This page is part of the CARIN Digital Insurance Card (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
Active as of 2022-07-13 |
Definitions for the C4DIC-Coverage resource profile.
1. Coverage | |||||
Definition | Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. | ||||
Control | 0..* | ||||
Comments | The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. | ||||
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.`div`.exists()) | ||||
2. Coverage.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Control | 0..1 | ||||
Type | string | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
3. Coverage.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
Control | 1..1 | ||||
Type | Meta | ||||
Must Support | true | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
4. Coverage.meta.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
5. Coverage.meta.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
6. Coverage.meta.versionId | |||||
Definition | The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. | ||||
Control | 0..1 | ||||
Type | id | ||||
Comments | The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
7. Coverage.meta.lastUpdated | |||||
Definition | When the resource last changed - e.g. when the version changed. | ||||
Control | 1..1 | ||||
Type | instant | ||||
Must Support | true | ||||
Comments | Defines the date the coverage that was effective as of the date of service or admission (163). The Coverage Reference Resource SHALL be returned with data that was effective as of the date of service or admission of the claim | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
8. Coverage.meta.source | |||||
Definition | A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Comments | In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
9. Coverage.meta.profile | |||||
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. | ||||
Control | 1..* | ||||
Type | canonical(StructureDefinition) | ||||
Comments | meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
Slicing | This element introduces a set of slices on Coverage.meta.profile. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
10. Coverage.meta.profile:supportedProfile | |||||
SliceName | supportedProfile | ||||
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. | ||||
Control | 1..1 | ||||
Type | canonical(StructureDefinition) | ||||
Comments | It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. | ||||
Pattern Value | http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
11. Coverage.meta.security | |||||
Definition | Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable Security Labels from the Healthcare Privacy and Security Classification System. | ||||
Type | Coding | ||||
Comments | The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
12. Coverage.meta.tag | |||||
Definition | Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. | ||||
Control | 0..* | ||||
Binding | For example codes, see CommonTags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
Type | Coding | ||||
Comments | The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
13. Coverage.implicitRules | |||||
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true | ||||
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
14. Coverage.language | |||||
Definition | The base language in which the resource is written. | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages
A human language.
| ||||
Type | code | ||||
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
15. Coverage.text | |||||
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
16. Coverage.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
17. Coverage.extension | |||||
Definition | An Extension | ||||
Control | 0..* | ||||
Type | Extension | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
18. Coverage.extension:C4DIC-PlanBeneficiaries-extension | |||||
SliceName | C4DIC-PlanBeneficiaries-extension | ||||
Definition | This extension allows for the representation of all of the members on the plan with corresponding Names and MemberIDs. This enables health plans to pass this information along with the Coverage resources to align with how this content is printed on physical insurance cards. | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(PlanBeneficiaries) (Complex Extension) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
19. Coverage.extension:C4DIC-AdditionalCardInformation-extension | |||||
SliceName | C4DIC-AdditionalCardInformation-extension | ||||
Definition | This extension enables the passing of free text items often found on insurance cards. Health plans may provide this extension as part of the Coverage resource to communicate concepts such as TTY, disclaimers about eligibility or limits to coverage, notice of dental or vision coverage, etc. | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(AdditionalCardInformation) (Extension Type: Annotation) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
20. Coverage.extension:C4DIC-BackgroundColor-extension | |||||
SliceName | C4DIC-BackgroundColor-extension | ||||
Definition | This extension enables an insurance company to provide a background color to be used by consuming applications when they render the information found on an insurance card for the insurance plan member. | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(BackgroundColor) (Extension Type: CodeableConcept) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
21. Coverage.extension:C4DIC-HighlightColor-extension | |||||
SliceName | C4DIC-HighlightColor-extension | ||||
Definition | This extension enables an insurance company to provide a highlight color to be used by consuming applications when they render the information found on an insurance card for the insurance plan member | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(HighlightColor) (Extension Type: CodeableConcept) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
22. Coverage.extension:C4DIC-Logo-extension | |||||
SliceName | C4DIC-Logo-extension | ||||
Definition | This extension enables payers to provide an image of their company or organization logo for use by consuming applications when rendering the coverage information for use by the health plan member. This may assist in making the information provided feel more relevant or recongizable by the member. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility. | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Logo) (Complex Extension) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
23. Coverage.extension:C4DIC-QRCode-extension | |||||
SliceName | C4DIC-QRCode-extension | ||||
