Plan number." ] ;
fhir:requirements [ fhir:v "The insurer issued label and identifier are necessary to identify the specific policy, group, etc.." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.class.value" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C11 (Division,Section)" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-2" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.31" ]
] )
] [
fhir:id [ fhir:v "Coverage.class.name" ] ;
fhir:path [ fhir:v "Coverage.class.name" ] ;
fhir:short [ fhir:v "Human readable description of the type and value" ] ;
fhir:definition [ fhir:v "A short description for the class." ] ;
fhir:requirements [ fhir:v "Used to provide a meaningful description in correspondence to the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.class.name" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C11 (Division,Section)" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-8" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.31" ]
] )
] [
fhir:id [ fhir:v "Coverage.order" ] ;
fhir:path [ fhir:v "Coverage.order" ] ;
fhir:short [ fhir:v "Relative order of the coverage" ] ;
fhir:definition [ fhir:v "The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. For example; a patient might have (0) auto insurance (1) their own health insurance and (2) spouse's health insurance. When claiming for treatments which were not the result of an auto accident then only coverages (1) and (2) above would be applicatble and would apply in the order specified in parenthesis." ] ;
fhir:requirements [ fhir:v "Used in managing the coordination of benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.order" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.network" ] ;
fhir:path [ fhir:v "Coverage.network" ] ;
fhir:short [ fhir:v "Insurer network" ] ;
fhir:definition [ fhir:v "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply." ] ;
fhir:requirements [ fhir:v "Used in referral for treatment and in claims processing." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.network" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D10" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "CostToBeneficiary" ]
] ) ;
fhir:path [ fhir:v "Coverage.costToBeneficiary" ] ;
fhir:short [ fhir:v "Patient payments for services/products" ] ;
fhir:definition [ fhir:v "A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card." ] ;
fhir:comment [ fhir:v "For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment." ] ;
fhir:requirements [ fhir:v "Required by providers to manage financial transaction with the patient." ] ;
fhir:alias ( [ fhir:v "CoPay" ] [ fhir:v "Deductible" ] [ fhir:v "Exceptions" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.id" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.extension" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.modifierExtension" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.type" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.type" ] ;
fhir:short [ fhir:v "Cost category" ] ;
fhir:definition [ fhir:v "The category of patient centric costs associated with treatment." ] ;
fhir:comment [ fhir:v "For example visit, specialist visits, emergency, inpatient care, etc." ] ;
fhir:requirements [ fhir:v "Needed to identify the category associated with the amount for the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.type" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CopayTypes" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The types of services to which patient copayments are specified." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-copay-type" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.category" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.category" ] ;
fhir:short [ fhir:v "Benefit classification" ] ;
fhir:definition [ fhir:v "Code to identify the general type of benefits under which products and services are provided." ] ;
fhir:comment [ fhir:v "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage." ] ;
fhir:requirements [ fhir:v "Needed to convey the category of service or product for which eligibility is sought." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.category" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitCategory" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-benefitcategory" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.network" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.network" ] ;
fhir:short [ fhir:v "In or out of network" ] ;
fhir:definition [ fhir:v "Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers." ] ;
fhir:requirements [ fhir:v "Needed as in or out of network providers are treated differently under the coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.network" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitNetwork" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/benefit-network" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.unit" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.unit" ] ;
fhir:short [ fhir:v "Individual or family" ] ;
fhir:definition [ fhir:v "Indicates if the benefits apply to an individual or to the family." ] ;
fhir:requirements [ fhir:v "Needed for the understanding of the benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.unit" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitUnit" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/benefit-unit" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.term" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.term" ] ;
fhir:short [ fhir:v "Annual or lifetime" ] ;
fhir:definition [ fhir:v "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'." ] ;
fhir:requirements [ fhir:v "Needed for the understanding of the benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.term" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitTerm" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/benefit-term" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.value[x]" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.value[x]" ] ;
