Extensions for Using Data Elements from FHIR R5 in FHIR R4
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR R5 in FHIR R4 - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R5_Coverage_R4

Official URL: http://hl7.org/fhir/5.0/StructureDefinition/profile-Coverage Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R5_Coverage_R4

This cross-version profile allows R5 Coverage content to be represented via FHIR R4 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(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 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:kind 1..1 code R5: insurance | self-pay | other (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
Binding: R5CoverageKindForR4 (0.1.0) (required)
Constraints: ext-1
.... extension:paymentBy 0..* (Complex) R5: Self-pay parties and responsibility (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.paymentBy
Constraints: ext-1
.... extension:insurancePlan 0..1 Reference(Cross-version Profile for R5.InsurancePlan for use in FHIR R4(0.1.0) | InsurancePlan) R5: Insurance plan details (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan
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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, 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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, 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 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:kind 1..1 code R5: insurance | self-pay | other (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
Binding: R5CoverageKindForR4 (0.1.0) (required)
.... extension:paymentBy 0..* (Complex) R5: Self-pay parties and responsibility (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.paymentBy
.... extension:insurancePlan 0..1 Reference(Cross-version Profile for R5.InsurancePlan for use in FHIR R4(0.1.0) | InsurancePlan) R5: Insurance plan details (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan
... subscriberId
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:subscriberId 0..* Identifier R5: subscriberId additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.subscriberId
... class
.... value
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:value 0..1 Identifier R5: value additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.class.value
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:category 0..1 CodeableConcept R5: Benefit classification (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.category
Binding: BenefitCategoryCodes (example)
..... extension:network 0..1 CodeableConcept R5: In or out of network (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.network
Binding: NetworkTypeCodes (example)
..... extension:unit 0..1 CodeableConcept R5: Individual or family (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.unit
Binding: UnitTypeCodes (example)
..... extension:term 0..1 CodeableConcept R5: Annual or lifetime (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.term
Binding: BenefitTermCodes (example)

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 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:kind 1..1 code R5: insurance | self-pay | other (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
Binding: R5CoverageKindForR4 (0.1.0) (required)
Constraints: ext-1
.... extension:paymentBy 0..* (Complex) R5: Self-pay parties and responsibility (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.paymentBy
Constraints: ext-1
.... extension:insurancePlan 0..1 Reference(Cross-version Profile for R5.InsurancePlan for use in FHIR R4(0.1.0) | InsurancePlan) R5: Insurance plan details (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan
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
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:subscriberId 0..* Identifier R5: subscriberId additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.subscriberId
Constraints: ext-1
.... value 0..1 string Primitive value for string
Max Length:1048576
... 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
.... 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, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
..... id 0..1 string xml:id (or equivalent in JSON)
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:value 0..1 Identifier R5: value additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.class.value
Constraints: ext-1
..... value 0..1 string Primitive value for string
Max Length:1048576
.... 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
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:category 0..1 CodeableConcept R5: Benefit classification (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.category
Binding: BenefitCategoryCodes (example)
Constraints: ext-1
..... extension:network 0..1 CodeableConcept R5: In or out of network (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.network
Binding: NetworkTypeCodes (example)
Constraints: ext-1
..... extension:unit 0..1 CodeableConcept R5: Individual or family (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.unit
Binding: UnitTypeCodes (example)
Constraints: ext-1
..... extension:term 0..1 CodeableConcept R5: Annual or lifetime (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.term
Binding: BenefitTermCodes (example)
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 tx.fhir.org
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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.type, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.subscriberId.extension, Coverage.subscriberId.extension:subscriberId, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.payor, 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.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.extension:category, Coverage.costToBeneficiary.extension:network, Coverage.costToBeneficiary.extension:unit, Coverage.costToBeneficiary.extension:term, 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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, Coverage.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.extension:category, Coverage.costToBeneficiary.extension:network, Coverage.costToBeneficiary.extension:unit, Coverage.costToBeneficiary.extension:term, 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 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:kind 1..1 code R5: insurance | self-pay | other (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
Binding: R5CoverageKindForR4 (0.1.0) (required)
Constraints: ext-1
.... extension:paymentBy 0..* (Complex) R5: Self-pay parties and responsibility (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.paymentBy
Constraints: ext-1
.... extension:insurancePlan 0..1 Reference(Cross-version Profile for R5.InsurancePlan for use in FHIR R4(0.1.0) | InsurancePlan) R5: Insurance plan details (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan
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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, 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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, 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 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:kind 1..1 code R5: insurance | self-pay | other (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
Binding: R5CoverageKindForR4 (0.1.0) (required)
.... extension:paymentBy 0..* (Complex) R5: Self-pay parties and responsibility (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.paymentBy
.... extension:insurancePlan 0..1 Reference(Cross-version Profile for R5.InsurancePlan for use in FHIR R4(0.1.0) | InsurancePlan) R5: Insurance plan details (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan
... subscriberId
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:subscriberId 0..* Identifier R5: subscriberId additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.subscriberId
... class
.... value
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:value 0..1 Identifier R5: value additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.class.value
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:category 0..1 CodeableConcept R5: Benefit classification (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.category
Binding: BenefitCategoryCodes (example)
..... extension:network 0..1 CodeableConcept R5: In or out of network (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.network
Binding: NetworkTypeCodes (example)
..... extension:unit 0..1 CodeableConcept R5: Individual or family (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.unit
Binding: UnitTypeCodes (example)
..... extension:term 0..1 CodeableConcept R5: Annual or lifetime (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.term
Binding: BenefitTermCodes (example)

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 1..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:kind 1..1 code R5: insurance | self-pay | other (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
Binding: R5CoverageKindForR4 (0.1.0) (required)
Constraints: ext-1
.... extension:paymentBy 0..* (Complex) R5: Self-pay parties and responsibility (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.paymentBy
Constraints: ext-1
.... extension:insurancePlan 0..1 Reference(Cross-version Profile for R5.InsurancePlan for use in FHIR R4(0.1.0) | InsurancePlan) R5: Insurance plan details (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan
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
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:subscriberId 0..* Identifier R5: subscriberId additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.subscriberId
Constraints: ext-1
.... value 0..1 string Primitive value for string
Max Length:1048576
... 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
.... 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, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
..... id 0..1 string xml:id (or equivalent in JSON)
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:value 0..1 Identifier R5: value additional types
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.class.value
Constraints: ext-1
..... value 0..1 string Primitive value for string
Max Length:1048576
.... 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
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:category 0..1 CodeableConcept R5: Benefit classification (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.category
Binding: BenefitCategoryCodes (example)
Constraints: ext-1
..... extension:network 0..1 CodeableConcept R5: In or out of network (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.network
Binding: NetworkTypeCodes (example)
Constraints: ext-1
..... extension:unit 0..1 CodeableConcept R5: Individual or family (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.unit
Binding: UnitTypeCodes (example)
Constraints: ext-1
..... extension:term 0..1 CodeableConcept R5: Annual or lifetime (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.costToBeneficiary.term
Binding: BenefitTermCodes (example)
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 tx.fhir.org
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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.type, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.subscriberId.extension, Coverage.subscriberId.extension:subscriberId, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.payor, 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.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.extension:category, Coverage.costToBeneficiary.extension:network, Coverage.costToBeneficiary.extension:unit, Coverage.costToBeneficiary.extension:term, 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:kind, Coverage.extension:paymentBy, Coverage.extension:insurancePlan, Coverage.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.extension:category, Coverage.costToBeneficiary.extension:network, Coverage.costToBeneficiary.extension:unit, Coverage.costToBeneficiary.extension:term, 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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