# QICore Coverage - QI-Core Implementation Guide v7.0.2

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **QICore Coverage**

## Resource Profile: QICore Coverage 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage | *Version*:7.0.2 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 4 | *Computable Name*:QICoreCoverage |

 
Profile of Coverage for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors. 

"Must Have", "QI Elements" and "primary code path" are defined in the
[QI-Core Must Support section](index.md#mustsupport-flag).

**Must Have:**
* payor: (QI) Issuer of the policy
* class.value: Group Number
* identifier.type: Member Number identifier type
* class.value: Plan Number
* beneficiary: (QI) Plan beneficiary
* status: active | cancelled | draft | entered-in-error
* relationship: Beneficiary relationship to the subscriber

**QI Elements:**
* subscriberId: (QI) ID assigned to the subscriber
* policyHolder: (QI) Owner of the policy
* period: (QI) Coverage start and end dates
* type: (QI) Coverage category such as medical or accident

**Primary code path:**type

(PCPath) This element is the primary code path for this resource
[CQL Retrieve](https://cql.hl7.org/02-authorsguide.html#retrieve)

**Usage** 
```
define "SDE Payer":
  [Coverage: type in "Payer"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

```

  See the [patterns](patterns.md) page for implementation and usage patterns.  

### Examples

 

| |
| :--- |
| [General Person Primary Coverage Example](Coverage-example.md) |
| [General Subscriber ID Coverage Example](Coverage-example-new.md) |

 

**Usages:**

* Refer to this Profile: [QICore Claim](StructureDefinition-qicore-claim.md)
* Examples for this Profile: [Coverage/example-new](Coverage-example-new.md) and [Coverage/example](Coverage-example.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.qicore|current/StructureDefinition/qicore-coverage)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-qicore-coverage.csv), [Excel](StructureDefinition-qicore-coverage.xlsx), [Schematron](StructureDefinition-qicore-coverage.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "qicore-coverage",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-modelInfo-primaryCodePath",
    "valueString" : "type"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-modelInfo-isIncluded",
    "valueBoolean" : true
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-modelInfo-isRetrievable",
    "valueBoolean" : true
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-modelInfo-label",
    "valueString" : "Coverage"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cqi"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 4,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/qicore/ImplementationGuide/us-qicore"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/qicore/ImplementationGuide/us-qicore"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage",
  "version" : "7.0.2",
  "name" : "QICoreCoverage",
  "title" : "QICore Coverage",
  "status" : "active",
  "experimental" : false,
  "date" : "2018-08-22",
  "publisher" : "HL7 International / Clinical Quality Information",
  "contact" : [{
    "name" : "Clinical Quality Information WG",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cqi"
    }]
  }],
  "description" : "Profile of Coverage for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "cdanetv4",
    "uri" : "http://www.cda-adc.ca/en/services/cdanet/",
    "name" : "Canadian Dental Association eclaims standard"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "cpha3pharm",
    "uri" : "http://www.pharmacists.ca/",
    "name" : "Canadian Pharmacy Associaiton eclaims standard"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Coverage",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Coverage",
      "path" : "Coverage"
    },
    {
      "id" : "Coverage.type",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-keyelement",
        "valueBoolean" : true
      }],
      "path" : "Coverage.type",
      "short" : "(QI) Coverage category such as medical or accident",
      "binding" : {
        "strength" : "extensible",
        "description" : "Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      }
    },
    {
      "id" : "Coverage.policyHolder",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-keyelement",
        "valueBoolean" : true
      }],
      "path" : "Coverage.policyHolder",
      "short" : "(QI) Owner of the policy",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["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"]
      }]
    },
    {
      "id" : "Coverage.subscriberId",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-keyelement",
        "valueBoolean" : true
      }],
      "path" : "Coverage.subscriberId",
      "short" : "(QI) ID assigned to the subscriber",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Coverage.beneficiary",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-keyelement",
        "valueBoolean" : true
      }],
      "path" : "Coverage.beneficiary",
      "short" : "(QI) Plan beneficiary",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"]
      }]
    },
    {
      "id" : "Coverage.period",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-keyelement",
        "valueBoolean" : true
      }],
      "path" : "Coverage.period",
      "short" : "(QI) Coverage start and end dates"
    },
    {
      "id" : "Coverage.payor",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-keyelement",
        "valueBoolean" : true
      }],
      "path" : "Coverage.payor",
      "short" : "(QI) Issuer of the policy",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["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"]
      }]
    }]
  }
}

```