fhir:short [ fhir:v "The amount or percentage due from the beneficiary" ] ;
fhir:definition [ fhir:v "The amount due from the patient for the cost category." ] ;
fhir:comment [ fhir:v "Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency." ] ;
fhir:requirements [ fhir:v "Needed to identify the amount for the patient associated with the category." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.value[x]" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C11 (Division,Section)" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-8" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.31" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Exemption" ]
] ) ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception" ] ;
fhir:short [ fhir:v "Exceptions for patient payments" ] ;
fhir:definition [ fhir:v "A suite of codes indicating exceptions or reductions to patient costs and their effective periods." ] ;
fhir:requirements [ fhir:v "Required by providers to manage financial transaction with the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.id" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.extension" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.modifierExtension" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] [
fhir:key [ fhir:v "ext-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "Must have either extensions or value[x], not both" ] ;
fhir:expression [ fhir:v "extension.exists() != value.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Extension" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.type" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.type" ] ;
fhir:short [ fhir:v "Exception category" ] ;
fhir:definition [ fhir:v "The code for the specific exception." ] ;
fhir:requirements [ fhir:v "Needed to identify the exception associated with the amount for the patient." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.type" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageFinancialException" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The types of exceptions from the part or full value of financial obligations such as copays." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-financial-exception" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.period" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.period" ] ;
fhir:short [ fhir:v "The effective period of the exception" ] ;
fhir:definition [ fhir:v "The timeframe the exception is in force." ] ;
fhir:requirements [ fhir:v "Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.period" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.subrogation" ] ;
fhir:path [ fhir:v "Coverage.subrogation" ] ;
fhir:short [ fhir:v "Reimbursement to insurer" ] ;
fhir:definition [ fhir:v "When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs." ] ;
fhir:comment [ fhir:v "Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims." ] ;
fhir:requirements [ fhir:v "See definition for when to be used." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.subrogation" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "boolean" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.contract" ] ;
fhir:path [ fhir:v "Coverage.contract" ] ;
fhir:short [ fhir:v "Contract details" ] ;
fhir:definition [ fhir:v "The policy(s) which constitute this insurance coverage." ] ;
fhir:requirements [ fhir:v "To reference the legally binding contract between the policy holder and the insurer." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.contract" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Contract" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.insurancePlan" ] ;
fhir:path [ fhir:v "Coverage.insurancePlan" ] ;
fhir:short [ fhir:v "Insurance plan details" ] ;
fhir:definition [ fhir:v "The insurance plan details, benefits and costs, which constitute this insurance coverage." ] ;
fhir:requirements [ fhir:v "To associate the plan benefits and costs with the coverage which is an instance of that plan." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Coverage.insurancePlan" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/InsurancePlan" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] )
] ;
fhir:differential [
fhir:element ( [
fhir:id [ fhir:v "Coverage" ] ;
fhir:path [ fhir:v "Coverage" ] ;
fhir:short [ fhir:v "Insurance or medical plan or a payment agreement" ] ;
fhir:definition [ fhir:v "Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment." ] ;
fhir:comment [ fhir:v "The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "financial.support" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Coverage" ]
] )
] [
fhir:id [ fhir:v "Coverage.identifier" ] ;
fhir:path [ fhir:v "Coverage.identifier" ] ;
fhir:short [ fhir:v "Business identifier(s) for this coverage" ] ;
fhir:definition [ fhir:v "The identifier of the coverage as issued by the insurer." ] ;
fhir:comment [ fhir:v "The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant. Note that not all insurers issue unique member IDs therefore searches may result in multiple responses." ] ;
fhir:requirements [ fhir:v "Allows coverages to be distinguished and referenced." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.identifier" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.identifier" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C02" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v ".id" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.32, C.33, C.39" ]
] )
] [
fhir:id [ fhir:v "Coverage.status" ] ;
fhir:path [ fhir:v "Coverage.status" ] ;
fhir:short [ fhir:v "active | cancelled | draft | entered-in-error" ] ;
fhir:definition [ fhir:v "The status of the resource instance." ] ;
fhir:comment [ fhir:v "This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid." ] ;
fhir:requirements [ fhir:v "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageStatus" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "A code specifying the state of the resource instance." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/fm-status|5.0.0" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.status" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.status" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Act.status" ]
] )
] [
fhir:id [ fhir:v "Coverage.kind" ] ;
fhir:path [ fhir:v "Coverage.kind" ] ;
fhir:short [ fhir:v "insurance | self-pay | other" ] ;
fhir:definition [ fhir:v "The nature of the coverage be it insurance, or cash payment such as self-pay." ] ;
fhir:requirements [ fhir:v "This is used to implement conformance on other elements." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageKind" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0" ]
]
] [
fhir:id [ fhir:v "Coverage.paymentBy" ] ;
fhir:path [ fhir:v "Coverage.paymentBy" ] ;
fhir:short [ fhir:v "Self-pay parties and responsibility" ] ;
fhir:definition [ fhir:v "Link to the paying party and optionally what specifically they will be responsible to pay." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.paymentBy.party" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.party" ] ;
fhir:short [ fhir:v "Parties performing self-payment" ] ;
fhir:definition [ fhir:v "The list of parties providing non-insurance payment for the treatment costs." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.paymentBy.responsibility" ] ;
fhir:path [ fhir:v "Coverage.paymentBy.responsibility" ] ;
fhir:short [ fhir:v "Party's responsibility" ] ;
fhir:definition [ fhir:v " Description of the financial responsibility." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.type" ] ;
fhir:path [ fhir:v "Coverage.type" ] ;
fhir:short [ fhir:v "Coverage category such as medical or accident" ] ;
fhir:definition [ fhir:v "The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization." ] ;
fhir:requirements [ fhir:v "The order of application of coverages is dependent on the types of coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageType" ]
] ) ;
fhir:strength [ fhir:v "preferred" ] ;
fhir:description [ fhir:v "The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-type" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-15" ]
] )
] [
fhir:id [ fhir:v "Coverage.policyHolder" ] ;
fhir:path [ fhir:v "Coverage.policyHolder" ] ;
fhir:short [ fhir:v "Owner of the policy" ] ;
fhir:definition [ fhir:v "The party who 'owns' the insurance policy." ] ;
fhir:comment [ fhir:v "For example: may be an individual, corporation or the subscriber's employer." ] ;
fhir:requirements [ fhir:v "This provides employer information in the case of Worker's Compensation and other policies." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.subscriber" ] ;
fhir:path [ fhir:v "Coverage.subscriber" ] ;
fhir:short [ fhir:v "Subscriber to the policy" ] ;
fhir:definition [ fhir:v "The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due." ] ;
fhir:comment [ fhir:v "May be self or a parent in the case of dependants. A subscriber is only required on certain types of policies not all policies and that it is appropriate to have just a policyholder and a beneficiary when not other party can join that policy instance." ] ;
fhir:requirements [ fhir:v "This is the party who is entitled to the benfits under the policy." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.subscriberId" ] ;
fhir:path [ fhir:v "Coverage.subscriberId" ] ;
fhir:short [ fhir:v "ID assigned to the subscriber" ] ;
fhir:definition [ fhir:v "The insurer assigned ID for the Subscriber." ] ;
fhir:requirements [ fhir:v "The insurer requires this identifier on correspondance and claims (digital and otherwise)." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.beneficiary" ] ;
fhir:path [ fhir:v "Coverage.beneficiary" ] ;
fhir:short [ fhir:v "Plan beneficiary" ] ;
fhir:definition [ fhir:v "The party who benefits from the insurance coverage; the patient when products and/or services are provided." ] ;
fhir:requirements [ fhir:v "This is the party who receives treatment for which the costs are reimbursed under the coverage." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.subject" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19-name of insured, address, date of birth" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.dependent" ] ;
fhir:path [ fhir:v "Coverage.dependent" ] ;
fhir:short [ fhir:v "Dependent number" ] ;
fhir:definition [ fhir:v "A designator for a dependent under the coverage." ] ;
fhir:comment [ fhir:v "Sometimes the member number is constructed from the subscriberId and the dependant number." ] ;
fhir:requirements [ fhir:v "For some coverages a single identifier is issued to the Subscriber and then an additional dependent number is issued to each beneficiary." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C17" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "- No exact HL7 V2 equivalent concept seems to exist;" ]
] )
] [
fhir:id [ fhir:v "Coverage.relationship" ] ;
fhir:path [ fhir:v "Coverage.relationship" ] ;
fhir:short [ fhir:v "Beneficiary relationship to the subscriber" ] ;
fhir:definition [ fhir:v "The relationship of beneficiary (patient) to the subscriber." ] ;
fhir:comment [ fhir:v "Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others." ] ;
fhir:requirements [ fhir:v "The relationship between the patient and the subscriber to determine coordination of benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Relationship" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The relationship between the Subscriber and the Beneficiary (insured/covered party/patient)." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/subscriber-relationship" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C03" ]
