Da Vinci - Member Attribution (ATR) List
1.0.0 - STU 1 Publication

This page is part of the Risk Based Contracts Member Attribution List FHIR IG (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: ATRCoverage

Defining URL:http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-coverage
Version:1.0.0
Name:ATRCoverage
Title:Davinci ATR Coverage
Status:Draft as of 2019-09-01
Definition:

This is the Coverage Resource profile for the IG.

Publisher:HL7 International - Financial Management Work Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-coverage

Introduction

This profile is used to associate a specific coverage instance to a specific member who is on the Member Attribution List. Since patients can have multiple coverages, it is important to identify the specific coverage instance that led to the patient being on the Member Attribution List. The Coverage instance will contain the member information, payer information and the plan information.

Implementation Requirements

Implementers are advised to read Data Model Requirements to implement the Coverage profile.

APIs : Retrieval of Coverage Resource Instance:

The Coverage instance is retrieved as part of the Bulk API request on the Group resource representing the Member Attribution List.

Formal Views of Profile Content

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

This structure is derived from Coverage

Summary

Mandatory: 5 elements (11 nested mandatory elements)
Must-Support: 25 elements
Fixed Value: 5 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element Coverage.identifier is sliced based on the values of value:type.coding.system, value:type.coding.code
  • The element Coverage.class is sliced based on the values of value:type.coding.system, value:type.coding.code

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageDavinci ATR Coverage
... ext-insuranceProductType S0..1CodeableConceptIndicates the Insurance Product Type related to the Coverage.
URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType
Binding: Insurance Product Type (extensible)
... identifier S0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... identifier:MemberIdentifier S0..1IdentifierBusiness Identifier for the coverage
..... type S1..1CodeableConceptDescription of identifier
...... coding S1..1CodingCode defined by a terminology system
....... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code S1..1codeSymbol in syntax defined by the system
Fixed Value: MB
..... system S1..1uriThe namespace for the identifier value
..... value S1..1stringThe value that is unique
... status S1..1codeactive | cancelled | draft | entered-in-error
Fixed Value: active
... subscriber S0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)Subscriber to the policy
... subscriberId S1..1stringID assigned to the subscriber
... beneficiary S1..1Reference(Davinci ATR Patient)Plan beneficiary
... dependent S0..1stringDependent number
... relationship S0..1CodeableConceptBeneficiary relationship to the subscriber
... period S1..1PeriodCoverage start and end dates
... payor S1..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Issuer of the policy
... class S0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... class:PlanIdentifier S0..1BackboneElementAdditional coverage classifications
..... type S1..1CodeableConceptType of class such as 'group' or 'plan'
...... coding S1..1CodingCode defined by a terminology system
....... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code S1..1codeSymbol in syntax defined by the system
Fixed Value: plan
..... value S1..1stringValue associated with the type

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageDavinci ATR Coverage
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ext-insuranceProductType S0..1CodeableConceptIndicates the Insurance Product Type related to the Coverage.
URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType
Binding: Insurance Product Type (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... identifier:MemberIdentifier SΣ0..1IdentifierBusiness Identifier for the coverage
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ1..1CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version Σ0..1stringVersion of the system - if relevant
....... code SΣ1..1codeSymbol in syntax defined by the system
Fixed Value: MB
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... type Σ0..1CodeableConceptCoverage 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 SΣ0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Owner of the policy
... subscriber SΣ0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)Subscriber to the policy
... subscriberId SΣ1..1stringID assigned to the subscriber
... beneficiary SΣ1..1Reference(Davinci ATR Patient)Plan beneficiary
... dependent SΣ0..1stringDependent number
... relationship S0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period SΣ1..1PeriodCoverage start and end dates
... payor SΣ1..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Issuer of the policy
... class S0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... class:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:PlanIdentifier S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ1..1CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version Σ0..1stringVersion of the system - if relevant
....... code SΣ1..1codeSymbol in syntax defined by the system
Fixed Value: plan
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... value SΣ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageDavinci ATR Coverage
... ext-insuranceProductType 0..1CodeableConceptIndicates the Insurance Product Type related to the Coverage.
URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType
Binding: Insurance Product Type (extensible)
... identifier Σ0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... identifier:MemberIdentifier Σ0..1IdentifierBusiness Identifier for the coverage
..... type Σ1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... coding Σ1..1CodingCode defined by a terminology system
....... system Σ1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code Σ1..1codeSymbol in syntax defined by the system
Fixed Value: MB
..... system Σ1..1uriThe namespace for the identifier value
..... value Σ1..1stringThe value that is unique
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... subscriber Σ0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)Subscriber to the policy
... subscriberId Σ1..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(Davinci ATR Patient)Plan beneficiary
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ1..1PeriodCoverage start and end dates
... payor Σ1..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Issuer of the policy
... class 0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... class:PlanIdentifier 0..1BackboneElementAdditional coverage classifications
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

