This page is part of the Da Vinci Data Exchange for Quality Measures (DEQM) FHIR IG (v1.0.0: STU 1) based on FHIR R3. The current version which supercedes this version is 3.1.0. For a full list of available versions, see the Directory of published versions 
XML Format: StructureDefinition-coverage-deqm
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<StructureDefinition xmlns="http://hl7.org/fhir"> <id value="coverage-deqm"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Minimum and Maximum # of times the the element can appear in the instance">Card.</a></th><th style="width: 100px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Additional information about the element">Description & Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/STU3/help16.png" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-coverage-deqm-definitions.html#Coverage" title="This is the Coverage profile which is used to provide insurance information for scheduling an appointment and or registering a patient.">Coverage</a><a name="Coverage"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.4">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.4">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/us/qicore/STU32/StructureDefinition-qicore-coverage.html">QICore-Coverage</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7;"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-coverage-deqm-definitions.html#Coverage.subscriberId">subscriberId</a><a name="Coverage.subscriberId"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.4" href="http://hl7.org/fhir/STU3/datatypes.html#string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Subscriber ID</td></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-coverage-deqm-definitions.html#Coverage.beneficiary">beneficiary</a><a name="Coverage.beneficiary"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.4">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.4">1</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(<a href="http://hl7.org/fhir/us/qicore/STU32/StructureDefinition-qicore-patient.html">QICore-Patient</a>)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/STU3/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div> </text> <url value="http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/coverage-deqm"/> <version value="1.0.0"/> <name value="DEQM Coverage Profile"/> <status value="active"/> <experimental value="false"/> <date value="2018-06-19T00:00:00+00:00"/> <publisher value="Da Vinci Project"/> <contact> <telecom> <system value="url"/> <value value="http://www.hl7.org/Special/committees/cqi/index.cfm"/> </telecom> </contact> <description value="The DEQM Coverage Profile defines the constraints for representing the subscriber information to the Payer. This along with the patient first name, last name, date of birth and gender allows the payer to identify the member in their system for which the MRP was performed"/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <fhirVersion value="3.0.2"/> <mapping> <identity value="qdm"/> <uri value="http://www.healthit.gov/quality-data-model"/> <name value="Quality Data Model"/> </mapping> <mapping> <identity value="workflow"/> <uri value="http://hl7.org/fhir/workflow"/> <name value="Workflow Mapping"/> </mapping> <mapping> <identity value="rim"/> <uri value="http://hl7.org/v3"/> <name value="RIM Mapping"/> </mapping> <mapping> <identity value="w5"/> <uri value="http://hl7.org/fhir/w5"/> <name value="W5 Mapping"/> </mapping> <mapping> <identity value="cdanetv4"/> <uri value="http://www.cda-adc.ca/en/services/cdanet/"/> <name value="Canadian Dental Association eclaims standard"/> </mapping> <mapping> <identity value="v2"/> <uri value="http://hl7.org/v2"/> <name value="HL7 v2 Mapping"/> </mapping> <mapping> <identity value="cpha3pharm"/> <uri value="http://www.pharmacists.ca/"/> <name value="Canadian Pharmacy Associaiton eclaims standard"/> </mapping> <kind value="resource"/> <abstract value="false"/> <type value="Coverage"/> <baseDefinition value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/> <derivation value="constraint"/> <snapshot> <element id="Coverage"> <path value="Coverage"/> <short value="Insurance or medical plan or a payment agreement"/> <definition value="This is the Coverage profile which is used to provide insurance information for scheduling an appointment and or registering a patient."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage"/> <min value="0"/> <max value="*"/> </base> <constraint> <key value="dom-2"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> <expression value="contained.contained.empty()"/> <xpath value="not(parent::f:contained and f:contained)"/> <source value="DomainResource"/> </constraint> <constraint> <key value="dom-1"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain any narrative"/> <expression value="contained.text.empty()"/> <xpath value="not(parent::f:contained and f:text)"/> <source value="DomainResource"/> </constraint> <constraint> <key value="dom-4"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/> <source value="DomainResource"/> </constraint> <constraint> <key value="dom-3"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource"/> <expression value="contained.where(('#'+id in %resource.descendants().reference).not()).empty()"/> <xpath value="not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))"/> <source value="DomainResource"/> </constraint> <mustSupport value="false"/> <mapping> <identity value="rim"/> <map value="Entity. Role, or Act"/> </mapping> <mapping> <identity value="workflow"/> <map value="Event"/> </mapping> <mapping> <identity value="rim"/> <map value="Coverage"/> </mapping> <mapping> <identity value="w5"/> <map value="financial.support"/> </mapping> <mapping> <identity value="qdm"/> <map value="Participation"/> </mapping> </element> <element id="Coverage.id"> <path value="Coverage.id"/> <short value="Logical id of this artifact"/> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/> <comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="id"/> </type> <mustSupport value="false"/> <isSummary value="true"/> <mapping> <identity value="qdm"/> <map value="id"/> </mapping> </element> <element id="Coverage.meta"> <path value="Coverage.meta"/> <short value="Metadata about the resource"/> <definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.meta"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Meta"/> </type> <isSummary value="true"/> </element> <element id="Coverage.implicitRules"> <path value="Coverage.implicitRules"/> <short value="A set of rules under which this content was created"/> <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content."