This page is part of the CARIN Blue Button Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions
SD.6 StructureDefinition-CARIN-BB-Coverage
CARIN Blue Button Coverage Profile
SD.6.1 Formal Views of Profile Content
Description of Profiles, Differentials, and Snapshots.
The official URL for this profile is: http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-coverage
Published on Sat Jul 27 00:00:00 UTC 2019 as a active by .
This profile builds on Coverage
Summary
Mandatory: 2 elements
Structures
This structure refers to these other structures:
- http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-patient
- http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-organization
Slices
This structure defines the following Slices:
- The element Coverage.class is sliced based on the value of value:type
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | ||
![]() ![]() ![]() | 0..1 | Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile) | ||
![]() ![]() ![]() | 1..1 | string | ||
![]() ![]() ![]() | 1..1 | Reference(CARIN Blue Button Patient Profile) | ||
![]() ![]() ![]() | 1..1 | CodeableConcept | ||
![]() ![]() ![]() | 1..* | Reference(CARIN Blue Button Organization Profile) | ||
![]() ![]() ![]() | 0..* | (Slice Definition) | Slice: Unordered, Open by value:type | |
![]() ![]() ![]() ![]() | 0..1 | BackboneElement | ||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
![]() ![]() ![]() ![]() | 0..1 | BackboneElement | ||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | I | 0..* | Coverage | Insurance or medical plan or a payment agreement |
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact |
![]() ![]() ![]() | ΣI | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() | ?!ΣI | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() | I | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages |
![]() ![]() ![]() | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |
![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() | ?!I | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() | ΣI | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() ![]() | ?!ΣI | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
![]() ![]() ![]() | ΣI | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred) |
![]() ![]() ![]() | ΣI | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
![]() ![]() ![]() | ΣI | 0..1 | Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile) | Subscriber to the policy |
![]() ![]() ![]() | ΣI | 1..1 | string | ID assigned to the subscriber |
![]() ![]() ![]() | ΣI | 1..1 | Reference(CARIN Blue Button Patient Profile) | Plan beneficiary |
![]() ![]() ![]() | ΣI | 0..1 | string | Dependent number |
![]() ![]() ![]() | I | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible) |
![]() ![]() ![]() | ΣI | 0..1 | Period | Coverage start and end dates |
![]() ![]() ![]() | ΣI | 1..* | Reference(CARIN Blue Button Organization Profile) | Issuer of the policy |
![]() ![]() ![]() | I | 0..* | (Slice Definition) | Additional coverage classifications Slice: Unordered, Open by value:type |
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() ![]() | I | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() ![]() | I | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() | ΣI | 0..1 | positiveInt | Relative order of the coverage |
![]() ![]() ![]() | ΣI | 0..1 | string | Insurer network |
![]() ![]() ![]() | I | 0..* | BackboneElement | Patient payments for services/products |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | ΣI | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible) |
![]() ![]() ![]() ![]() | ΣI | 1..1 | The amount or percentage due from the beneficiary | |
![]() ![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||
![]() ![]() ![]() ![]() ![]() | Money | |||
![]() ![]() ![]() ![]() | I | 0..* | BackboneElement | Exceptions for patient payments |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example) |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | Period | The effective period of the exception |
![]() ![]() ![]() | I | 0..1 | boolean | Reimbursement to insurer |
![]() ![]() ![]() | I | 0..* | Reference(Contract) | Contract details |
![]() |
Summary
Mandatory: 2 elements
Structures
This structure refers to these other structures:
- http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-patient
- http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-organization
Slices
This structure defines the following Slices:
- The element Coverage.class is sliced based on the value of value:type
Differential View
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | ||
![]() ![]() ![]() | 0..1 | Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile) | ||
![]() ![]() ![]() | 1..1 | string | ||
![]() ![]() ![]() | 1..1 | Reference(CARIN Blue Button Patient Profile) | ||
![]() ![]() ![]() | 1..1 | CodeableConcept | ||
![]() ![]() ![]() | 1..* | Reference(CARIN Blue Button Organization Profile) | ||
![]() ![]() ![]() | 0..* | (Slice Definition) | Slice: Unordered, Open by value:type | |
![]() ![]() ![]() ![]() | 0..1 | BackboneElement | ||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
![]() ![]() ![]() ![]() | 0..1 | BackboneElement | ||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
![]() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | I | 0..* | Coverage | Insurance or medical plan or a payment agreement |
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact |
![]() ![]() ![]() | ΣI | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() | ?!ΣI | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() | I | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages |
![]() ![]() ![]() | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |
![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() | ?!I | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() | ΣI | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() ![]() | ?!ΣI | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) |
![]() ![]() ![]() | ΣI | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred) |
![]() ![]() ![]() | ΣI | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
![]() ![]() ![]() | ΣI | 0..1 | Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile) | Subscriber to the policy |
![]() ![]() ![]() | ΣI | 1..1 | string | ID assigned to the subscriber |
![]() ![]() ![]() | ΣI | 1..1 | Reference(CARIN Blue Button Patient Profile) | Plan beneficiary |
![]() ![]() ![]() | ΣI | 0..1 | string | Dependent number |
![]() ![]() ![]() | I | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible) |
![]() ![]() ![]() | ΣI | 0..1 | Period | Coverage start and end dates |
![]() ![]() ![]() | ΣI | 1..* | Reference(CARIN Blue Button Organization Profile) | Issuer of the policy |
![]() ![]() ![]() | I | 0..* | (Slice Definition) | Additional coverage classifications Slice: Unordered, Open by value:type |
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() ![]() | I | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() ![]() | I | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() | ΣI | 0..1 | positiveInt | Relative order of the coverage |
![]() ![]() ![]() | ΣI | 0..1 | string | Insurer network |
![]() ![]() ![]() | I | 0..* | BackboneElement | Patient payments for services/products |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | ΣI | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible) |
![]() ![]() ![]() ![]() | ΣI | 1..1 | The amount or percentage due from the beneficiary | |
![]() ![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||
![]() ![]() ![]() ![]() ![]() | Money | |||
![]() ![]() ![]() ![]() | I | 0..* | BackboneElement | Exceptions for patient payments |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example) |
![]() ![]() ![]() ![]() ![]() | ΣI | 0..1 | Period | The effective period of the exception |
![]() ![]() ![]() | I | 0..1 | boolean | Reimbursement to insurer |
![]() ![]() ![]() | I | 0..* | Reference(Contract) | Contract details |
![]() |
Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron