Consumer Real-Time Pharmacy Benefit Check
1.0.0 - STU1

This page is part of the Consumer Real-time Pharmacy Benefit Check (v1.0.0: STU 1) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: RtpbcCoverage - Mappings

Mappings for the rtpbc-coverage resource profile.

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

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

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

RtpbcCoverage
CoverageEntity. Role, or Act, Coverage
   textAct.text?
   containedN/A
   extensionN/A
   modifierExtensionN/A
   identifier.id
   statusAct.status
   periodAct.effectiveTime
   payor
      idn/a
      extensionn/a
      referenceN/A
      typeN/A
      identifier.identifier
         idn/a
         extensionn/a
         useRole.code or implied by context
         typeRole.code or implied by context
         systemII.root or Role.id.root
         valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
         periodRole.effectiveTime or implied by context
         assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
      displayN/A
   class
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (bin)
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (pcn)
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (rxgroup-id)
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (pbm-member-id)
      idn/a
      extensionn/a
      modifierExtensionN/A
   costToBeneficiary
      idn/a
      extensionn/a
      modifierExtensionN/A
      exception
         idn/a
         extensionn/a
         modifierExtensionN/A
   contractn/a

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

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

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

RtpbcCoverage
Coverage
   identifierC02
   policyHolderD01 through D09
   subscriberD01 through D09
   subscriberIdD01 through D09
   beneficiaryD01 through D09
   dependentC17
   relationshipC03
   payorA05
   class
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (bin)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (pcn)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (rxgroup-id)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (pbm-member-id)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   networkD10
   costToBeneficiary
      value[x]C11 (Division,Section)
   contractD01 through D09

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

RtpbcCoverage
Coverage
   identifierIN1-2
   typeIN1-15
   policyHolderIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIdIN1-16, 18, 19-name of insured, address, date of birth
   beneficiaryIN1-16, 18, 19-name of insured, address, date of birth
   dependent- No exact HL7 v2 equivalent concept seems to exist;
   periodIN1-12 / IN1-13
   payorIN1-3
      identifier
         useN/A
         typeCX.5
         systemCX.4 / EI-2-4
         valueCX.1 / EI.1
         periodCX.7 + CX.8
         assignerCX.4 / (CX.4,CX.9,CX.10)
   class
      valueIN1-8
      nameIN1-8
   class (bin)
      valueIN1-8
      nameIN1-8
   class (pcn)
      valueIN1-8
      nameIN1-8
   class (rxgroup-id)
      valueIN1-8
      nameIN1-8
   class (pbm-member-id)
      valueIN1-8
      nameIN1-8
   order- No exact HL7 v2 equivalent concept seems to exist;
   costToBeneficiary
      value[x]IN1-8
   contractIN1-16, 18, 19

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

RtpbcCoverage
Coverage
   identifierC.32, C.33, C.39
   policyHolderC.35
   subscriberC.35
   subscriberIdC.35
   beneficiaryC.35
   payorC.30
   class
      valueC.31
      nameC.31
   class (bin)
      valueC.31
      nameC.31
   class (pcn)
      valueC.31
      nameC.31
   class (rxgroup-id)
      valueC.31
      nameC.31
   class (pbm-member-id)
      valueC.31
      nameC.31
   costToBeneficiary
      value[x]C.31
   contractC.35