/> <comment value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.implicitRules"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <isModifier value="true"/> <isSummary value="true"/> </element> <element id="Coverage.language"> <path value="Coverage.language"/> <short value="Language of the resource content"/> <definition value="The base language in which the resource is written."/> <comment value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.language"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet"> <valueReference> <reference value="http://hl7.org/fhir/ValueSet/all-languages"/> </valueReference> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding"> <valueBoolean value="true"/> </extension> <strength value="extensible"/> <description value="A human language."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/languages"/> </valueSetReference> </binding> </element> <element id="Coverage.text"> <path value="Coverage.text"/> <short value="Text summary of the resource, for human interpretation"/> <definition value="A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/> <comment value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later."/> <alias value="narrative"/> <alias value="html"/> <alias value="xhtml"/> <alias value="display"/> <min value="0"/> <max value="1"/> <base> <path value="DomainResource.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Narrative"/> </type> <condition value="dom-1"/> <mapping> <identity value="rim"/> <map value="Act.text?"/> </mapping> </element> <element id="Coverage.contained"> <path value="Coverage.contained"/> <short value="Contained, inline Resources"/> <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope."/> <comment value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."/> <alias value="inline resources"/> <alias value="anonymous resources"/> <alias value="contained resources"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.contained"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Resource"/> </type> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.extension"> <path value="Coverage.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.modifierExtension"> <path value="Coverage.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.identifier"> <path value="Coverage.identifier"/> <short value="The primary coverage ID"/> <definition value="The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant."/> <requirements value="This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.identifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.identifier"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="C02"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-2"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.32, C.33, C.39"/> </mapping> <mapping> <identity value="w5"/> <map value="id"/> </mapping> </element> <element id="Coverage.status"> <path value="Coverage.status"/> <short value="active | cancelled | draft | entered-in-error"/> <definition value="The status of the resource instance."/> <comment value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.status"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <isModifier value="true"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageStatus"/> </extension> <strength value="required"/> <description value="A code specifying the state of the resource instance."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/fm-status"/> </valueSetReference> </binding> <mapping> <identity value="workflow"/> <map value="Event.status"/> </mapping> <mapping> <identity value="w5"/> <map value="status"/> </mapping> </element> <element id="Coverage.type"> <path value="Coverage.type"/> <short value="Type of coverage such as medical or accident"/> <definition value="The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization."/> <requirements value="The order of application of coverages is dependent on the types of coverage."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <mustSupport value="false"/> <isSummary value="true"/> <binding> <strength value="required"/> <description value="Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system"/> <valueSetReference> <reference value="https://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/> </valueSetReference> </binding> <mapping> <identity value="v2"/> <map value="IN1-15"/> </mapping> <mapping> <identity value="w5"/> <map value="class"/> </mapping> <mapping> <identity value="qdm"/> <map value="code"/> </mapping> </element> <element id="Coverage.policyHolder"> <path value="Coverage.policyHolder"/> <short value="Owner of the policy"/> <definition value="The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.policyHolder"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson"/> </type> <mustSupport value="true"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> <mapping> <identity value="w5"/> <map value="who.focus"/> </mapping> </element> <element id="Coverage.subscriber"> <path value="Coverage.subscriber"/> <short value="Subscriber to the policy"/> <definition value="The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.subscriber"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> <mapping> <identity value="w5"/> <map value="who.focus"/> </mapping> </element> <element id="Coverage.subscriberId"> <path value="Coverage.subscriberId"/> <short value="Subscriber ID"/> <definition value="The insurer assigned ID for the Subscriber."