This Section describes the expected capabilities of the C4DIC Server actor which is responsible for providing responses to the queries submitted by the C4DIC Requestors.

Data that reflect a payer’s coverage of the member.

This profile builds upon the US Core Organization profile. It is used to convey a payer organization.

The goal of this profile is to describe a data-minimized version of Patient used to convey information about the Member who has health insurance coverage. Information that would normally not appear on a health insurance card is not required. The use of this profile is only approved for conveying information related to a health insurance card as part of this IG.

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.

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. When rendering foreground and background colors, the implementer SHOULD not use the same foreground and background colors and instead should algorithmically determine a high color contrast.

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.

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.

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.)

This extension groups the Foreground, Background and Highlight color extensions into a single extension. When rendering foreground and background colors, the implementer SHOULD not use the same foreground and background colors and instead should algorithmically determine a high color contrast.

This extension enables an insurance company to provide a foreground color to be used by consuming applications when they render the information found on an insurance card for the insurance plan member. When rendering foreground and background colors, the implementer SHOULD not use the same foreground and background colors and instead should algorithmically determine a high color contrast.

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. When rendering foreground and background colors, the implementer SHOULD not use the same foreground and background colors and instead should algorithmically determine a high color contrast.

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.

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.

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.

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.

This value set includes an extended set of contact type codes.

This value set includes an extended set of copay type codes.

This value set includes an extended set of coverage class codes.

Identifies the type of identifier for payer coverage

ISO Color Measurement and Management

This code system includes an extended set of Contact Type codes.

This code system includes an extended set of Copay Type codes.

This code system includes an extended set of Coverage Class codes.

Identifier Type codes that extend those defined in http://terminology.hl7.org/CodeSystem/v2-0203 to define the type of identifier payers and providers assign to insurers and patients

Coverage Example 1

Coverage Example 1 in FSH

Patient Example 1 (subscriber)

Patient Example 2 (beneficiary)

Payer Organization Example 1