abstractbaseDefinition- Values Differ
copyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindname- Values Differ
publisherpurposestatustitletypeurlversion- Values Differ
| Left: | CRD Coverage (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage) |
| Right: | CRD Coverage (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage) |
| Error | StructureDefinition.version | Values for version differ: '2.0.0' vs '2.1.0-preview' |
| Information | StructureDefinition.name | Values for name differ: 'Coverage' vs 'CRDCoverage' |
| Information | StructureDefinition.date | Values for date differ: '2023-05-30T11:47:53-07:00' vs '2024-09-26T14:59:51-04:00' |
| Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/StructureDefinition/Coverage' vs 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage' |
| Information | StructureDefinition.short | Values for short differ: 'Business Identifier for the coverage' vs 'Member ID and other identifiers' |
| Information | StructureDefinition.comment | Values for comment differ: 'This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.' vs 'The `Coverage.status` alone does not indicate whether an individual's coverage is terminated or that the individual is not covered. The `Coverage.period` needs to be considered as well.' |
| Information | StructureDefinition.comment | Values for comment differ: 'Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.' vs 'Relationship of the member to the person insured (subscriber)' |
| Information | Coverage.relationship | Element minimum cardinalities differ: '0' vs '1' |
| Information | StructureDefinition.comment | Values for comment differ: 'May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.' vs 'Issuer of the Policy' |
| Information | Coverage.payor | Element maximum cardinalities differ: '2147483647' vs '1' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/Coverage | http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage |
|
| copyright | |||
| date | 2023-05-30T11:47:53-07:00 | 2024-09-26T14:59:51-04:00 |
|
| description | This profile specifies constraints on the Coverage resource to support coverage requirements discovery. | ||
| experimental | false | ||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | Coverage | CRDCoverage |
|
| publisher | HL7 International / Financial Management | ||
| purpose | |||
| status | active | ||
| title | CRD Coverage | ||
| type | Coverage | ||
| url | http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage | ||
| version | 2.0.0 | 2.1.0-preview |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 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 | C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement This profile also complies with the profile US Core Practitioner Profile (6.1.0) us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present | |||||||||
 id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
 extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| Slices for identifier | SΣ | 0..* | Identifier | Business Identifier for the coverage Slice: Unordered, Open by pattern:type | SΣ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type | |||||||||
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
| type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible) | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes | |||||||||
| policyHolder | SΣ | 0..1 | Reference(CRD Patient | CRD Organization) | Owner of the policy | SΣ | 0..1 | Reference(CRD Patient | CRD Organization) | Owner of the policy | |||||||||
| subscriber | SΣ | 0..1 | Reference(CRD Patient) | Subscriber to the policy | SΣ | 0..1 | Reference(CRD Patient) | Subscriber to the policy | |||||||||
| subscriberId | SΣ | 0..1 | string | ID assigned to the subscriber | SΣC | 0..1 | string | ID assigned to the subscriber | |||||||||
| beneficiary | SΣ | 1..1 | Reference(CRD Patient) | Plan beneficiary | SΣ | 1..1 | Reference(CRD Patient) | Plan beneficiary | |||||||||
| dependent | SΣ | 0..1 | string | Dependent number | SΣ | 0..1 | string | Dependent number | |||||||||
| relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) |
| ||||||||
| period | SΣ | 0..1 | Period | Coverage start and end dates | SΣ | 0..1 | Period | Coverage start and end dates | |||||||||
| payor | SΣ | 1..* | Reference(CRD Patient | CRD Organization) | Issuer of the policy | SΣ | 1..1 | Reference(CRD Patient | CRD Organization) | Issuer of the policy |
| ||||||||
 Slices for class | S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. | |||||||||
| value | Σ | 1..1 | string | Value associated with the type | Σ | 1..1 | string | Value associated with the type | |||||||||
| name | Σ | 0..1 | string | Human readable description of the type and value | Σ | 0..1 | string | Human readable description of the type and value | |||||||||
| order | SΣ | 0..1 | positiveInt | Relative order of the coverage | SΣ | 0..1 | positiveInt | Relative order of the coverage | |||||||||
| network | SΣ | 0..1 | string | Insurer network | SΣ | 0..1 | string | Insurer network | |||||||||
| costToBeneficiary | 0..0 | 0..0 | |||||||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. | |||||||||
| value[x] | Σ | 1..1 | ??, Money | The amount or percentage due from the beneficiary | Σ | 1..1 | ??, Money | The amount or percentage due from the beneficiary | |||||||||
 exception | 0..* | BackboneElement | Exceptions for patient payments | 0..* | BackboneElement | Exceptions for patient payments | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. | |||||||||
| period | Σ | 0..1 | Period | The effective period of the exception | Σ | 0..1 | Period | The effective period of the exception | |||||||||
| subrogation | 0..1 | boolean | Reimbursement to insurer | 0..1 | boolean | Reimbursement to insurer | |||||||||||
| contract | 0..* | Reference(Contract) | Contract details | 0..* | Reference(Contract) | Contract details | |||||||||||
| Documentation for this format | |||||||||||||||||