HL7.FHIR.US.DAVINCI-CRD\CoverageDeident

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CoverageDeident

Defining URL:

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

Version:

1.0.0

Name:

CoverageDeident

Status:

Draft as of 2018-07-25

Definition:

This profile specifies constraints on the Coverage resource to identify coverage plan type without exposing patient identity during coverage requirements discovery.

Publisher:

HL7 International - Financial Management Work Group

Source Resource:

XML / JSON / Turtle

The official URL for this profile is:

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

Usage

CRD Clients SHALL use this profile to resolve references to insurance Coverage resources passed to CRD Services when performing coverage requirements discovery without patient-identifiable protected health information (PHI).

Refer to the section on PHI and Hook Invocation in the formal specification for more information.

Formal Views of Profile Content

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

Text Summary
Differential Table
Snapshot Table
Snapshot Table (Must Support)
All

This structure is derived from Coverage

Summary

Mandatory: 0 element (1 nested mandatory element)
Must-Support: 8 elements
Fixed Value: 1 element
Prohibited: 12 elements

Structures

This structure refers to these other structures:

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
text		0..0
identifier		0..0
status	S	1..1	code	active \| cancelled \| draft \| entered-in-error
type	S	0..1	CodeableConcept	Coverage category such as medical or accident
policyHolder		0..0
subscriber		0..0
subscriberId		0..0
beneficiary		1..1	Reference(CRD Deidentified Patient)	Plan beneficiary
dependent		0..0
relationship		0..0
period	S	0..1	Period	Coverage start and end dates
payor	S	1..*	Reference(CRD Deidentified Patient \| Organization)	Issuer of the policy
class	S	0..1	BackboneElement	Additional coverage classifications
type	S	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Fixed Value: As shown (Plan)
coding		1..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	Value associated with the type
name	S	0..1	string	Human readable description of the type and value
order		0..0
network		0..0
costToBeneficiary		0..0
subrogation		0..0
contract		0..0
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	string	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: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
beneficiary	Σ	1..1	Reference(CRD Deidentified Patient)	Plan beneficiary
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..*	Reference(CRD Deidentified Patient \| Organization)	Issuer of the policy
class	S	0..1	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Fixed Value: As shown (Plan)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
value	SΣ	1..1	string	Value associated with the type
name	SΣ	0..1	string	Human readable description of the type and value
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
status	?!Σ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..*	Reference(CRD Deidentified Patient \| Organization)	Issuer of the policy
class		0..1	BackboneElement	Additional coverage classifications
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Fixed Value: As shown (Plan)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
Documentation for this format

This structure is derived from Coverage

Summary

Mandatory: 0 element (1 nested mandatory element)
Must-Support: 8 elements
Fixed Value: 1 element
Prohibited: 12 elements

Structures

This structure refers to these other structures:

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
text		0..0
identifier		0..0
status	S	1..1	code	active \| cancelled \| draft \| entered-in-error
type	S	0..1	CodeableConcept	Coverage category such as medical or accident
policyHolder		0..0
subscriber		0..0
subscriberId		0..0
beneficiary		1..1	Reference(CRD Deidentified Patient)	Plan beneficiary
dependent		0..0
relationship		0..0
period	S	0..1	Period	Coverage start and end dates
payor	S	1..*	Reference(CRD Deidentified Patient \| Organization)	Issuer of the policy
class	S	0..1	BackboneElement	Additional coverage classifications
type	S	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Fixed Value: As shown (Plan)
coding		1..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	Value associated with the type
name	S	0..1	string	Human readable description of the type and value
order		0..0
network		0..0
costToBeneficiary		0..0
subrogation		0..0
contract		0..0
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	string	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: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
beneficiary	Σ	1..1	Reference(CRD Deidentified Patient)	Plan beneficiary
period	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..*	Reference(CRD Deidentified Patient \| Organization)	Issuer of the policy
class	S	0..1	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Fixed Value: As shown (Plan)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
value	SΣ	1..1	string	Value associated with the type
name	SΣ	0..1	string	Human readable description of the type and value
Documentation for this format

Other representations of profile: Schematron

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Max Binding: AllLanguages
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.class.type	extensible	Fixed Value: plan
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

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-3	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	Coverage.meta	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.implicitRules	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.language	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.status	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.beneficiary	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.payor	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.class.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.class.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.class.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.class.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class.value	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class.name	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.value[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.exception	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.exception.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.exception.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.exception.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.exception.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.exception.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.exception.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())