Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - STU 2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

Resource Profile: PASCoverage - Mappings

Page standards status: Trial-use Maturity Level: 3

Mappings for the profile-coverage resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

PASCoverage
CoverageEvent
   identifierEvent.identifier
   identifier (memberid)Event.identifier
   statusEvent.status
   beneficiaryEvent.subject
   periodEvent.occurrence[x]

Mappings for RIM Mapping (http://hl7.org/v3)

PASCoverage
CoverageEntity. Role, or Act, Coverage
   textAct.text?
   containedN/A
   extensionN/A
   modifierExtensionN/A
   identifier.id
   identifier (memberid).id
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   statusAct.status
   relationship
      idn/a
      extensionn/a
      codingunion(., ./translation)
      coding (X12Code)union(., ./translation)
      text./originalText[mediaType/code="text/plain"]/data
   periodAct.effectiveTime
   class
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (group)
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (plan)
      idn/a
      extensionn/a
      modifierExtensionN/A
   costToBeneficiary
      idn/a
      extensionn/a
      modifierExtensionN/A
      exception
         idn/a
         extensionn/a
         modifierExtensionN/A
   contractn/a

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

PASCoverage
Coverage
   identifierFiveWs.identifier
   identifier (memberid)FiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   policyHolderFiveWs.subject[x], FiveWs.subject
   subscriberFiveWs.subject[x], FiveWs.subject
   subscriberIdFiveWs.subject[x], FiveWs.subject
   beneficiaryFiveWs.subject[x], FiveWs.subject
   periodFiveWs.done[x]
   payorFiveWs.author

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

PASCoverage
Coverage
   identifierC02
   identifier (memberid)C02
   policyHolderD01 through D09
   subscriberD01 through D09
   subscriberIdD01 through D09
   beneficiaryD01 through D09
   dependentC17
   relationshipC03
   payorA05
   class
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (group)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (plan)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   networkD10
   costToBeneficiary
      value[x]C11 (Division,Section)
   contractD01 through D09

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

PASCoverage
Coverage
   identifierIN1-2
   identifier (memberid)IN1-2
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   typeIN1-15
   policyHolderIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIdIN1-16, 18, 19-name of insured, address, date of birth
   beneficiaryIN1-16, 18, 19-name of insured, address, date of birth
   dependent- No exact HL7 v2 equivalent concept seems to exist;
   relationship
      codingC*E.1-8, C*E.10-22
      coding (X12Code)C*E.1-8, C*E.10-22
      textC*E.9. But note many systems use C*E.2 for this
   periodIN1-12 / IN1-13
   payorIN1-3
   class
      valueIN1-8
      nameIN1-8
   class (group)
      valueIN1-8
      nameIN1-8
   class (plan)
      valueIN1-8
      nameIN1-8
   order- No exact HL7 v2 equivalent concept seems to exist;
   costToBeneficiary
      value[x]IN1-8
   contractIN1-16, 18, 19

Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

PASCoverage
Coverage
   identifierC.32, C.33, C.39
   identifier (memberid)C.32, C.33, C.39
   policyHolderC.35
   subscriberC.35
   subscriberIdC.35
   beneficiaryC.35
   payorC.30
   class
      valueC.31
      nameC.31
   class (group)
      valueC.31
      nameC.31
   class (plan)
      valueC.31
      nameC.31
   costToBeneficiary
      value[x]C.31
   contractC.35