Definition | This extension enables payers to provide an image of the QR code found on a member's physicial insurance card. This image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. Often there are data elements relevant to the health plan coverage encoded in the QR code. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility. | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(QRCode) (Complex Extension) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
24. Coverage.extension:C4DIC-Barcode-extension | |||||
SliceName | C4DIC-Barcode-extension | ||||
Definition | This extension enables payers to provide an image of the barcode found on a member's physicial insurance card. This image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. Often there are data elements relevant to the health plan coverage encoded in the barcode. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility. | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Barcode) (Complex Extension) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
25. Coverage.extension:C4DIC-SupportingImage-extension | |||||
SliceName | C4DIC-SupportingImage-extension | ||||
Definition | This extension enables payers to provide other supporting images found on a member's physicial insurance card. A supporting image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. These images may communicate additional information to the member such as the type of coverage provided or partner logos. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility. | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(SupportingImage) (Complex Extension) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
26. Coverage.extension:C4DIC-CardIssueDate-extension | |||||
SliceName | C4DIC-CardIssueDate-extension | ||||
Definition | This extension allows for the expression of the date at which the insurance card was issued by the payer. The health plan may pass this along with the Coverage resource to indicate when the information became in force. Please note, this data element is distinct from the coverage period for the health plan as the insurance card may be provided in advance of the coverage start date or following the coverage start date (for example, in the event a replacement card is needed.) | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(CardIssueDate) (Extension Type: date) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
27. Coverage.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
28. Coverage.identifier | |||||
Definition | A unique identifier assigned to this coverage. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..* | ||||
Type | Identifier | ||||
Must Support | true | ||||
Requirements | Allows coverages to be distinguished and referenced. | ||||
Comments | The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
Slicing | This element introduces a set of slices on Coverage.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
29. Coverage.identifier.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
30. Coverage.identifier.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
31. Coverage.identifier.use | |||||
Definition | The purpose of this identifier. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known . | ||||
Type | code | ||||
Is Modifier | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
32. Coverage.identifier.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from C4DIC Coverage Identifier Type; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
33. Coverage.identifier.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Comments | Identifier.system is always case sensitive. | ||||
Example | General:http://www.acme.com/identifiers/patient | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
34. Coverage.identifier.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Control | 0..1 | ||||
Type | string | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Example | General:123456 | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
35. Coverage.identifier.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
36. Coverage.identifier.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Control | 0..1 | ||||
Type | Reference(Organization) | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
37. Coverage.identifier:memberid | |||||
SliceName | memberid | ||||
Definition | A unique identifier assigned to this coverage. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..1 | ||||
Type | Identifier | ||||
Must Support | true | ||||
Requirements | Allows coverages to be distinguished and referenced. | ||||
Comments | The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
38. Coverage.identifier:memberid.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
39. Coverage.identifier:memberid.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
40. Coverage.identifier:memberid.use | |||||
Definition | The purpose of this identifier. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known . | ||||
Type | code | ||||
Is Modifier | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
41. Coverage.identifier:memberid.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Type | CodeableConcept | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/> <code value="MB"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
42. Coverage.identifier:memberid.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Control | 1..1 | ||||
Type | uri | ||||
Must Support | true | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Comments | Identifier.system is always case sensitive. | ||||
Example | General:http://www.acme.com/identifiers/patient | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
43. Coverage.identifier:memberid.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Control | 1..1 | ||||
Type | string | ||||
Must Support | true | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Example | General:123456 | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
44. Coverage.identifier:memberid.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
45. Coverage.identifier:memberid.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Control | 1..1 | ||||
Type | Reference(Organization) | ||||
Must Support | true | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
46. Coverage.status | |||||
Definition | The status of the resource instance. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from FinancialResourceStatusCodes A code specifying the state of the resource instance. | ||||
Type | code | ||||
Is Modifier | true | ||||
Must Support | true | ||||
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. | ||||
Comments | Identfies the status of the coverage information (default: active) (133) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
47. Coverage.type | |||||
Definition | The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. | ||||
Control | 1..1 | ||||
Binding | The codes SHOULD be taken from CoverageTypeAndSelf-PayCodes The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | The order of application of coverages is dependent on the types of coverage. | ||||
