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

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

Resource Profile: Profile_R4_Coverage_R3

Official URL: http://hl7.org/fhir/4.0/StructureDefinition/profile-Coverage Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R4_Coverage_R3

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

Usages:

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 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
.... extension:costToBeneficiary 0..* (Complex) R4: Patient payments for services/products (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.costToBeneficiary
.... extension:subrogation 0..1 boolean R4: Reimbursement to insurer (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.subrogation
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍3.0.2 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-1 error Coverage If the resource is contained in another resource, it SHALL NOT contain any narrative contained.text.empty()
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 contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() | (children().count() > id.count())
ext-1 error **ALL** extensions 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 Insurance or medical plan or a payment agreement
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:costToBeneficiary 0..* (Complex) R4: Patient payments for services/products (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.costToBeneficiary
.... extension:subrogation 0..1 boolean R4: Reimbursement to insurer (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.subrogation

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage 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
.... extension:costToBeneficiary 0..* (Complex) R4: Patient payments for services/products (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.costToBeneficiary
.... extension:subrogation 0..1 boolean R4: Reimbursement to insurer (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.subrogation
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier The primary coverage ID
... status ?!Σ 0..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required): A code specifying the state of the resource instance.
... type Σ 0..1 CodeableConcept Type of coverage such as medical or accident
Binding: Coverage Type and Self-Pay Codes (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 0..1 Reference(Patient) Plan Beneficiary
... relationship 0..1 CodeableConcept Beneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (example): The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 0..* Reference(Organization | Patient | RelatedPerson) Identifier for the plan or agreement issuer
... grouping 0..1 BackboneElement Additional coverage classifications
.... id 0..1 string xml:id (or equivalent in JSON)
.... extension 0..* Extension Additional Content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... group Σ 0..1 string An identifier for the group
.... groupDisplay Σ 0..1 string Display text for an identifier for the group
.... subGroup Σ 0..1 string An identifier for the subsection of the group
.... subGroupDisplay Σ 0..1 string Display text for the subsection of the group
.... plan Σ 0..1 string An identifier for the plan
.... planDisplay Σ 0..1 string Display text for the plan
.... subPlan Σ 0..1 string An identifier for the subsection of the plan
.... subPlanDisplay Σ 0..1 string Display text for the subsection of the plan
.... class Σ 0..1 string An identifier for the class
.... classDisplay Σ 0..1 string Display text for the class
.... subClass Σ 0..1 string An identifier for the subsection of the class
.... subClassDisplay Σ 0..1 string Display text for the subsection of the subclass
... dependent Σ 0..1 string Dependent number
... sequence Σ 0..1 string The plan instance or sequence counter
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base extensible Common Languages 📍3.0.2 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍3.0.2 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍3.0.2 FHIR Std.
Coverage.relationship Base example Policyholder Relationship Codes 📍3.0.2 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-1 error Coverage If the resource is contained in another resource, it SHALL NOT contain any narrative contained.text.empty()
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 contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() | (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage 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
.... extension:costToBeneficiary 0..* (Complex) R4: Patient payments for services/products (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.costToBeneficiary
.... extension:subrogation 0..1 boolean R4: Reimbursement to insurer (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.subrogation
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍3.0.2 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-1 error Coverage If the resource is contained in another resource, it SHALL NOT contain any narrative contained.text.empty()
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 contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() | (children().count() > id.count())
ext-1 error **ALL** extensions 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 Insurance or medical plan or a payment agreement
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:costToBeneficiary 0..* (Complex) R4: Patient payments for services/products (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.costToBeneficiary
.... extension:subrogation 0..1 boolean R4: Reimbursement to insurer (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.subrogation

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage 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
.... extension:costToBeneficiary 0..* (Complex) R4: Patient payments for services/products (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.costToBeneficiary
.... extension:subrogation 0..1 boolean R4: Reimbursement to insurer (new)
URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Coverage.subrogation
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier The primary coverage ID
... status ?!Σ 0..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required): A code specifying the state of the resource instance.
... type Σ 0..1 CodeableConcept Type of coverage such as medical or accident
Binding: Coverage Type and Self-Pay Codes (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 0..1 Reference(Patient) Plan Beneficiary
... relationship 0..1 CodeableConcept Beneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (example): The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 0..* Reference(Organization | Patient | RelatedPerson) Identifier for the plan or agreement issuer
... grouping 0..1 BackboneElement Additional coverage classifications
.... id 0..1 string xml:id (or equivalent in JSON)
.... extension 0..* Extension Additional Content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... group Σ 0..1 string An identifier for the group
.... groupDisplay Σ 0..1 string Display text for an identifier for the group
.... subGroup Σ 0..1 string An identifier for the subsection of the group
.... subGroupDisplay Σ 0..1 string Display text for the subsection of the group
.... plan Σ 0..1 string An identifier for the plan
.... planDisplay Σ 0..1 string Display text for the plan
.... subPlan Σ 0..1 string An identifier for the subsection of the plan
.... subPlanDisplay Σ 0..1 string Display text for the subsection of the plan
.... class Σ 0..1 string An identifier for the class
.... classDisplay Σ 0..1 string Display text for the class
.... subClass Σ 0..1 string An identifier for the subsection of the class
.... subClassDisplay Σ 0..1 string Display text for the subsection of the subclass
... dependent Σ 0..1 string Dependent number
... sequence Σ 0..1 string The plan instance or sequence counter
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base extensible Common Languages 📍3.0.2 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍3.0.2 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍3.0.2 FHIR Std.
Coverage.relationship Base example Policyholder Relationship Codes 📍3.0.2 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-1 error Coverage If the resource is contained in another resource, it SHALL NOT contain any narrative contained.text.empty()
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 contained.where(('#'+id in %resource.descendants().reference).not()).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()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() | (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron