This is the set of resources that conform to either of the profiles US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage) and BSeR Coverage (http://hl7.org/fhir/us/bser/StructureDefinition/BSeR-Coverage). E.g. what you have to deal with if you get resources conforming to one of them
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | C | 0..* | Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present | |
meta | Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children | |
text | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
identifier | SΣ | 0..* | Identifier | Member ID and other identifiers ele-1: All FHIR elements must have a @value or children |
status | ?!SΣ | 1..1 | code | left: active | cancelled | draft | entered-in-error; right: (USCDI) active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes ele-1: All FHIR elements must have a @value or children |
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy ele-1: All FHIR elements must have a @value or children |
subscriber | SΣ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy ele-1: All FHIR elements must have a @value or children |
subscriberId | SΣ | 0..1 | string | ID assigned to the subscriber ele-1: All FHIR elements must have a @value or children |
beneficiary | SΣ | 1..1 | Reference(US Core Patient Profile) | Plan beneficiary ele-1: All FHIR elements must have a @value or children |
dependent | Σ | 0..1 | string | Dependent number ele-1: All FHIR elements must have a @value or children |
relationship | S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children |
period | SΣ | 0..1 | Period | Coverage start and end dates ele-1: All FHIR elements must have a @value or children |
payor | SΣ | 1..1 | Reference(US Core Organization Profile S | US Core Patient Profile | US Core RelatedPerson Profile) | Issuer of the policy ele-1: All FHIR elements must have a @value or children |
class | S | 0..* | BackboneElement | Additional coverage classifications ele-1: All FHIR elements must have a @value or children |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children |
value | Σ | 1..1 | string | Value associated with the type ele-1: All FHIR elements must have a @value or children |
name | Σ | 0..1 | string | Human readable description of the type and value ele-1: All FHIR elements must have a @value or children |
order | Σ | 0..1 | positiveInt | Relative order of the coverage ele-1: All FHIR elements must have a @value or children |
network | Σ | 0..1 | string | Insurer network ele-1: All FHIR elements must have a @value or children |
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. ele-1: All FHIR elements must have a @value or children |
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary ele-1: All FHIR elements must have a @value or children | |
valueQuantity | Quantity(SimpleQuantity) | |||
valueMoney | Money | |||
exception | 0..* | BackboneElement | Exceptions for patient payments ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. ele-1: All FHIR elements must have a @value or children |
period | Σ | 0..1 | Period | The effective period of the exception ele-1: All FHIR elements must have a @value or children |
subrogation | 0..1 | boolean | Reimbursement to insurer ele-1: All FHIR elements must have a @value or children | |
contract | 0..* | Reference(Contract) | Contract details ele-1: All FHIR elements must have a @value or children | |
Documentation for this format |