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/us/core/StructureDefinition/us-core-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	HL7 International / Clinical Quality Information	Values Differ
purpose
status	active
title	QICore Coverage
type	Coverage
url	http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
version	6.0.0-ballot	6.0.0	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	L Type	L Description & Constraints	Comments
Coverage	C	0..*	USCoreCoverageProfile	Insurance or medical plan or a payment agreement us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present	C	0..*	USCoreCoverageProfile	Insurance or medical plan or a payment agreement us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present
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. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? 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
Slices for identifier	SΣ	0..*	Identifier	(USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type	SΣ	0..*	Identifier	(USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
status	?!SΣ	1..1	code	(USCDI) active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.	?!SΣ	1..1	code	(USCDI) active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
type	SΣ	0..1	CodeableConcept	(USCDI) Coverage category such as medical or accident Binding: ?? (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system	SΣ	0..1	CodeableConcept	(QI-Core)(USCDI) Coverage category such as medical or accident Binding: ?? (extensible): 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(QICore Patient | QICore Organization | QICore RelatedPerson)	Owner of the policy	Σ	0..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson)	(QI-Core) Owner of the policy	Elements differ in definition for mustSupport: 'true' vs 'false'
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	SΣC	0..1	string	(USCDI) ID assigned to the subscriber	SΣC	0..1	string	(QI-Core)(USCDI) ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(QICore Patient)	(USCDI) Plan beneficiary	SΣ	1..1	Reference(QICore Patient)	(QI-Core)(USCDI) Plan beneficiary
dependent	Σ	0..1	string	Dependent number	Σ	0..1	string	Dependent number
relationship	S	1..1	CodeableConcept	(USCDI) Beneficiary relationship to the subscriber Binding: ?? (extensible)	S	1..1	CodeableConcept	(USCDI) Beneficiary relationship to the subscriber Binding: ?? (extensible)
period	SΣ	0..1	Period	(USCDI) Coverage start and end dates	SΣ	0..1	Period	(QI-Core)(USCDI) Coverage start and end dates
payor	SΣ	1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson)	(USCDI) Issuer of the policy	SΣ	1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson)	(QI-Core)(USCDI) Issuer of the policy
Slices for class	S	0..*	BackboneElement	(USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type	S	0..*	BackboneElement	(USCDI) 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	0..1	string	Human readable description of the type and value	Σ	0..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: ?? (extensible): The types of services to which patient copayments are specified.	Σ	0..1	CodeableConcept	Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified.
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