/> <requirements value="The subscriber Id is a number that is needed by the payor to associate the attestation with the meber in their system."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.subscriberId"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mustSupport value="true"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> <mapping> <identity value="w5"/> <map value="who.focus"/> </mapping> </element> <element id="Coverage.beneficiary"> <path value="Coverage.beneficiary"/> <short value="Plan Beneficiary"/> <definition value="The party who benefits from the insurance coverage., the patient when services are provided."/> <requirements value="While not required, this would usually be the US Core Patient Resource for which the MRP was performed."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.beneficiary"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <mustSupport value="true"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.subject"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> <mapping> <identity value="w5"/> <map value="who.focus"/> </mapping> </element> <element id="Coverage.relationship"> <path value="Coverage.relationship"/> <short value="Beneficiary relationship to the Subscriber"/> <definition value="The relationship of beneficiary (patient) to the subscriber."/> <requirements value="To determine relationship between the patient and the subscriber."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.relationship"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Relationship"/> </extension> <strength value="example"/> <description value="The relationship between the Policyholder and the Beneficiary (insured/covered party/patient)."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/policyholder-relationship"/> </valueSetReference> </binding> <mapping> <identity value="cdanetv4"/> <map value="C03"/> </mapping> </element> <element id="Coverage.period"> <path value="Coverage.period"/> <short value="Coverage start and end dates"/> <definition value="Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.period"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <mustSupport value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.occurrence"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-12 / IN1-13"/> </mapping> <mapping> <identity value="w5"/> <map value="when.done"/> </mapping> <mapping> <identity value="qdm"/> <map value="participationPeriod"/> </mapping> </element> <element id="Coverage.payor"> <path value="Coverage.payor"/> <short value="Identifier for the plan or agreement issuer"/> <definition value="The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)."/> <requirements value="Need to identify the issuer to target for processing and for coordination of benefit processing."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.payor"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson"/> </type> <mustSupport value="true"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="A05"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-3"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.30"/> </mapping> <mapping> <identity value="w5"/> <map value="who.author"/> </mapping> </element> <element id="Coverage.grouping"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Group"/> </extension> <path value="Coverage.grouping"/> <short value="Additional coverage classifications"/> <definition value="A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> </element> <element id="Coverage.grouping.id"> <path value="Coverage.grouping.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.grouping.extension"> <path value="Coverage.grouping.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.grouping.modifierExtension"> <path value="Coverage.grouping.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.grouping.group"> <path value="Coverage.grouping.group"/> <short value="An identifier for the group"/> <definition value="Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify an employer group. May also be referred to as a Policy or Group ID."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.group"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.grouping.groupDisplay"> <path value="Coverage.grouping.groupDisplay"/> <short value="Display text for an identifier for the group"/> <definition value="A short description for the group."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.groupDisplay"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.grouping.subGroup"> <path value="Coverage.grouping.subGroup"/> <short value="An identifier for the subsection of the group"/> <definition value="Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer group."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.subGroup"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> </element> <element id="Coverage.grouping.subGroupDisplay"> <path value="Coverage.grouping.subGroupDisplay"/> <short value="Display text for the subsection of the group"/> <definition value="A short description for the subgroup."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.subGroupDisplay"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> </element> <element id="Coverage.grouping.plan"> <path value="Coverage.grouping.plan"/> <short value="An identifier for the plan"/> <definition value="Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division ID."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.plan"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C01"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-35"/> </mapping> </element> <element id="Coverage.grouping.planDisplay"> <path value="Coverage.grouping.planDisplay"/> <short value="Display text for the plan"/> <definition value="A short description for the plan."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.planDisplay"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C01"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-35"/> </mapping> </element> <element id="Coverage.grouping.subPlan"> <path value="Coverage.grouping.subPlan"/> <short value="An identifier for the subsection of the plan"/> <definition value="Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employees."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.subPlan"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="IN1-10"/> </mapping> </element> <element id="Coverage.grouping.subPlanDisplay"> <path value="Coverage.grouping.subPlanDisplay"/> <short value="Display text for the subsection of the plan"/> <definition value="A short description for the subplan."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.subPlanDisplay"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="IN1-10"/> </mapping> </element> <element id="Coverage.grouping.class"> <path value="Coverage.grouping.class"/> <short value="An identifier for the class"/> <definition value="Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage such as a level of deductables or co-payment."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.class"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C01"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-35"/> </mapping> </element> <element id="Coverage.grouping.classDisplay"> <path value="Coverage.grouping.classDisplay"/> <short value="Display text for the class"/> <definition value="A short description for the class."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.classDisplay"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C01"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-35"/> </mapping> </element> <element id="Coverage.grouping.subClass"> <path value="Coverage.grouping.subClass"/> <short value="An identifier for the subsection of the class"/> <definition value="Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a subclass of coverage such as a sub-level of deductables or co-payment."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.subClass"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C01"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-35"/> </mapping> </element> <element id="Coverage.grouping.subClassDisplay"> <path value="Coverage.grouping.subClassDisplay"/> <short value="Display text for the subsection of the subclass"/> <definition value="A short description for the subclass."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.grouping.subClassDisplay"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C01"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-35"/> </mapping> </element> <element id="Coverage.dependent"> <path value="Coverage.dependent"/> <short value="Dependent number"/> <definition value="A unique identifier for a dependent under the coverage."/> <requirements value="For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.dependent"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C17"/> </mapping> <mapping> <identity value="v2"/> <map value="- No exact HL7 v2 equivalent concept seems to exist;"/> </mapping> </element> <element id="Coverage.sequence"> <path value="Coverage.sequence"/> <short value="The plan instance or sequence counter"/> <definition value="An optional counter for a particular instance of the identified coverage which increments upon each renewal."/> <requirements value="Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.sequence"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D11"/> </mapping> <mapping> <identity value="v2"/> <map value="No HL7 v2 equivalent concept seems to exist"/> </mapping> </element> <element id="Coverage.order"> <path value="Coverage.order"/> <short value="Relative order of the coverage"/> <definition value="The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.order"/> <min value="0"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="- No exact HL7 v2 equivalent concept seems to exist;"/> </mapping> </element> <element id="Coverage.network"> <path value="Coverage.network"/> <short value="Insurer network"/> <definition value="The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.network"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D10"/> </mapping> </element> <element id="Coverage.contract"> <path value="Coverage.contract"/> <short value="Contract details"/> <definition value="The policy(s) which constitute this insurance coverage."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.contract"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Contract"/> </type> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> </snapshot> <differential> <element id="Coverage"> <path value="Coverage"/> <definition value="This is the Coverage profile which is used to provide insurance information for scheduling an appointment and or registering a patient."/> <mustSupport value="false"/> </element> <element id="Coverage.subscriberId"> <path value="Coverage.subscriberId"/> <short value="Subscriber ID"/> <requirements value="The subscriber Id is a number that is needed by the payor to associate the attestation with the meber in their system."/> <min value="1"/> <max value="1"/> <mustSupport value="true"/> </element> <element id="Coverage.beneficiary"> <path value="Coverage.beneficiary"/> <requirements value="While not required, this would usually be the US Core Patient Resource for which the MRP was performed."/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <mustSupport value="true"/> </element> </differential> </StructureDefinition>
