0.3.0 - Second STU ballot

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. The current version which supercedes this version is 1.0.0. 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.

This structure is derived from Coverage

Summary

Must-Support: 26 elements

Structures

This structure refers to these other structures:

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*Insurance or medical plan or a payment agreement
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
Max Binding: All Languages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierThe primary coverage ID
... status ?!SΣ0..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type SΣ0..1CodeableConceptType of coverage such as medical or accident
Binding: Coverage Type and Self-Pay Codes (preferred)
... policyHolder SΣ0..1Reference(PatientSTU3 | OrganizationSTU3)Owner of the policy
... subscriber SΣ0..1Reference(PatientSTU3)Subscriber to the policy
... subscriberId SΣ0..1stringID assigned to the Subscriber
... beneficiary SΣ0..1Reference(PatientSTU3)Plan Beneficiary
... relationship S0..1CodeableConceptBeneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (example)
... period SΣ0..1PeriodCoverage start and end dates
... payor SΣ0..*Reference(PatientSTU3 | OrganizationSTU3)Identifier for the plan or agreement issuer
... grouping SI0..1BackboneElementAdditional coverage classifications
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... group SΣ0..1stringAn identifier for the group
.... groupDisplay SΣ0..1stringDisplay text for an identifier for the group
.... subGroup SΣ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay SΣ0..1stringDisplay text for the subsection of the group
.... plan SΣ0..1stringAn identifier for the plan
.... planDisplay SΣ0..1stringDisplay text for the plan
.... subPlan SΣ0..1stringAn identifier for the subsection of the plan
.... subPlanDisplay SΣ0..1stringDisplay text for the subsection of the plan
.... class SΣ0..1stringAn identifier for the class
.... classDisplay SΣ0..1stringDisplay text for the class
.... subClass SΣ0..1stringAn identifier for the subsection of the class
.... subClassDisplay SΣ0..1stringDisplay text for the subsection of the subclass
... dependent SΣ0..1stringDependent number
... sequence Σ0..1stringThe plan instance or sequence counter
... order SΣ0..1positiveIntRelative order of the coverage
... network SΣ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

This structure is derived from Coverage

Summary

Must-Support: 26 elements

Structures

This structure refers to these other structures:

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*Insurance or medical plan or a payment agreement
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
Max Binding: All Languages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierThe primary coverage ID
... status ?!SΣ0..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type SΣ0..1CodeableConceptType of coverage such as medical or accident
Binding: Coverage Type and Self-Pay Codes (preferred)
... policyHolder SΣ0..1Reference(PatientSTU3 | OrganizationSTU3)Owner of the policy
... subscriber SΣ0..1Reference(PatientSTU3)Subscriber to the policy
... subscriberId SΣ0..1stringID assigned to the Subscriber
... beneficiary SΣ0..1Reference(PatientSTU3)Plan Beneficiary
... relationship S0..1CodeableConceptBeneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (example)
... period SΣ0..1PeriodCoverage start and end dates
... payor SΣ0..*Reference(PatientSTU3 | OrganizationSTU3)Identifier for the plan or agreement issuer
... grouping SI0..1BackboneElementAdditional coverage classifications
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... group SΣ0..1stringAn identifier for the group
.... groupDisplay SΣ0..1stringDisplay text for an identifier for the group
.... subGroup SΣ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay SΣ0..1stringDisplay text for the subsection of the group
.... plan SΣ0..1stringAn identifier for the plan
.... planDisplay SΣ0..1stringDisplay text for the plan
.... subPlan SΣ0..1stringAn identifier for the subsection of the plan
.... subPlanDisplay SΣ0..1stringDisplay text for the subsection of the plan
.... class SΣ0..1stringAn identifier for the class
.... classDisplay SΣ0..1stringDisplay text for the class
.... subClass SΣ0..1stringAn identifier for the subsection of the class
.... subClassDisplay SΣ0..1stringDisplay text for the subsection of the subclass
... dependent SΣ0..1stringDependent number
... sequence Σ0..1stringThe plan instance or sequence counter
... order SΣ0..1positiveIntRelative order of the coverage
... network SΣ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet
Coverage.statusrequiredFinancial Resource Status Codes
Coverage.typepreferredCoverage Type and Self-Pay Codes
Coverage.relationshipexamplePolicyholder Relationship Codes

Constraints

IdPathDetailsRequirements
dom-2CoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-1CoverageIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-4CoverageIf 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-3CoverageIf 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-1Coverage.groupingAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())