Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | C | 0..* | Coverage | Insurance or medical plan or a payment agreement us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present |
Slices for identifier | S | 0..* | Identifier | (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type |
identifier:memberid | SC | 0..1 | Identifier | (USCDI) Member ID |
type | S | 1..1 | CodeableConcept | (USCDI) Member Number identifier type Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MB | |
status | S | 1..1 | code | (USCDI) active | cancelled | draft | entered-in-error |
type | S | 0..1 | CodeableConcept | (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): US Public Health Data Consortium Source of Payment Codes |
subscriberId | SC | 0..1 | string | (USCDI) ID assigned to the subscriber |
beneficiary | S | 1..1 | Reference(US Core Patient Profile) | (USCDI) Plan beneficiary |
relationship | S | 1..1 | CodeableConcept | (USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible) |
period | S | 0..1 | Period | (USCDI) Coverage start and end dates |
payor | S | 1..1 | Reference(US Core Organization Profile S | US Core Patient Profile | US Core RelatedPerson Profile) | (USCDI) Issuer of the policy |
Slices for class | S | 0..* | BackboneElement | (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type |
class:group | S | 0..1 | BackboneElement | (USCDI) Group |
type | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
value | S | 1..1 | string | (USCDI) Group Number |
name | S | 0..1 | string | (USCDI) Group Name |
class:plan | S | 0..1 | BackboneElement | (USCDI) Plan |
type | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
value | S | 1..1 | string | (USCDI) Plan Number |
name | S | 0..1 | string | (USCDI) Plan Name |
Documentation for this format |