Comments | Identifies if the coverage is PPO, HMO, POS, etc. (3) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
48. Coverage.policyHolder | |||||
Definition | The party who 'owns' the insurance policy. | ||||
Control | 0..1 | ||||
Type | Reference(Patient | RelatedPerson | Organization) | ||||
Requirements | This provides employer information in the case of Worker's Compensation and other policies. | ||||
Comments | For example: may be an individual, corporation or the subscriber's employer. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
49. Coverage.subscriber | |||||
Definition | The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. | ||||
Control | 1..1 | ||||
Type | Reference(Patient | RelatedPerson) | ||||
Must Support | true | ||||
Must Support Types | No must-support rules about the choice of types/profiles | ||||
Requirements | This is the party who is entitled to the benfits under the policy. | ||||
Comments | May be self or a parent in the case of dependants. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
50. Coverage.subscriber.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
51. Coverage.subscriber.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.subscriber.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
52. Coverage.subscriber.reference | |||||
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
Control | 1..1 This element is affected by the following invariants: ref-1 | ||||
Type | string | ||||
Must Support | true | ||||
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
53. Coverage.subscriber.type | |||||
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from ResourceType; other codes may be used where these codes are not suitable Aa resource (or, for logical models, the URI of the logical model). | ||||
Type | uri | ||||
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
54. Coverage.subscriber.identifier | |||||
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
55. Coverage.subscriber.display | |||||
Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
Control | 0..1 | ||||
Type | string | ||||
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
56. Coverage.subscriberId | |||||
Definition | The insurer assigned ID for the Subscriber. | ||||
Control | 1..1 | ||||
Type | string | ||||
Must Support | true | ||||
Requirements | The insurer requires this identifier on correspondance and claims (digital and otherwise). | ||||
Comments | The identifier assigned by the Payer on the subscriber's ID card (132) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
57. Coverage.beneficiary | |||||
Definition | The party who benefits from the insurance coverage; the patient when products and/or services are provided. | ||||
Control | 1..1 | ||||
Type | Reference(C4DICPatient) | ||||
Must Support | true | ||||
Requirements | This is the party who receives treatment for which the costs are reimbursed under the coverage. | ||||
Comments | Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided (1). This is the party who receives treatment for which the costs are reimbursed under the coverage. alternate path: EOB.patient(Patient).identifier | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
58. Coverage.beneficiary.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
59. Coverage.beneficiary.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.beneficiary.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
60. Coverage.beneficiary.reference | |||||
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
Control | 1..1 This element is affected by the following invariants: ref-1 | ||||
Type | string | ||||
Must Support | true | ||||
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
61. Coverage.beneficiary.type | |||||
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from ResourceType; other codes may be used where these codes are not suitable Aa resource (or, for logical models, the URI of the logical model). | ||||
Type | uri | ||||
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
62. Coverage.beneficiary.identifier | |||||
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
63. Coverage.beneficiary.display | |||||
Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
Control | 0..1 | ||||
Type | string | ||||
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
64. Coverage.dependent | |||||
Definition | A unique identifier for a dependent under the coverage. | ||||
Control | 0..1 | ||||
Type | string | ||||
Must Support | true | ||||
Requirements | For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. | ||||
Comments | Periodically the member number is constructed from the subscriberId and the dependant number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
65. Coverage.relationship | |||||
Definition | The relationship of beneficiary (patient) to the subscriber. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from SubscriberRelationshipCodes | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | To determine relationship between the patient and the subscriber to determine coordination of benefits. | ||||
Comments | Relationship of the member to the person insured (subscriber). (72) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
66. Coverage.period | |||||
Definition | Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Must Support | true | ||||
Requirements | Some insurers require the submission of the coverage term. | ||||
Comments | Date that the contract became effective (74) and Date that the contract was terminated or coverage changed (75) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
67. Coverage.payor | |||||
Definition | The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. | ||||
Control | 1..1 | ||||
Type | Reference(C4DICOrganization) | ||||
Must Support | true | ||||
Requirements | Need to identify the issuer to target for claim processing and for coordination of benefit processing. | ||||
Comments | Issuer of the Policy (2) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
68. Coverage.class | |||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
Slicing | This element introduces a set of slices on Coverage.class. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
69. Coverage.class.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
70. Coverage.class.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
71. Coverage.class.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
72. Coverage.class.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4DIC Coverage Class | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
73. Coverage.class.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
74. Coverage.class.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
75. Coverage.class:group | |||||
