Extensions for Using Data Elements from FHIR R5 in FHIR R4B
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR R4B
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR R4B - Downloaded Version null See the Directory of published versions
| 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_R4B | ||
This cross-version profile allows R5 Coverage content to be represented via FHIR R4B Coverage resources.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.3.0 | FHIR Std. |
| 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.exists() and ('#'+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(uri) = '#').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
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||
|---|---|---|---|---|---|---|---|---|
  Coverage |
0..* | Coverage(4.3.0) | 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: CommonLanguages (preferred): IETF language tag
| |||||
| 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 Constraints: dom-r4b | |||||
  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: R5CoverageKindForR4B (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 R4B(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 | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📍4.3.0 | FHIR Std. |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.3.0 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.3.0 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.3.0 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.3.0 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.3.0 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.3.0 | FHIR Std. |
| 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.exists() and ('#'+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(uri) = '#').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()
|
| dom-r4b | warning | Coverage.contained | Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems |
($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
|
| 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()
|
This structure is derived from Coverage
Summary
Mandatory: 2 elements
Extensions
This structure refers to these extensions:
Maturity: 0
Key Elements View
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.3.0 | FHIR Std. |
| 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.exists() and ('#'+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(uri) = '#').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
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Coverage |
0..* | Coverage(4.3.0) | 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: CommonLanguages (preferred): IETF language tag
| |||||
| 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 Constraints: dom-r4b | |||||
| 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: R5CoverageKindForR4B (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 R4B(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 | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📍4.3.0 | FHIR Std. |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.3.0 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.3.0 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.3.0 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.3.0 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.3.0 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.3.0 | FHIR Std. |
| 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.exists() and ('#'+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(uri) = '#').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()
|
| dom-r4b | warning | Coverage.contained | Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems |
($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
|
| 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()
|
This structure is derived from Coverage
Summary
Mandatory: 2 elements
Extensions
This structure refers to these extensions:
Maturity: 0
Other representations of profile: CSV, Excel, Schematron
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r5.r4b#0.1.0 based on FHIR 4.3.0. Generated 2026-03-20
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