Extensions for Using Data Elements from FHIR STU3 in FHIR R4
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR STU3 in FHIR R4 - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R3_Coverage_R4

Official URL: http://hl7.org/fhir/3.0/StructureDefinition/profile-Coverage Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R3_Coverage_R4

This cross-version profile allows STU3 Coverage content to be represented via FHIR R4 Coverage resources.

Usages:

  • This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(4.0.1) Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:sequence 0..1 string STU3: The plan instance or sequence counter (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.sequence
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error Coverage.implicitRules, Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension, Coverage.status, Coverage.beneficiary, Coverage.payor All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(4.0.1) Insurance or medical plan or a payment agreement
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:sequence 0..1 string STU3: The plan instance or sequence counter (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.sequence
... class
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:group 0..1 string STU3: An identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.group
..... extension:groupDisplay 0..1 string STU3: Display text for an identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.groupDisplay
..... extension:subGroup 0..1 string STU3: An identifier for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroup
..... extension:subGroupDisplay 0..1 string STU3: Display text for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroupDisplay
..... extension:plan 0..1 string STU3: An identifier for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.plan
..... extension:planDisplay 0..1 string STU3: Display text for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.planDisplay
..... extension:subPlan 0..1 string STU3: An identifier for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlan
..... extension:subPlanDisplay 0..1 string STU3: Display text for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlanDisplay
..... extension:class 0..1 string STU3: An identifier for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.class
..... extension:classDisplay 0..1 string STU3: Display text for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.classDisplay
..... extension:subClass 0..1 string STU3: An identifier for the subsection of the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClass
..... extension:subClassDisplay 0..1 string STU3: Display text for the subsection of the subclass (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClassDisplay

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(4.0.1) Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:sequence 0..1 string STU3: The plan instance or sequence counter (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.sequence
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (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(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:group 0..1 string STU3: An identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.group
Constraints: ext-1
..... extension:groupDisplay 0..1 string STU3: Display text for an identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.groupDisplay
Constraints: ext-1
..... extension:subGroup 0..1 string STU3: An identifier for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroup
Constraints: ext-1
..... extension:subGroupDisplay 0..1 string STU3: Display text for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroupDisplay
Constraints: ext-1
..... extension:plan 0..1 string STU3: An identifier for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.plan
Constraints: ext-1
..... extension:planDisplay 0..1 string STU3: Display text for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.planDisplay
Constraints: ext-1
..... extension:subPlan 0..1 string STU3: An identifier for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlan
Constraints: ext-1
..... extension:subPlanDisplay 0..1 string STU3: Display text for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlanDisplay
Constraints: ext-1
..... extension:class 0..1 string STU3: An identifier for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.class
Constraints: ext-1
..... extension:classDisplay 0..1 string STU3: Display text for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.classDisplay
Constraints: ext-1
..... extension:subClass 0..1 string STU3: An identifier for the subsection of the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClass
Constraints: ext-1
..... extension:subClassDisplay 0..1 string STU3: Display text for the subsection of the subclass (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClassDisplay
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 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
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 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
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error Coverage.meta, Coverage.implicitRules, Coverage.language, Coverage.text, Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.type, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.payor, Coverage.class, Coverage.class.extension, Coverage.class.extension:group, Coverage.class.extension:groupDisplay, Coverage.class.extension:subGroup, Coverage.class.extension:subGroupDisplay, Coverage.class.extension:plan, Coverage.class.extension:planDisplay, Coverage.class.extension:subPlan, Coverage.class.extension:subPlanDisplay, Coverage.class.extension:class, Coverage.class.extension:classDisplay, Coverage.class.extension:subClass, Coverage.class.extension:subClassDisplay, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.value, Coverage.class.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.type, Coverage.costToBeneficiary.value[x], Coverage.costToBeneficiary.exception, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension, Coverage.costToBeneficiary.exception.type, Coverage.costToBeneficiary.exception.period, Coverage.subrogation, Coverage.contract All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension, Coverage.class.extension, Coverage.class.extension:group, Coverage.class.extension:groupDisplay, Coverage.class.extension:subGroup, Coverage.class.extension:subGroupDisplay, Coverage.class.extension:plan, Coverage.class.extension:planDisplay, Coverage.class.extension:subPlan, Coverage.class.extension:subPlanDisplay, Coverage.class.extension:class, Coverage.class.extension:classDisplay, Coverage.class.extension:subClass, Coverage.class.extension:subClassDisplay, Coverage.class.modifierExtension, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(4.0.1) Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:sequence 0..1 string STU3: The plan instance or sequence counter (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.sequence
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error Coverage.implicitRules, Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension, Coverage.status, Coverage.beneficiary, Coverage.payor All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(4.0.1) Insurance or medical plan or a payment agreement
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:sequence 0..1 string STU3: The plan instance or sequence counter (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.sequence
... class
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:group 0..1 string STU3: An identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.group
..... extension:groupDisplay 0..1 string STU3: Display text for an identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.groupDisplay
..... extension:subGroup 0..1 string STU3: An identifier for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroup
..... extension:subGroupDisplay 0..1 string STU3: Display text for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroupDisplay
..... extension:plan 0..1 string STU3: An identifier for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.plan
..... extension:planDisplay 0..1 string STU3: Display text for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.planDisplay
..... extension:subPlan 0..1 string STU3: An identifier for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlan
..... extension:subPlanDisplay 0..1 string STU3: Display text for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlanDisplay
..... extension:class 0..1 string STU3: An identifier for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.class
..... extension:classDisplay 0..1 string STU3: Display text for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.classDisplay
..... extension:subClass 0..1 string STU3: An identifier for the subsection of the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClass
..... extension:subClassDisplay 0..1 string STU3: Display text for the subsection of the subclass (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClassDisplay

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(4.0.1) Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:sequence 0..1 string STU3: The plan instance or sequence counter (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.sequence
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (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(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:group 0..1 string STU3: An identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.group
Constraints: ext-1
..... extension:groupDisplay 0..1 string STU3: Display text for an identifier for the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.groupDisplay
Constraints: ext-1
..... extension:subGroup 0..1 string STU3: An identifier for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroup
Constraints: ext-1
..... extension:subGroupDisplay 0..1 string STU3: Display text for the subsection of the group (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subGroupDisplay
Constraints: ext-1
..... extension:plan 0..1 string STU3: An identifier for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.plan
Constraints: ext-1
..... extension:planDisplay 0..1 string STU3: Display text for the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.planDisplay
Constraints: ext-1
..... extension:subPlan 0..1 string STU3: An identifier for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlan
Constraints: ext-1
..... extension:subPlanDisplay 0..1 string STU3: Display text for the subsection of the plan (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subPlanDisplay
Constraints: ext-1
..... extension:class 0..1 string STU3: An identifier for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.class
Constraints: ext-1
..... extension:classDisplay 0..1 string STU3: Display text for the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.classDisplay
Constraints: ext-1
..... extension:subClass 0..1 string STU3: An identifier for the subsection of the class (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClass
Constraints: ext-1
..... extension:subClassDisplay 0..1 string STU3: Display text for the subsection of the subclass (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Coverage.grouping.subClassDisplay
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 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
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 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
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error Coverage.meta, Coverage.implicitRules, Coverage.language, Coverage.text, Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.type, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.payor, Coverage.class, Coverage.class.extension, Coverage.class.extension:group, Coverage.class.extension:groupDisplay, Coverage.class.extension:subGroup, Coverage.class.extension:subGroupDisplay, Coverage.class.extension:plan, Coverage.class.extension:planDisplay, Coverage.class.extension:subPlan, Coverage.class.extension:subPlanDisplay, Coverage.class.extension:class, Coverage.class.extension:classDisplay, Coverage.class.extension:subClass, Coverage.class.extension:subClassDisplay, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.value, Coverage.class.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.type, Coverage.costToBeneficiary.value[x], Coverage.costToBeneficiary.exception, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension, Coverage.costToBeneficiary.exception.type, Coverage.costToBeneficiary.exception.period, Coverage.subrogation, Coverage.contract All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:sequence, Coverage.modifierExtension, Coverage.class.extension, Coverage.class.extension:group, Coverage.class.extension:groupDisplay, Coverage.class.extension:subGroup, Coverage.class.extension:subGroupDisplay, Coverage.class.extension:plan, Coverage.class.extension:planDisplay, Coverage.class.extension:subPlan, Coverage.class.extension:subPlanDisplay, Coverage.class.extension:class, Coverage.class.extension:classDisplay, Coverage.class.extension:subClass, Coverage.class.extension:subClassDisplay, Coverage.class.modifierExtension, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

 

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