SliceName | group | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
76. Coverage.class:group.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
77. Coverage.class:group.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
78. Coverage.class:group.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
79. Coverage.class:group.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="group"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
80. Coverage.class:group.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | Employer account identifier (134) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
81. Coverage.class:group.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Comments | Name of the Employer Account (135) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
82. Coverage.class:plan | |||||
SliceName | plan | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
83. Coverage.class:plan.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
84. Coverage.class:plan.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
85. Coverage.class:plan.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
86. Coverage.class:plan.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="plan"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
87. Coverage.class:plan.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | Business concept used by a health plan to describe its benefit offerings (154) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
88. Coverage.class:plan.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Comments | Name of the health plan benefit offering assigned to the Plan Identfier (155) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
89. Coverage.class:division | |||||
SliceName | division | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
90. Coverage.class:division.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
91. Coverage.class:division.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
92. Coverage.class:division.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
93. Coverage.class:division.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS"/> <code value="division"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
94. Coverage.class:division.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
95. Coverage.class:division.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
96. Coverage.class:network | |||||
SliceName | network | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
97. Coverage.class:network.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
98. Coverage.class:network.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
99. Coverage.class:network.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
100. Coverage.class:network.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS"/> <code value="network"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
101. Coverage.class:network.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
102. Coverage.class:network.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
103. Coverage.class:rxbin | |||||
SliceName | rxbin | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
104. Coverage.class:rxbin.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
105. Coverage.class:rxbin.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
106. Coverage.class:rxbin.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
107. Coverage.class:rxbin.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="rxbin"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
108. Coverage.class:rxbin.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
109. Coverage.class:rxbin.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
110. Coverage.class:rxpcn | |||||
SliceName | rxpcn | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
111. Coverage.class:rxpcn.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
112. Coverage.class:rxpcn.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
113. Coverage.class:rxpcn.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
114. Coverage.class:rxpcn.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="rxpcn"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
115. Coverage.class:rxpcn.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
116. Coverage.class:rxpcn.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
117. Coverage.class:rxgroup | |||||
SliceName | rxgroup | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
118. Coverage.class:rxgroup.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
119. Coverage.class:rxgroup.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
120. Coverage.class:rxgroup.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
121. Coverage.class:rxgroup.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="rxgroup"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
122. Coverage.class:rxgroup.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
123. Coverage.class:rxgroup.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
124. Coverage.class:rxid | |||||
SliceName | rxid | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
125. Coverage.class:rxid.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
126. Coverage.class:rxid.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
127. Coverage.class:rxid.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
128. Coverage.class:rxid.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/> <code value="rxid"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
129. Coverage.class:rxid.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
130. Coverage.class:rxid.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
131. Coverage.class:rxiin | |||||
SliceName | rxiin | ||||
Definition | A suite of underwriter specific classifiers. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
132. Coverage.class:rxiin.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
133. Coverage.class:rxiin.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
134. Coverage.class:rxiin.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
135. Coverage.class:rxiin.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CoverageClassCodes; other codes may be used where these codes are not suitable The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS"/> <code value="rxiin"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
136. Coverage.class:rxiin.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Control | 1..1 | ||||
Type | string | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Comments | For example, the Group or Plan number. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
137. Coverage.class:rxiin.name | |||||
Definition | A short description for the class. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
138. Coverage.order | |||||
Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. | ||||
Control | 0..1 | ||||
Type | positiveInt | ||||
Requirements | Used in managing the coordination of benefits. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
139. Coverage.network | |||||
Definition | The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Used in referral for treatment and in claims processing. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
140. Coverage.costToBeneficiary | |||||
Definition | A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | Required by providers to manage financial transaction with the patient. | ||||
Alternate Names | CoPay, Deductible, Exceptions | ||||
Comments | For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
141. Coverage.costToBeneficiary.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
142. Coverage.costToBeneficiary.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
143. Coverage.costToBeneficiary.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
144. Coverage.costToBeneficiary.type | |||||
Definition | The category of patient centric costs associated with treatment. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4DIC Copay Type; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | Needed to identify the category associated with the amount for the patient. | ||||
Comments | For example visit, specialist visits, emergency, inpatient care, etc. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
145. Coverage.costToBeneficiary.value[x] | |||||
Definition | The amount due from the patient for the cost category. | ||||
Control | 1..1 | ||||
Type | Money | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Requirements | Needed to identify the amount for the patient associated with the category. | ||||
Comments | Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
Slicing | This element introduces a set of slices on Coverage.costToBeneficiary.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
146. Coverage.costToBeneficiary.value[x]:valueMoney | |||||
SliceName | valueMoney | ||||
Definition | The amount due from the patient for the cost category. | ||||
Control | 1..1 | ||||
Type | Money | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Must Support | true | ||||
Requirements | Needed to identify the amount for the patient associated with the category. | ||||
Comments | Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. | ||||
Invariants | Defined on this element ValueMoney-details-or-extension: costToBeneficiary SHALL have (value AND currency) OR Beneficiary Cost String extension, but not both (: ((value.exists() and currency.exists()) xor extension.where(url='http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension').exists()) and ((value.exists() xor currency.exists())).not()) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
147. Coverage.costToBeneficiary.value[x]:valueMoney.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
148. Coverage.costToBeneficiary.value[x]:valueMoney.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
Slicing | This element introduces a set of slices on Coverage.costToBeneficiary.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
149. Coverage.costToBeneficiary.value[x]:valueMoney.extension:C4DIC-BeneficiaryCostString-extension | |||||
SliceName | C4DIC-BeneficiaryCostString-extension | ||||
Definition | This extension allows for the representation of copay details as strings. This can be passed as part of the Coverage resource where payors need to communicate costToBeneficiary details that cannot be expressed as SimpleQuantity or Money data types. | ||||
Control | 0..1 | ||||
Type | Extension(BeneficiaryCostString) (Extension Type: string) | ||||
Must Support | true | ||||
Comments | Either valueMoney.value and valueMoney.currency is MS or Beneficiary Cost String extension is MS | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
150. Coverage.costToBeneficiary.value[x]:valueMoney.value | |||||
Definition | Numerical value (with implicit precision). | ||||
Control | 0..1 | ||||
Type | decimal | ||||
Must Support | true | ||||
Requirements | The amount of the currency. The value includes an implicit precision in the presentation of the value. | ||||
Comments | Either valueMoney.value and valueMoney.currency is MS or Beneficiary Cost String extension is MS | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
151. Coverage.costToBeneficiary.value[x]:valueMoney.currency | |||||
Definition | ISO 4217 Currency Code. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from Currencies A code indicating the currency, taken from ISO 4217. | ||||
Type | code | ||||
Must Support | true | ||||
Requirements | A code indicating the currency, taken from ISO 4217. | ||||
Comments | Either valueMoney.value and valueMoney.currency is MS or Beneficiary Cost String extension is MS | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
152. Coverage.costToBeneficiary.exception | |||||
Definition | A suite of codes indicating exceptions or reductions to patient costs and their effective periods. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Requirements | Required by providers to manage financial transaction with the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
153. Coverage.costToBeneficiary.exception.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Control | 0..1 | ||||
Type | string | ||||
154. Coverage.costToBeneficiary.exception.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
155. Coverage.costToBeneficiary.exception.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) | ||||
156. Coverage.costToBeneficiary.exception.type | |||||
Definition | The code for the specific exception. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleCoverageFinancialExceptionCodes The types of exceptions from the part or full value of financial obligations such as copays. | ||||
Type | CodeableConcept | ||||
Requirements | Needed to identify the exception associated with the amount for the patient. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
157. Coverage.costToBeneficiary.exception.period | |||||
Definition | The timeframe during when the exception is in force. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Requirements | Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
158. Coverage.subrogation | |||||
Definition | When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Requirements | See definition for when to be used. | ||||
Comments | Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
159. Coverage.contract | |||||
Definition | The policy(s) which constitute this insurance coverage. | ||||
Control | 0..* | ||||
Type | Reference(Contract) | ||||
Requirements | To reference the legally binding contract between the policy holder and the insurer. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |