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

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Coverage
copyright
date	2020-12-22T13:50:28+00:00	2022-02-18T14:02:32+00:00	Values Differ
description	The HRex Coverage Profile defines the constraints for representing a member's healthcare insurance information to the Payer. Coverage instances complying with this profile, sometimes together with the Patient which this profile references via `beneficiary`, allows a payer to identify a member in their system.
experimental	true
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	HrexCoverage
publisher	HL7 International	HL7 Financial Management Working Group	Values Differ
purpose
status	draft
title	HRex Coverage Profile
type	Coverage
url	http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/hrex-coverage
version	1.0.0	2.0.0-ballot	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	string	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: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
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	SΣ	0..*	Identifier	Business Identifier for the coverage	SΣ	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.	?!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 (required)	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (required)
policyHolder	Σ	0..1	Reference(US Core Patient Profile | US Core Organization Profile | RelatedPerson)	Owner of the policy	Σ	0..1	Reference(US Core Patient Profile | US Core Organization Profile | RelatedPerson)	Owner of the policy
subscriber	Σ	0..1	Reference(US Core Patient Profile)	Subscriber to the policy	Σ	0..1	Reference(US Core Patient Profile)	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(US Core Patient Profile)	Plan beneficiary	SΣ	1..1	Reference(US Core Patient Profile)	Plan beneficiary
dependent	Σ	0..1	string	Dependent number	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).		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	Σ	0..1	Period	Coverage start and end dates
payor	SΣ	1..*	Reference(US Core Organization Profile)	Issuer of the policy	SΣ	1..*	Reference(US Core Organization Profile)	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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.	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	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: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary	Σ	1..1	SimpleQuantity, 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: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.	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	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