This is the set of resources that conform to either of the profiles HRex Coverage Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage) and HRex Member Match Coverage Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage). E.g. what you have to deal with if you get resources conforming to one of them
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | C | 0..* | Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management hrex-cov-1: Coverage.identifier or Coverage.subscriberId SHALL be present | |
meta | Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children | |
text | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
identifier | SΣ | 0..* | Identifier | left: Also known as Member identifier; right: Member ID and other identifiers ele-1: All FHIR elements must have a @value or children |
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children |
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children |
system | Σ | 0..1 | uri | The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient |
value | SΣ | 1..1 | string | The value that is unique within the system. ele-1: All FHIR elements must have a @value or children Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children |
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): left: The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.; right: US Public Health Data Consortium Source of Payment Codes ele-1: All FHIR elements must have a @value or children |
policyHolder | SΣ | 0..1 | Reference(US Core Patient Profile | HRex Organization Profile | RelatedPerson | #sd-us-core-patient-us-core-patient) | Owner of the policy ele-1: All FHIR elements must have a @value or children |
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy ele-1: All FHIR elements must have a @value or children |
subscriberId | SΣ | 0..1 | string | Subscriber ID ele-1: All FHIR elements must have a @value or children |
beneficiary | SΣ | 1..1 | Reference(HRex Patient Demographics | #sd-hrex-patient-demographics-hrex-patient-demographics) | Plan beneficiary ele-1: All FHIR elements must have a @value or children |
dependent | SΣ | 0..1 | string | Dependent number ele-1: All FHIR elements must have a @value or children |
relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). ele-1: All FHIR elements must have a @value or children |
period | SΣ | 0..1 | Period | Coverage start and end dates ele-1: All FHIR elements must have a @value or children |
payor | SΣ | 1..1 | Reference(HRex Organization Profile | #sd-hrex-organization-hrex-organization) | Issuer of the policy ele-1: All FHIR elements must have a @value or children |
class | 0..* | BackboneElement | Additional coverage classifications ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children |
value | Σ | 1..1 | string | Value associated with the type ele-1: All FHIR elements must have a @value or children |
name | Σ | 0..1 | string | Human readable description of the type and value ele-1: All FHIR elements must have a @value or children |
order | Σ | 0..1 | positiveInt | Relative order of the coverage ele-1: All FHIR elements must have a @value or children |
network | Σ | 0..1 | string | Insurer network ele-1: All FHIR elements must have a @value or children |
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. ele-1: All FHIR elements must have a @value or children |
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary ele-1: All FHIR elements must have a @value or children | |
valueQuantity | Quantity(SimpleQuantity) | |||
valueMoney | Money | |||
exception | 0..* | BackboneElement | Exceptions for patient payments ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
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. ele-1: All FHIR elements must have a @value or children |
period | Σ | 0..1 | Period | The effective period of the exception ele-1: All FHIR elements must have a @value or children |
subrogation | 0..1 | boolean | Reimbursement to insurer ele-1: All FHIR elements must have a @value or children | |
contract | 0..* | Reference(Contract) | Contract details ele-1: All FHIR elements must have a @value or children | |
Documentation for this format |