Consumer-Directed Payer Data Exchange
- Release 0.1.0

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:

Slices

This structure defines the following Slices:

  • The element Coverage.class is sliced based on the value of value:type
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*Coverage
... subscriber 0..1Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile)
... subscriberId 1..1string
... beneficiary 1..1Reference(CARIN Blue Button Patient Profile)
... relationship 1..1CodeableConcept
... payor 1..*Reference(CARIN Blue Button Organization Profile)
... class 0..*(Slice Definition)Slice: Unordered, Open by value:type
.... class:group 0..1BackboneElement
..... type 1..1CodeableConceptRequired Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
.... class:plan 0..1BackboneElement
..... type 1..1CodeableConceptRequired Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*CoverageInsurance or medical plan or a payment agreement
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for the coverage
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type ΣI0..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred)
... policyHolder ΣI0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber ΣI0..1Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile)Subscriber to the policy
... subscriberId ΣI1..1stringID assigned to the subscriber
... beneficiary ΣI1..1Reference(CARIN Blue Button Patient Profile)Plan beneficiary
... dependent ΣI0..1stringDependent number
... relationship I1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible)
... period ΣI0..1PeriodCoverage start and end dates
... payor ΣI1..*Reference(CARIN Blue Button Organization Profile)Issuer of the policy
... class I0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type
.... class:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
..... value ΣI1..1stringValue associated with the type
..... name ΣI0..1stringHuman readable description of the type and value
.... class:group I0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system0..1uriIdentity of the terminology system
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value ΣI1..1stringValue associated with the type
..... name ΣI0..1stringHuman readable description of the type and value
.... class:plan I0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system0..1uriIdentity of the terminology system
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value ΣI1..1stringValue associated with the type
..... name ΣI0..1stringHuman readable description of the type and value
... order ΣI0..1positiveIntRelative order of the coverage
... network ΣI0..1stringInsurer network
... costToBeneficiary I0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type ΣI0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible)
.... value[x] ΣI1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception I0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example)
..... period ΣI0..1PeriodThe effective period of the exception
... subrogation I0..1booleanReimbursement to insurer
... contract I0..*Reference(Contract)Contract details

doco Documentation for this format
{% include StructureDefinition-CARIN-BB-Coverage-pseudo-xml.xhtml %}
{% include StructureDefinition-CARIN-BB-Coverage-pseudo-json.xhtml %}

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Coverage.class is sliced based on the value of value:type

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*Coverage
... subscriber 0..1Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile)
... subscriberId 1..1string
... beneficiary 1..1Reference(CARIN Blue Button Patient Profile)
... relationship 1..1CodeableConcept
... payor 1..*Reference(CARIN Blue Button Organization Profile)
... class 0..*(Slice Definition)Slice: Unordered, Open by value:type
.... class:group 0..1BackboneElement
..... type 1..1CodeableConceptRequired Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
.... class:plan 0..1BackboneElement
..... type 1..1CodeableConceptRequired Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*CoverageInsurance or medical plan or a payment agreement
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for the coverage
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type ΣI0..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred)
... policyHolder ΣI0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber ΣI0..1Reference(CARIN Blue Button Patient Profile | CARIN Blue Button Related Person Profile)Subscriber to the policy
... subscriberId ΣI1..1stringID assigned to the subscriber
... beneficiary ΣI1..1Reference(CARIN Blue Button Patient Profile)Plan beneficiary
... dependent ΣI0..1stringDependent number
... relationship I1..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible)
... period ΣI0..1PeriodCoverage start and end dates
... payor ΣI1..*Reference(CARIN Blue Button Organization Profile)Issuer of the policy
... class I0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type
.... class:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
..... value ΣI1..1stringValue associated with the type
..... name ΣI0..1stringHuman readable description of the type and value
.... class:group I0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system0..1uriIdentity of the terminology system
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: group
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value ΣI1..1stringValue associated with the type
..... name ΣI0..1stringHuman readable description of the type and value
.... class:plan I0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system0..1uriIdentity of the terminology system
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: plan
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value ΣI1..1stringValue associated with the type
..... name ΣI0..1stringHuman readable description of the type and value
... order ΣI0..1positiveIntRelative order of the coverage
... network ΣI0..1stringInsurer network
... costToBeneficiary I0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type ΣI0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible)
.... value[x] ΣI1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception I0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example)
..... period ΣI0..1PeriodThe effective period of the exception
... subrogation I0..1booleanReimbursement to insurer
... contract I0..*Reference(Contract)Contract details

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron