This page is part of the Common CQL Assets for FHIR (US-Based) (v1.0.0: Informative 1 - Informative) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Coverage Patterns

Page standards status: Informative

USCore defines the USCore Coverage

Modifier Elements

The base Coverage resource defines the following modifier elements:

• status

In general, applications should ensure that the status element for a Coverage resource is appropriately set for their use case. Note that for many applications, such as prior-authorization, Coverage resources would be expected to have a status of active in order to be considered.

The US Core Coverage profile does not introduce any modifier extensions.

Search Parameters

In general, the Coverage under consideration will be established by application context, so although US Core does define search parameters for Coverage based on Patient, no special considerations are discussed here.

Cross-Version Considerations

There are no significant backwards-compatibility issues between versions for the Coverage profile.

Common Elements and Functions

Member or Subscriber ID

The USCore Coverage Profile defines a slice on identifier called memberid that can be used to access the patient's member id

define "Covered Member ID":
  Coverage.memberId()

In addition, the profile defines an invariant that either the memberId slice or subscriberId must be present.