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13.1.8 Resource Coverage - Mappings

Responsible Owner: Financial Management icon Work GroupStandards Status: InformativeSecurity Category: Patient Compartments: Patient, RelatedPerson

Mappings:

FiveWs Pattern Mapping

Workflow Pattern

HL7 V2 Mapping

RIM Mapping

Canadian Dental Association eclaims standard

Canadian Pharmacy Association eclaims standard

Mappings for the Coverage resource (see Mappings to Other Standards for further information & status).

13.1.8.1 FiveWs Pattern Mapping (http://hl7.org/fhir/fivews icon)

Coverage financial.support
    identifier FiveWs.identifier
    status FiveWs.status
    type FiveWs.class
    policyHolder FiveWs.subject
    subscriber FiveWs.subject
    subscriberId FiveWs.subject
    beneficiary FiveWs.subject
    period FiveWs.done[x]

13.1.8.2 Workflow Pattern (http://hl7.org/fhir/workflow icon)

Coverage Event
    identifier Event.identifier
    status Event.status
    beneficiary Event.subject
    period Event.occurrence[x]

13.1.8.3 HL7 V2 Mapping (http://hl7.org/v2 icon)

The mappings provided in this tab are indicative of how HL7 v2 fields relate to HL7 FHIR attributes in this resource, but is not complete and without critical HL7 v2 context. The HL7 v2-FHIR Implementation guide, located here icon, provides additional guidance on transforming an HL7 v2 message to FHIR resources for FHIR R4 and FHIR R6.
Coverage
    identifier
    status
    statusReason
    kind
    paymentBy
        party
        responsibility
    type IN1-15
    policyHolder IN1-16, 18, 19-name of insured, address, date of birth
    subscriber IN1-16, 18, 19-name of insured, address, date of birth
    subscriberId IN1-16, 18, 19-name of insured, address, date of birth
    beneficiary IN1-16, 18, 19-name of insured, address, date of birth
    dependent - No exact HL7 V2 equivalent concept seems to exist;
    relationship
    period IN1-12 / IN1-13
    insurer
    class
        type
        value IN1-2
        name IN1-8
    order
    network
    costToBeneficiary
        type
        category
        network
        unit
        term
        value[x] IN1-8
        exception
            type
            period
    subrogation
    contract IN1-16, 18, 19
    insurancePlan

13.1.8.4 RIM Mapping (http://hl7.org/v3 icon)

Coverage Coverage
    identifier .id
    status Act.status
    period Act.effectiveTime
    contract n/a

13.1.8.5 Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/ icon)

Coverage
    identifier C02
    status
    statusReason
    kind
    paymentBy
        party
        responsibility
    type
    policyHolder D01 through D09
    subscriber D01 through D09
    subscriberId D01 through D09
    beneficiary D01 through D09
    dependent C17
    relationship C03
    period
    insurer
    class
        type
        value C11 (Division,Section)
        name C11 (Division,Section)
    order
    network D10
    costToBeneficiary
        type
        category
        network
        unit
        term
        value[x] C11 (Division,Section)
        exception
            type
            period
    subrogation
    contract D01 through D09
    insurancePlan

13.1.8.6 Canadian Pharmacy Association eclaims standard (http://www.pharmacists.ca/ icon)

Coverage
    identifier C.32, C.33, C.39
    status
    statusReason
    kind
    paymentBy
        party
        responsibility
    type
    policyHolder C.35
    subscriber C.35
    subscriberId C.35
    beneficiary C.35
    dependent
    relationship
    period
    insurer
    class
        type
        value C.31
        name C.31
    order
    network
    costToBeneficiary
        type
        category
        network
        unit
        term
        value[x] C.31
        exception
            type
            period
    subrogation
    contract C.35
    insurancePlan