...... coding Σ1..1CodingCode defined by a terminology system
....... system Σ1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code Σ1..1codeSymbol in syntax defined by the system
Fixed Value: plan
..... value Σ1..1stringValue associated with the type

doco Documentation for this format

This structure is derived from Coverage

Summary

Mandatory: 5 elements (11 nested mandatory elements)
Must-Support: 25 elements
Fixed Value: 5 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element Coverage.identifier is sliced based on the values of value:type.coding.system, value:type.coding.code
  • The element Coverage.class is sliced based on the values of value:type.coding.system, value:type.coding.code

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageDavinci ATR Coverage
... ext-insuranceProductType S0..1CodeableConceptIndicates the Insurance Product Type related to the Coverage.
URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType
Binding: Insurance Product Type (extensible)
... identifier S0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... identifier:MemberIdentifier S0..1IdentifierBusiness Identifier for the coverage
..... type S1..1CodeableConceptDescription of identifier
...... coding S1..1CodingCode defined by a terminology system
....... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code S1..1codeSymbol in syntax defined by the system
Fixed Value: MB
..... system S1..1uriThe namespace for the identifier value
..... value S1..1stringThe value that is unique
... status S1..1codeactive | cancelled | draft | entered-in-error
Fixed Value: active
... subscriber S0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)Subscriber to the policy
... subscriberId S1..1stringID assigned to the subscriber
... beneficiary S1..1Reference(Davinci ATR Patient)Plan beneficiary
... dependent S0..1stringDependent number
... relationship S0..1CodeableConceptBeneficiary relationship to the subscriber
... period S1..1PeriodCoverage start and end dates
... payor S1..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Issuer of the policy
... class S0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... class:PlanIdentifier S0..1BackboneElementAdditional coverage classifications
..... type S1..1CodeableConceptType of class such as 'group' or 'plan'
...... coding S1..1CodingCode defined by a terminology system
....... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code S1..1codeSymbol in syntax defined by the system
Fixed Value: plan
..... value S1..1stringValue associated with the type

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageDavinci ATR Coverage
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... ext-insuranceProductType S0..1CodeableConceptIndicates the Insurance Product Type related to the Coverage.
URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType
Binding: Insurance Product Type (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... identifier:MemberIdentifier SΣ0..1IdentifierBusiness Identifier for the coverage
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ1..1CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version Σ0..1stringVersion of the system - if relevant
....... code SΣ1..1codeSymbol in syntax defined by the system
Fixed Value: MB
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... type Σ0..1CodeableConceptCoverage 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 SΣ0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Owner of the policy
... subscriber SΣ0..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson)Subscriber to the policy
... subscriberId SΣ1..1stringID assigned to the subscriber
... beneficiary SΣ1..1Reference(Davinci ATR Patient)Plan beneficiary
... dependent SΣ0..1stringDependent number
... relationship S0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period SΣ1..1PeriodCoverage start and end dates
... payor SΣ1..1Reference(Davinci ATR Patient | Davinci ATR RelatedPerson | Davinci ATR Organization)Issuer of the policy
... class S0..*(Slice Definition)Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system, value:type.coding.code
.... class:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

..... value Σ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
.... class:PlanIdentifier S0..1BackboneElementAdditional coverage classifications
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ1..1CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version Σ0..1stringVersion of the system - if relevant
....... code SΣ1..1codeSymbol in syntax defined by the system
Fixed Value: plan
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... value SΣ1..1stringValue associated with the type
..... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
Coverage.languagepreferredCommonLanguages
Max Binding: AllLanguages
Coverage.identifier:MemberIdentifier.userequiredIdentifierUse
Coverage.identifier:MemberIdentifier.typeextensibleIdentifier Type Codes
Coverage.statusrequiredFixed Value: active
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.class.typeextensibleCoverageClassCodes
Coverage.class:PlanIdentifier.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Constraints

IdPathDetailsRequirements
dom-2CoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3CoverageIf 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-4CoverageIf 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-5CoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6CoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1Coverage.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.extension:insuranceProductTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.extension:insuranceProductTypeMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.identifier:MemberIdentifier.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifier:MemberIdentifier.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.identifier:MemberIdentifier.type.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifier:MemberIdentifier.type.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.identifier:MemberIdentifier.type.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifier:MemberIdentifier.type.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.type.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:MemberIdentifier.assignerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.policyHolderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subscriberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subscriberIdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.beneficiaryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.dependentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.payorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.classAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.nameAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class:PlanIdentifier.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class:PlanIdentifier.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class:PlanIdentifier.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class:PlanIdentifier.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class:PlanIdentifier.type.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class:PlanIdentifier.type.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class:PlanIdentifier.type.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class:PlanIdentifier.type.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.type.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class:PlanIdentifier.nameAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.orderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.networkAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiaryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exceptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exception.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.exception.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.exception.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.exception.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.exception.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exception.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subrogationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.contractAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())