Extensions for Using Data Elements from FHIR R4B in FHIR R5
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR R4B in FHIR R5 - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R4B_Coverage_R5

Official URL: http://hl7.org/fhir/4.3/StructureDefinition/profile-Coverage Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R4B_Coverage_R5

This cross-version profile allows R4B Coverage content to be represented via FHIR R5 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(5.0.0) Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:payor 1..* Reference(Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization | Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient | Cross-version Profile for R4B.RelatedPerson for use in FHIR R5(0.1.0) | RelatedPerson) R4B: Issuer of the policy (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.payor
Constraints: ext-1
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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:payor, Coverage.modifierExtension, Coverage.status, Coverage.kind, Coverage.beneficiary All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:payor, 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(5.0.0) Insurance or medical plan or a payment agreement
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:payor 1..* Reference(Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization | Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient | Cross-version Profile for R4B.RelatedPerson for use in FHIR R5(0.1.0) | RelatedPerson) R4B: Issuer of the policy (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.payor
... subscriberId
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:subscriberId 0..1 string R4B: subscriberId additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.subscriberId
... class
.... value
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:value 0..1 string R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.class.value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(5.0.0) 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
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:payor 1..* Reference(Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization | Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient | Cross-version Profile for R4B.RelatedPerson for use in FHIR R5(0.1.0) | RelatedPerson) R4B: Issuer of the policy (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.payor
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier Σ 0..* Identifier Business identifier(s) for this coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... paymentBy 0..* BackboneElement Self-pay parties and responsibility
.... 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
.... party Σ 1..1 Reference(Patient | RelatedPerson | Organization) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelfPayCodes (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..* Identifier ID assigned to the subscriber
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:subscriberId 0..1 string R4B: subscriberId additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.subscriberId
Constraints: ext-1
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value ΣC 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... 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
... insurer Σ 0..1 Reference(Organization) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... 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 Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
.... value Σ 1..1 Identifier Value associated with the type
..... id 0..1 id Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:value 1..1 string R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.class.value
Constraints: ext-1
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣC 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... 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.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example)
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example)
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example)
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example)
.... value[x] Σ 0..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
... insurancePlan 0..1 Reference(InsurancePlan) Insurance plan details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base required All Languages 📍5.0.0 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍5.0.0 FHIR Std.
Coverage.subscriberId.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.subscriberId.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍5.0.0 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍5.0.0 FHIR Std.
Coverage.class.value.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.class.value.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​network Base example Network Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​unit Base example Unit Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​term Base example Benefit Term Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍5.0.0 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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:payor, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.kind, Coverage.paymentBy, Coverage.paymentBy.extension, Coverage.paymentBy.modifierExtension, Coverage.paymentBy.party, Coverage.paymentBy.responsibility, Coverage.type, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.subscriberId.extension, Coverage.subscriberId.extension:subscriberId, Coverage.subscriberId.use, Coverage.subscriberId.type, Coverage.subscriberId.system, Coverage.subscriberId.value, Coverage.subscriberId.period, Coverage.subscriberId.assigner, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.insurer, Coverage.class, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.value, Coverage.class.value.extension, Coverage.class.value.extension:value, Coverage.class.value.use, Coverage.class.value.type, Coverage.class.value.system, Coverage.class.value.value, Coverage.class.value.period, Coverage.class.value.assigner, Coverage.class.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.type, Coverage.costToBeneficiary.category, Coverage.costToBeneficiary.network, Coverage.costToBeneficiary.unit, Coverage.costToBeneficiary.term, 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, Coverage.insurancePlan All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:payor, Coverage.modifierExtension, Coverage.paymentBy.extension, Coverage.paymentBy.modifierExtension, Coverage.subscriberId.extension, Coverage.subscriberId.extension:subscriberId, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.value.extension, Coverage.class.value.extension:value, 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(5.0.0) Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:payor 1..* Reference(Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization | Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient | Cross-version Profile for R4B.RelatedPerson for use in FHIR R5(0.1.0) | RelatedPerson) R4B: Issuer of the policy (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.payor
Constraints: ext-1
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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:payor, Coverage.modifierExtension, Coverage.status, Coverage.kind, Coverage.beneficiary All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:payor, 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(5.0.0) Insurance or medical plan or a payment agreement
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:payor 1..* Reference(Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization | Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient | Cross-version Profile for R4B.RelatedPerson for use in FHIR R5(0.1.0) | RelatedPerson) R4B: Issuer of the policy (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.payor
... subscriberId
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:subscriberId 0..1 string R4B: subscriberId additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.subscriberId
... class
.... value
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:value 0..1 string R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.class.value

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage(5.0.0) 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
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:payor 1..* Reference(Cross-version Profile for R4B.Organization for use in FHIR R5(0.1.0) | Organization | Cross-version Profile for R4B.Patient for use in FHIR R5(0.1.0) | Patient | Cross-version Profile for R4B.RelatedPerson for use in FHIR R5(0.1.0) | RelatedPerson) R4B: Issuer of the policy (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.payor
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier Σ 0..* Identifier Business identifier(s) for this coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... paymentBy 0..* BackboneElement Self-pay parties and responsibility
.... 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
.... party Σ 1..1 Reference(Patient | RelatedPerson | Organization) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelfPayCodes (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..* Identifier ID assigned to the subscriber
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:subscriberId 0..1 string R4B: subscriberId additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.subscriberId
Constraints: ext-1
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value ΣC 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... 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
... insurer Σ 0..1 Reference(Organization) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... 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 Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
.... value Σ 1..1 Identifier Value associated with the type
..... id 0..1 id Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:value 1..1 string R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-Coverage.class.value
Constraints: ext-1
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣC 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... 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.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example)
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example)
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example)
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example)
.... value[x] Σ 0..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
... insurancePlan 0..1 Reference(InsurancePlan) Insurance plan details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base required All Languages 📍5.0.0 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍5.0.0 FHIR Std.
Coverage.subscriberId.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.subscriberId.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍5.0.0 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍5.0.0 FHIR Std.
Coverage.class.value.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.class.value.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​network Base example Network Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​unit Base example Unit Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​term Base example Benefit Term Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍5.0.0 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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:payor, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.kind, Coverage.paymentBy, Coverage.paymentBy.extension, Coverage.paymentBy.modifierExtension, Coverage.paymentBy.party, Coverage.paymentBy.responsibility, Coverage.type, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.subscriberId.extension, Coverage.subscriberId.extension:subscriberId, Coverage.subscriberId.use, Coverage.subscriberId.type, Coverage.subscriberId.system, Coverage.subscriberId.value, Coverage.subscriberId.period, Coverage.subscriberId.assigner, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.insurer, Coverage.class, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.value, Coverage.class.value.extension, Coverage.class.value.extension:value, Coverage.class.value.use, Coverage.class.value.type, Coverage.class.value.system, Coverage.class.value.value, Coverage.class.value.period, Coverage.class.value.assigner, Coverage.class.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.type, Coverage.costToBeneficiary.category, Coverage.costToBeneficiary.network, Coverage.costToBeneficiary.unit, Coverage.costToBeneficiary.term, 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, Coverage.insurancePlan All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error Coverage.extension, Coverage.extension:payor, Coverage.modifierExtension, Coverage.paymentBy.extension, Coverage.paymentBy.modifierExtension, Coverage.subscriberId.extension, Coverage.subscriberId.extension:subscriberId, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.value.extension, Coverage.class.value.extension:value, 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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