0.3.0 - Second STU ballot

This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.3.0: STU 1 Ballot 2) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

## StructureDefinition: CoverageSTU3

The official URL for this profile is:

    http://hl7.org/fhir/us/davinci-crd/STU3/StructureDefinition/profile-coverage-stu3

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- All

This structure is derived from Coverage

Summary

Must-Support: 26 elements

Structures

This structure refers to these other structures:

- http://hl7.org/fhir/us/davinci-crd/STU3/StructureDefinition/profile-patient-stu3

This structure is derived from Coverage

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage |  | 0..* |  |
identifier | S | 0..* | Identifier |
status | S | 0..1 | code |
type | S | 0..1 | CodeableConcept |
policyHolder | S | 0..1 | Reference(PatientSTU3 | OrganizationSTU3) |
subscriber | S | 0..1 | Reference(PatientSTU3) |
subscriberId | S | 0..1 | string |
beneficiary | S | 0..1 | Reference(PatientSTU3) |
relationship | S | 0..1 | CodeableConcept |
period | S | 0..1 | Period |
payor | S | 0..* | Reference(PatientSTU3 | OrganizationSTU3) |
grouping | S | 0..1 | BackboneElement |
group | S | 0..1 | string |
groupDisplay | S | 0..1 | string |
subGroup | S | 0..1 | string |
subGroupDisplay | S | 0..1 | string |
plan | S | 0..1 | string |
planDisplay | S | 0..1 | string |
subPlan | S | 0..1 | string |
subPlanDisplay | S | 0..1 | string |
class | S | 0..1 | string |
classDisplay | S | 0..1 | string |
subClass | S | 0..1 | string |
subClassDisplay | S | 0..1 | string |
dependent | S | 0..1 | string |
sequence |  | 0..1 | string |
order | S | 0..1 | positiveInt |
network | S | 0..1 | string |
contract |  | 0..* | Reference(Contract) |
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage | I | 0..* |  | Insurance or medical plan or a payment agreement
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible) Max Binding: All Languages
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | The primary coverage ID
status | ?!S Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required)
type | S Σ | 0..1 | CodeableConcept | Type of coverage such as medical or accident Binding: Coverage Type and Self-Pay Codes (preferred)
policyHolder | S Σ | 0..1 | Reference(PatientSTU3 | OrganizationSTU3) | Owner of the policy
subscriber | S Σ | 0..1 | Reference(PatientSTU3) | Subscriber to the policy
subscriberId | S Σ | 0..1 | string | ID assigned to the Subscriber
beneficiary | S Σ | 0..1 | Reference(PatientSTU3) | Plan Beneficiary
relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the Subscriber Binding: Policyholder Relationship Codes (example)
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 0..* | Reference(PatientSTU3 | OrganizationSTU3) | Identifier for the plan or agreement issuer
grouping | S I | 0..1 | BackboneElement | Additional coverage classifications
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
group | S Σ | 0..1 | string | An identifier for the group
groupDisplay | S Σ | 0..1 | string | Display text for an identifier for the group
subGroup | S Σ | 0..1 | string | An identifier for the subsection of the group
subGroupDisplay | S Σ | 0..1 | string | Display text for the subsection of the group
plan | S Σ | 0..1 | string | An identifier for the plan
planDisplay | S Σ | 0..1 | string | Display text for the plan
subPlan | S Σ | 0..1 | string | An identifier for the subsection of the plan
subPlanDisplay | S Σ | 0..1 | string | Display text for the subsection of the plan
class | S Σ | 0..1 | string | An identifier for the class
classDisplay | S Σ | 0..1 | string | Display text for the class
subClass | S Σ | 0..1 | string | An identifier for the subsection of the class
subClassDisplay | S Σ | 0..1 | string | Display text for the subsection of the subclass
dependent | S Σ | 0..1 | string | Dependent number
sequence | Σ | 0..1 | string | The plan instance or sequence counter
order | S Σ | 0..1 | positiveInt | Relative order of the coverage
network | S Σ | 0..1 | string | Insurer network
contract |  | 0..* | Reference(Contract) | Contract details
Documentation for this format

This structure is derived from Coverage

Summary

Must-Support: 26 elements

Structures

This structure refers to these other structures:

- http://hl7.org/fhir/us/davinci-crd/STU3/StructureDefinition/profile-patient-stu3

