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Resource Profile: USCoreCoverageProfile - Mappings

Active as of 2022-09-24

Mappings for the us-core-coverage resource profile.

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

USCoreCoverageProfile
Coverage	Event
identifier	Event.identifier
identifier (memberid)	Event.identifier
status	Event.status
beneficiary	Event.subject
period	Event.occurrence[x]

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

USCoreCoverageProfile
Coverage	Entity. Role, or Act, Coverage
text	Act.text?
contained	N/A
extension	N/A
modifierExtension	N/A
identifier	.id
identifier (memberid)	.id
id	n/a
extension	n/a
use	Role.code or implied by context
type	Role.code or implied by context
system	II.root or Role.id.root
value	II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period	Role.effectiveTime or implied by context
assigner	II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
status	Act.status
period	Act.effectiveTime
class
id	n/a
extension	n/a
modifierExtension	N/A
class (group)
id	n/a
extension	n/a
modifierExtension	N/A
class (plan)
id	n/a
extension	n/a
modifierExtension	N/A
costToBeneficiary
id	n/a
extension	n/a
modifierExtension	N/A
exception
id	n/a
extension	n/a
modifierExtension	N/A
contract	n/a

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

USCoreCoverageProfile
Coverage
identifier	FiveWs.identifier
identifier (memberid)	FiveWs.identifier
status	FiveWs.status
type	FiveWs.class
policyHolder	FiveWs.subject[x], FiveWs.subject
subscriber	FiveWs.subject[x], FiveWs.subject
subscriberId	FiveWs.subject[x], FiveWs.subject
beneficiary	FiveWs.subject[x], FiveWs.subject
period	FiveWs.done[x]
payor	FiveWs.author

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

USCoreCoverageProfile
Coverage
identifier	C02
identifier (memberid)	C02
policyHolder	D01 through D09
subscriber	D01 through D09
subscriberId	D01 through D09
beneficiary	D01 through D09
dependent	C17
relationship	C03
payor	A05
class
value	C11 (Division,Section)
name	C11 (Division,Section)
class (group)
value	C11 (Division,Section)
name	C11 (Division,Section)
class (plan)
value	C11 (Division,Section)
name	C11 (Division,Section)
network	D10
costToBeneficiary
value[x]	C11 (Division,Section)
contract	D01 through D09

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

USCoreCoverageProfile
Coverage
identifier	IN1-2
identifier (memberid)	IN1-2
use	N/A
type	CX.5
system	CX.4 / EI-2-4
value	CX.1 / EI.1
period	CX.7 + CX.8
assigner	CX.4 / (CX.4,CX.9,CX.10)
type	IN1-15
policyHolder	IN1-16, 18, 19-name of insured, address, date of birth
subscriber	IN1-16, 18, 19-name of insured, address, date of birth
subscriberId	IN1-16, 18, 19-name of insured, address, date of birth
beneficiary	IN1-16, 18, 19-name of insured, address, date of birth
dependent	- No exact HL7 v2 equivalent concept seems to exist;
period	IN1-12 / IN1-13
payor	IN1-3
class
value	IN1-8
name	IN1-8
class (group)
value	IN1-8
name	IN1-8
class (plan)
value	IN1-8
name	IN1-8
order	- No exact HL7 v2 equivalent concept seems to exist;
costToBeneficiary
value[x]	IN1-8
contract	IN1-16, 18, 19

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

USCoreCoverageProfile
Coverage
identifier	C.32, C.33, C.39
identifier (memberid)	C.32, C.33, C.39
policyHolder	C.35
subscriber	C.35
subscriberId	C.35
beneficiary	C.35
payor	C.30
class
value	C.31
name	C.31
class (group)
value	C.31
name	C.31
class (plan)
value	C.31
name	C.31
costToBeneficiary
value[x]	C.31
contract	C.35