] )
] [
fhir:id [ fhir:v "Coverage.period" ] ;
fhir:path [ fhir:v "Coverage.period" ] ;
fhir:short [ fhir:v "Coverage start and end dates" ] ;
fhir:definition [ fhir:v "Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force." ] ;
fhir:requirements [ fhir:v "Some insurers require the submission of the coverage term." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.occurrence[x]" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.done[x]" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-12 / IN1-13" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Act.effectiveTime" ]
] )
] [
fhir:id [ fhir:v "Coverage.insurer" ] ;
fhir:path [ fhir:v "Coverage.insurer" ] ;
fhir:short [ fhir:v "Issuer of the policy" ] ;
fhir:definition [ fhir:v "The program or plan underwriter, payor, insurance company." ] ;
fhir:comment [ fhir:v "May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)." ] ;
fhir:requirements [ fhir:v "Need to identify the issuer to target for claim processing and for coordination of benefit processing." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.class" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Class" ]
] ) ;
fhir:path [ fhir:v "Coverage.class" ] ;
fhir:short [ fhir:v "Additional coverage classifications" ] ;
fhir:definition [ fhir:v "A suite of underwriter specific classifiers." ] ;
fhir:comment [ fhir:v "For example, class may be used to identify a class of coverage or employer group, policy, or plan." ] ;
fhir:requirements [ fhir:v "The codes provided on the health card which identify or confirm the specific policy for the insurer." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.class.type" ] ;
fhir:path [ fhir:v "Coverage.class.type" ] ;
fhir:short [ fhir:v "Type of class such as 'group' or 'plan'" ] ;
fhir:definition [ fhir:v "The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan." ] ;
fhir:requirements [ fhir:v "The insurer issued label for a specific health card value." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageClass" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The policy classifications, e.g. Group, Plan, Class, etc." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-class" ]
]
] [
fhir:id [ fhir:v "Coverage.class.value" ] ;
fhir:path [ fhir:v "Coverage.class.value" ] ;
fhir:short [ fhir:v "Value associated with the type" ] ;
fhir:definition [ fhir:v "The alphanumeric identifier associated with the insurer issued label." ] ;
fhir:comment [ fhir:v "For example, the Group or Plan number." ] ;
fhir:requirements [ fhir:v "The insurer issued label and identifier are necessary to identify the specific policy, group, etc.." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C11 (Division,Section)" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-2" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.31" ]
] )
] [
fhir:id [ fhir:v "Coverage.class.name" ] ;
fhir:path [ fhir:v "Coverage.class.name" ] ;
fhir:short [ fhir:v "Human readable description of the type and value" ] ;
fhir:definition [ fhir:v "A short description for the class." ] ;
fhir:requirements [ fhir:v "Used to provide a meaningful description in correspondence to the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C11 (Division,Section)" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-8" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.31" ]
] )
] [
fhir:id [ fhir:v "Coverage.order" ] ;
fhir:path [ fhir:v "Coverage.order" ] ;
fhir:short [ fhir:v "Relative order of the coverage" ] ;
fhir:definition [ fhir:v "The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. For example; a patient might have (0) auto insurance (1) their own health insurance and (2) spouse's health insurance. When claiming for treatments which were not the result of an auto accident then only coverages (1) and (2) above would be applicatble and would apply in the order specified in parenthesis." ] ;
fhir:requirements [ fhir:v "Used in managing the coordination of benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.network" ] ;
fhir:path [ fhir:v "Coverage.network" ] ;
fhir:short [ fhir:v "Insurer network" ] ;
fhir:definition [ fhir:v "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply." ] ;
fhir:requirements [ fhir:v "Used in referral for treatment and in claims processing." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D10" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "CostToBeneficiary" ]
] ) ;
fhir:path [ fhir:v "Coverage.costToBeneficiary" ] ;
fhir:short [ fhir:v "Patient payments for services/products" ] ;
fhir:definition [ fhir:v "A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card." ] ;
fhir:comment [ fhir:v "For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment." ] ;
fhir:requirements [ fhir:v "Required by providers to manage financial transaction with the patient." ] ;
fhir:alias ( [ fhir:v "CoPay" ] [ fhir:v "Deductible" ] [ fhir:v "Exceptions" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.type" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.type" ] ;
fhir:short [ fhir:v "Cost category" ] ;
fhir:definition [ fhir:v "The category of patient centric costs associated with treatment." ] ;
fhir:comment [ fhir:v "For example visit, specialist visits, emergency, inpatient care, etc." ] ;
fhir:requirements [ fhir:v "Needed to identify the category associated with the amount for the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CopayTypes" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The types of services to which patient copayments are specified." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-copay-type" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.category" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.category" ] ;
fhir:short [ fhir:v "Benefit classification" ] ;
fhir:definition [ fhir:v "Code to identify the general type of benefits under which products and services are provided." ] ;
fhir:comment [ fhir:v "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage." ] ;
fhir:requirements [ fhir:v "Needed to convey the category of service or product for which eligibility is sought." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitCategory" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-benefitcategory" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.network" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.network" ] ;
fhir:short [ fhir:v "In or out of network" ] ;
fhir:definition [ fhir:v "Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers." ] ;
fhir:requirements [ fhir:v "Needed as in or out of network providers are treated differently under the coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitNetwork" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/benefit-network" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.unit" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.unit" ] ;
fhir:short [ fhir:v "Individual or family" ] ;
fhir:definition [ fhir:v "Indicates if the benefits apply to an individual or to the family." ] ;
fhir:requirements [ fhir:v "Needed for the understanding of the benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitUnit" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/benefit-unit" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.term" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.term" ] ;
fhir:short [ fhir:v "Annual or lifetime" ] ;
fhir:definition [ fhir:v "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'." ] ;
fhir:requirements [ fhir:v "Needed for the understanding of the benefits." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "BenefitTerm" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/benefit-term" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.value[x]" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.value[x]" ] ;
fhir:short [ fhir:v "The amount or percentage due from the beneficiary" ] ;
fhir:definition [ fhir:v "The amount due from the patient for the cost category." ] ;
fhir:comment [ fhir:v "Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency." ] ;
fhir:requirements [ fhir:v "Needed to identify the amount for the patient associated with the category." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "C11 (Division,Section)" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-8" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.31" ]
] )
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Exemption" ]
] ) ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception" ] ;
fhir:short [ fhir:v "Exceptions for patient payments" ] ;
fhir:definition [ fhir:v "A suite of codes indicating exceptions or reductions to patient costs and their effective periods." ] ;
fhir:requirements [ fhir:v "Required by providers to manage financial transaction with the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.type" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.type" ] ;
fhir:short [ fhir:v "Exception category" ] ;
fhir:definition [ fhir:v "The code for the specific exception." ] ;
fhir:requirements [ fhir:v "Needed to identify the exception associated with the amount for the patient." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "CoverageFinancialException" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The types of exceptions from the part or full value of financial obligations such as copays." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/coverage-financial-exception" ]
]
] [
fhir:id [ fhir:v "Coverage.costToBeneficiary.exception.period" ] ;
fhir:path [ fhir:v "Coverage.costToBeneficiary.exception.period" ] ;
fhir:short [ fhir:v "The effective period of the exception" ] ;
fhir:definition [ fhir:v "The timeframe the exception is in force." ] ;
fhir:requirements [ fhir:v "Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "Coverage.subrogation" ] ;
fhir:path [ fhir:v "Coverage.subrogation" ] ;
fhir:short [ fhir:v "Reimbursement to insurer" ] ;
fhir:definition [ fhir:v "When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs." ] ;
fhir:comment [ fhir:v "Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims." ] ;
fhir:requirements [ fhir:v "See definition for when to be used." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "boolean" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "Coverage.contract" ] ;
fhir:path [ fhir:v "Coverage.contract" ] ;
fhir:short [ fhir:v "Contract details" ] ;
fhir:definition [ fhir:v "The policy(s) which constitute this insurance coverage." ] ;
fhir:requirements [ fhir:v "To reference the legally binding contract between the policy holder and the insurer." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Contract" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "cdanetv4" ] ;
fhir:map [ fhir:v "D01 through D09" ]
] [
fhir:identity [ fhir:v "v2" ] ;
fhir:map [ fhir:v "IN1-16, 18, 19" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] [
fhir:identity [ fhir:v "cpha3pharm" ] ;
fhir:map [ fhir:v "C.35" ]
] )
] [
fhir:id [ fhir:v "Coverage.insurancePlan" ] ;
fhir:path [ fhir:v "Coverage.insurancePlan" ] ;
fhir:short [ fhir:v "Insurance plan details" ] ;
fhir:definition [ fhir:v "The insurance plan details, benefits and costs, which constitute this insurance coverage." ] ;
fhir:requirements [ fhir:v "To associate the plan benefits and costs with the coverage which is an instance of that plan." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/InsurancePlan" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] )
] .
# -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R5 hl7.fhir.core#5.0.0 generated on Sun, Mar 26, 2023 15:24+1100.
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