Profile Comparison between http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage vs http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Coverage
copyright
date	2018-08-22
description	Profile of Coverage for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
experimental	false
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	QICoreCoverage
publisher	http://www.hl7.org/Special/committees/cqi/index.cfm
purpose
status	active
title	QICore Coverage
type	Coverage
url	http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
version	5.0.0-ballot

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	L Type	L Description & Constraints	Comments
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	string	Logical id of this artifact	Σ	0..1	string	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: todo (preferred): A human language. Additional Bindings Purpose todo Max Binding		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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	Σ	0..*	Identifier	Business Identifier for the coverage	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: todo (required): A code specifying the state of the resource instance.	?!Σ	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: todo (required): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: https://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 (required): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder	SΣ	0..1	Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)	Owner of the policy	SΣ	0..1	Reference(QICorePatient | QICoreOrganization | QICoreRelatedPerson)	Owner of the policy	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson]])
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	SΣ	0..1	string	ID assigned to the subscriber	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)	Plan beneficiary	SΣ	1..1	Reference(QICorePatient)	Plan beneficiary	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient]])
dependent	Σ	0..1	string	Dependent number	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: todo (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣ	0..1	Period	Coverage start and end dates	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)	Issuer of the policy	SΣ	1..1	Reference(QICorePatient | QICoreOrganization | QICoreRelatedPerson)	Issuer of the policy	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson]])
class		0..*	BackboneElement	Additional coverage classifications		0..*	BackboneElement	Additional coverage classifications
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: todo (extensible): The policy classifications, eg. Group, Plan, Class, etc.	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (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	0..1	string	Human readable description of the type and value	Σ	0..1	string	Human readable description of the type and value
order	SΣ	0..1	positiveInt	Relative order of the coverage	SΣ	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: todo (extensible): The types of services to which patient copayments are specified.	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1	Quantity, Money	The amount or percentage due from the beneficiary	Σ	1..1	SimpleQuantity, 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: todo (example): The types of exceptions from the part or full value of financial obligations such as copays.	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (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	S	0..*	Reference(Contract)	Contract details	S	0..*	Reference(Contract)	Contract details
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