abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisher- Values Differ
purposestatustitletypeurlversion- Values Differ
| Left: | PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage) |
| Right: | PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage) |
| Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '1.1.0' |
| Information | StructureDefinition.date | Values for date differ: '2023-03-30T13:34:22+00:00' vs '2024-01-03T18:32:02+00:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Financial Management Work Group' vs 'HL7 International / Financial Management' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage | ||
| copyright | |||
| date | 2023-03-30T13:34:22+00:00 | 2024-01-03T18:32:02+00:00 |
|
| description | PCT Coverage is a profile for capturing data that reflect a payer’s coverage that was effective as of the proposed date of service or the date of admission of the GFE. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | PCTCoverage | ||
| publisher | HL7 International - Financial Management Work Group | HL7 International / Financial Management |
|
| purpose | |||
| status | active | ||
| title | PCT Coverage | ||
| type | Coverage | ||
| url | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage | ||
| version | 1.0.0 | 1.1.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Coverage | C | 0..* | HRexCoverage | Insurance or medical plan or a payment agreement | C | 0..* | HRexCoverage | Insurance or medical plan or a payment agreement | |||||||||
 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 | |||||||||
 identifier | SΣ | 0..1 | Identifier | Also known as Member identifier | SΣ | 0..1 | Identifier | Also known as Member identifier | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | |||||||||
| 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. | 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. | |||||||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |||||||||
| value | SΣ | 1..1 | string | The value that is unique within the system. Example General: 123456 | SΣ | 1..1 | string | The value that is unique within the system. Example General: 123456 | |||||||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | Σ | 0..1 | Period | Time period when id is/was valid for use | |||||||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
| type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | |||||||||
| policyHolder | Σ | 0..1 | Reference(US Core Patient Profile | HRex Organization Profile | RelatedPerson) | Owner of the policy | Σ | 0..1 | Reference(US Core Patient Profile | HRex Organization Profile | RelatedPerson) | Owner of the policy | |||||||||
| subscriber | Σ | 0..1 | Reference(US Core Patient Profile) | Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown. | Σ | 0..1 | Reference(US Core Patient Profile) | Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown. | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | |||||||||
| display | Σ | 1..1 | string | Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber’s prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference. | Σ | 1..1 | string | Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber’s prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference. | |||||||||
| subscriberId | SΣ | 1..1 | string | Subscriber ID | SΣ | 1..1 | string | Subscriber ID | |||||||||
| beneficiary | SΣ | 1..1 | Reference(HRex Patient Demographics) | Plan beneficiary | SΣ | 1..1 | Reference(HRex Patient Demographics) | Plan beneficiary | |||||||||
| dependent | SΣ | 0..1 | string | Dependent number | SΣ | 0..1 | string | Dependent number | |||||||||
| relationship | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||||||||
| period | Σ | 1..1 | Period | Coverage start and end dates | Σ | 1..1 | Period | Coverage start and end dates | |||||||||
| payor | SΣ | 1..1 | Reference(PCT Organization) | Issuer of the policy | SΣ | 1..1 | Reference(PCT Organization) | Issuer of the policy | |||||||||
| Slices for class | 1..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | 1..* | 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 | 1..1 | string | Human readable description of the type and value | Σ | 1..1 | string | Human readable description of the type and value | |||||||||
| order | Σ | 0..1 | positiveInt | Relative order of the coverage | Σ | 0..1 | positiveInt | Relative order of the coverage | |||||||||
| network | Σ | 0..1 | string | Insurer network | Σ | 0..1 | string | Insurer network | |||||||||
| costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | 0..* | BackboneElement | Patient payments for services/products | |||||||||||
| 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: ?? (required) | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (required) | |||||||||
| 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 | |||||||||||||||||