Profile Comparison between http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage vs http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Coverage
copyright
date	2022-02-17T07:51:22+00:00	2023-11-21T18:04:23+00:00	Values Differ
description	PAS constraints on Coverage resource mandating support for insurance elements relevant to the prior authorization request
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	PASCoverage
publisher	HL7 International - Financial Management Work Group	HL7 International / Financial Management	Values Differ
purpose
status	active
title	PAS Coverage
type	Coverage
url	http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage
version	1.2.0-ballot	2.0.0	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	L Type	L Description & Constraints	Comments
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	string	Logical id of this artifact	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage	SΣ	0..*	Identifier	Business Identifier for the coverage	Elements differ in definition for mustSupport: 'false' vs 'true'
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Fixed Value: active	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: ?? (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: ?? (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	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	SΣ	0..1	Reference(PAS Subscriber Patient)	Subscriber to the policy	SΣ	0..1	Reference(PAS Subscriber Patient)	Subscriber to the policy
subscriberId	SΣ	0..1	string	ID assigned to the subscriber	SΣ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(PAS Beneficiary Patient)	Plan beneficiary	SΣ	1..1	Reference(PAS Beneficiary Patient)	Plan beneficiary
dependent	Σ	0..1	string	Dependent number	Σ	0..1	string	Dependent number
relationship	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: ?? (required): Codes indicating the relationship between two individuals or entities. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.	S	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).	Unable to resolve left value set https://valueset.x12.org/x217/005010/request/2000D/INS/1/02/00/1069 at Coverage.relationship
id						0..1	string	Unique id for inter-element referencing	Added this element
Slices for extension						0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url	Added this element
Slices for coding					Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this	Added this element
text					Σ	0..1	string	Plain text representation of the concept	Added this element
period	Σ	0..1	Period	Coverage start and end dates	Σ	0..1	Period	Coverage start and end dates
payor	SΣ	1..*	Reference(PAS Insurer Organization)	Issuer of the policy	SΣ	1..*	Reference(PAS Insurer Organization)	Issuer of the policy
class		0..*	BackboneElement	Additional coverage classifications		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc.	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified.	Σ	0..1	CodeableConcept	Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1	??, Money	The amount or percentage due from the beneficiary	Σ	1..1	??, Money	The amount or percentage due from the beneficiary
exception		0..*	BackboneElement	Exceptions for patient payments		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays.	Σ	1..1	CodeableConcept	Exception category Binding: ?? (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	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details		0..*	Reference(Contract)	Contract details
Documentation for this format