Differential View

This structure is derived from Coverage

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage |  | 0..* |  |
identifier | S | 0..* | Identifier |
status | S | 0..1 | code |
type | S | 0..1 | CodeableConcept |
policyHolder | S | 0..1 | Reference(PatientSTU3 | OrganizationSTU3) |
subscriber | S | 0..1 | Reference(PatientSTU3) |
subscriberId | S | 0..1 | string |
beneficiary | S | 0..1 | Reference(PatientSTU3) |
relationship | S | 0..1 | CodeableConcept |
period | S | 0..1 | Period |
payor | S | 0..* | Reference(PatientSTU3 | OrganizationSTU3) |
grouping | S | 0..1 | BackboneElement |
group | S | 0..1 | string |
groupDisplay | S | 0..1 | string |
subGroup | S | 0..1 | string |
subGroupDisplay | S | 0..1 | string |
plan | S | 0..1 | string |
planDisplay | S | 0..1 | string |
subPlan | S | 0..1 | string |
subPlanDisplay | S | 0..1 | string |
class | S | 0..1 | string |
classDisplay | S | 0..1 | string |
subClass | S | 0..1 | string |
subClassDisplay | S | 0..1 | string |
dependent | S | 0..1 | string |
sequence |  | 0..1 | string |
order | S | 0..1 | positiveInt |
network | S | 0..1 | string |
contract |  | 0..* | Reference(Contract) |
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Coverage | I | 0..* |  | Insurance or medical plan or a payment agreement
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: Common Languages (extensible) Max Binding: All Languages
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 0..* | Identifier | The primary coverage ID
status | ?!S Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required)
type | S Σ | 0..1 | CodeableConcept | Type of coverage such as medical or accident Binding: Coverage Type and Self-Pay Codes (preferred)
policyHolder | S Σ | 0..1 | Reference(PatientSTU3 | OrganizationSTU3) | Owner of the policy
subscriber | S Σ | 0..1 | Reference(PatientSTU3) | Subscriber to the policy
subscriberId | S Σ | 0..1 | string | ID assigned to the Subscriber
beneficiary | S Σ | 0..1 | Reference(PatientSTU3) | Plan Beneficiary
relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the Subscriber Binding: Policyholder Relationship Codes (example)
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 0..* | Reference(PatientSTU3 | OrganizationSTU3) | Identifier for the plan or agreement issuer
grouping | S I | 0..1 | BackboneElement | Additional coverage classifications
id |  | 0..1 | string | xml:id (or equivalent in JSON)
extension |  | 0..* | Extension | Additional Content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
group | S Σ | 0..1 | string | An identifier for the group
groupDisplay | S Σ | 0..1 | string | Display text for an identifier for the group
subGroup | S Σ | 0..1 | string | An identifier for the subsection of the group
subGroupDisplay | S Σ | 0..1 | string | Display text for the subsection of the group
plan | S Σ | 0..1 | string | An identifier for the plan
planDisplay | S Σ | 0..1 | string | Display text for the plan
subPlan | S Σ | 0..1 | string | An identifier for the subsection of the plan
subPlanDisplay | S Σ | 0..1 | string | Display text for the subsection of the plan
class | S Σ | 0..1 | string | An identifier for the class
classDisplay | S Σ | 0..1 | string | Display text for the class
subClass | S Σ | 0..1 | string | An identifier for the subsection of the class
subClassDisplay | S Σ | 0..1 | string | Display text for the subsection of the subclass
dependent | S Σ | 0..1 | string | Dependent number
sequence | Σ | 0..1 | string | The plan instance or sequence counter
order | S Σ | 0..1 | positiveInt | Relative order of the coverage
network | S Σ | 0..1 | string | Insurer network
contract |  | 0..* | Reference(Contract) | Contract details
Documentation for this format

Other representations of profile: Schematron

### Terminology Bindings

Path | Conformance | ValueSet
Coverage.status | required | Financial Resource Status Codes
Coverage.type | preferred | Coverage Type and Self-Pay Codes
Coverage.relationship | example | Policyholder Relationship Codes

### Constraints

Id | Path | Details | Requirements
dom-2 | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-1 | Coverage | If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty() |
dom-4 | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-3 | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty() |
ele-1 | Coverage.grouping | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) |