CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot United States of America flag

CARIN Digital Insurance Card, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-digital-insurance-card/ and changes regularly. See the Directory of published versions

Resource Profile: C4DIC Coverage

Official URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 2 Computable Name: C4DICCoverage
Other Identifiers: OID:2.16.840.1.113883.4.642.40.9.42.7

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

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from USCoreCoverageProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* USCoreCoverageProfile(6.1.0) Insurance or medical plan or a payment agreement
... meta S 1..1 Meta Metadata about the resource
.... lastUpdated S 1..1 instant When the resource version last changed
.... Slices for profile 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:C4DIC-PlanBeneficiaries-extension 0..* (Complex) Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
.... extension:C4DIC-AdditionalCardInformation-extension 0..* Annotation, Reference(SBC Insurance Plan Profile) Additional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
.... extension:C4DIC-ColorPalette-extension 0..1 (Complex) Color Palette
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension
.... extension:C4DIC-Logo-extension 0..1 (Complex) Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
.... extension:C4DIC-QRCode-extension 0..* (Complex) QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
.... extension:C4DIC-Barcode-extension 0..* (Complex) Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
.... extension:C4DIC-SupportingImage-extension 0..* (Complex) Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
.... extension:C4DIC-CardIssueDate-extension 0..1 date Card Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... identifier 0..* Identifier (USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... type 0..1 CodeableConcept Description of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
... type 1..1 CodeableConcept (USCDI) Coverage category such as medical or accident
... subscriber S 1..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId 1..1 string (USCDI) ID assigned to the subscriber
... beneficiary 1..1 Reference(C4DIC Patient) (USCDI) Plan beneficiary
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... dependent S 0..1 string Dependent number
... relationship 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period 0..1 Period (USCDI) Coverage start and end dates
... payor 1..1 Reference(C4DIC Organization) (USCDI) Issuer of the policy
... class 0..* BackboneElement (USCDI) Additional coverage classifications
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
... Slices for class Content/Rules for all slices
.... class:group 0..1 BackboneElement (USCDI) Group
..... value 1..1 string (USCDI) Group Number
.... class:plan 0..1 BackboneElement (USCDI) Plan
..... value 1..1 string (USCDI) Plan Number
..... name 0..1 string (USCDI) Plan Name
.... class:division S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: division
.... class:network S 0..1 BackboneElement Preferred/Primary Network
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: network
.... class:alternatenetwork S 0..* BackboneElement Alternate Network(s)
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: alternatenetwork
.... class:rxbin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxbin
.... class:rxpcn S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxpcn
.... class:rxgroup S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxgroup
.... class:rxid S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxid
.... class:rxiin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxiin
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... type S 1..1 CodeableConcept Cost category
Binding: C4DIC Copay Type (extensible)
.... value[x] SC 1..1 Money The amount or percentage due from the beneficiary
Constraints: ValueMoney-details-or-extension
..... Slices for extension Content/Rules for all slices
...... extension:C4DIC-BeneficiaryCostString-extension S 0..1 string Beneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value S 0..1 decimal Numerical value (with implicit precision)
..... currency S 0..1 code ISO 4217 Currency Code

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.identifier.​type Base extensible C4DIC Coverage Identifier Type 📦2.0.0-ballot This IG
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required C4DIC Coverage Class 📦2.0.0-ballot This IG
Coverage.costToBeneficiary.​type Base extensible C4DIC Copay Type 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
ValueMoney-details-or-extension error Coverage.costToBeneficiary.value[x] 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()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* USCoreCoverageProfile(6.1.0) Insurance or medical plan or a payment agreement
Constraints: us-core-15
... meta SΣ 1..1 Meta Metadata about the resource
.... lastUpdated SΣ 1..1 instant When the resource version last changed
.... Slices for profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to

Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:C4DIC-PlanBeneficiaries-extension 0..* (Complex) Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
.... extension:C4DIC-AdditionalCardInformation-extension 0..* Annotation, Reference(SBC Insurance Plan Profile) Additional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
.... extension:C4DIC-ColorPalette-extension 0..1 (Complex) Color Palette
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension
.... extension:C4DIC-Logo-extension 0..1 (Complex) Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
.... extension:C4DIC-QRCode-extension 0..* (Complex) QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
.... extension:C4DIC-Barcode-extension 0..* (Complex) Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
.... extension:C4DIC-SupportingImage-extension 0..* (Complex) Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
.... extension:C4DIC-CardIssueDate-extension 0..1 date Card Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... Slices for identifier SΣ 0..* Identifier (USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
.... identifier:memberid SΣC 0..1 Identifier (USCDI) Member ID
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept (USCDI) Member Number identifier type
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
... status ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept (USCDI) Coverage category such as medical or accident
Binding: Payer Type . (extensible): US Public Health Data Consortium Source of Payment Codes
... subscriber SΣ 1..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId SΣC 1..1 string (USCDI) ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(C4DIC Patient) (USCDI) Plan beneficiary
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... dependent SΣ 0..1 string Dependent number
... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period SΣ 0..1 Period (USCDI) Coverage start and end dates
... payor SΣ 1..1 Reference(C4DIC Organization) (USCDI) Issuer of the policy
... Slices for class S 0..* BackboneElement (USCDI) Additional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
..... value Σ 1..1 string Value associated with the type
.... class:group S 0..1 BackboneElement (USCDI) Group
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Group Number
..... name SΣ 0..1 string (USCDI) Group Name
.... class:plan S 0..1 BackboneElement (USCDI) Plan
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Plan Number
..... name SΣ 0..1 string (USCDI) Plan Name
.... class:division S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: division
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:network S 0..1 BackboneElement Preferred/Primary Network
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: network
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:alternatenetwork S 0..* BackboneElement Alternate Network(s)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: alternatenetwork
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxbin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxbin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxpcn S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxpcn
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxgroup S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxgroup
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxid S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxid
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxiin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxiin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Cost category
Binding: C4DIC Copay Type (extensible)
.... value[x] SΣC 1..1 Money The amount or percentage due from the beneficiary
Constraints: ValueMoney-details-or-extension
..... Slices for extension Content/Rules for all slices
...... extension:C4DIC-BeneficiaryCostString-extension S 0..1 string Beneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value SΣ 0..1 decimal Numerical value (with implicit precision)
..... currency SΣ 0..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier.​type Base extensible C4DIC Coverage Identifier Type 📦2.0.0-ballot This IG
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Payer Type . 📦20221118 VSAC v0.19
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required C4DIC Coverage Class 📦2.0.0-ballot This IG
Coverage.class:group.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:division.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:network.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:alternatenetwork.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxbin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxpcn.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxgroup.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxid.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxiin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible C4DIC Copay Type 📦2.0.0-ballot This IG
Coverage.costToBeneficiary.​value[x].currency Base required CurrencyCode 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ValueMoney-details-or-extension error Coverage.costToBeneficiary.value[x] 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()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* USCoreCoverageProfile(6.1.0) Insurance or medical plan or a payment agreement
Constraints: us-core-15
... id Σ 0..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated SΣ 1..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... Slices for profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to

Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:C4DIC-PlanBeneficiaries-extension 0..* (Complex) Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
.... extension:C4DIC-AdditionalCardInformation-extension 0..* Annotation, Reference(SBC Insurance Plan Profile) Additional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
.... extension:C4DIC-ColorPalette-extension 0..1 (Complex) Color Palette
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension
.... extension:C4DIC-Logo-extension 0..1 (Complex) Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
.... extension:C4DIC-QRCode-extension 0..* (Complex) QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
.... extension:C4DIC-Barcode-extension 0..* (Complex) Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
.... extension:C4DIC-SupportingImage-extension 0..* (Complex) Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
.... extension:C4DIC-CardIssueDate-extension 0..1 date Card Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 0..* Identifier (USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:memberid SΣC 0..1 Identifier (USCDI) Member ID
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept (USCDI) Member Number identifier type
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept (USCDI) Coverage category such as medical or accident
Binding: Payer Type . (extensible): US Public Health Data Consortium Source of Payment Codes
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber SΣ 1..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... subscriberId SΣC 1..1 string (USCDI) ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(C4DIC Patient) (USCDI) Plan beneficiary
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... dependent SΣ 0..1 string Dependent number
... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period SΣ 0..1 Period (USCDI) Coverage start and end dates
... payor SΣ 1..1 Reference(C4DIC Organization) (USCDI) Issuer of the policy
... Slices for class S 0..* BackboneElement (USCDI) Additional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:group S 0..1 BackboneElement (USCDI) Group
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Group Number
..... name SΣ 0..1 string (USCDI) Group Name
.... class:plan S 0..1 BackboneElement (USCDI) Plan
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Plan Number
..... name SΣ 0..1 string (USCDI) Plan Name
.... class:division S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: division
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:network S 0..1 BackboneElement Preferred/Primary Network
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: network
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:alternatenetwork S 0..* BackboneElement Alternate Network(s)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: alternatenetwork
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxbin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxbin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxpcn S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxpcn
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxgroup S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxgroup
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxid S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxid
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxiin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxiin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Cost category
Binding: C4DIC Copay Type (extensible)
.... value[x] SΣC 1..1 Money The amount or percentage due from the beneficiary
Constraints: ValueMoney-details-or-extension
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:C4DIC-BeneficiaryCostString-extension S 0..1 string Beneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value SΣ 0..1 decimal Numerical value (with implicit precision)
..... currency SΣ 0..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Coverage.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier.​type Base extensible C4DIC Coverage Identifier Type 📦2.0.0-ballot This IG
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Payer Type . 📦20221118 VSAC v0.19
Coverage.subscriber.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required C4DIC Coverage Class 📦2.0.0-ballot This IG
Coverage.class:group.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:division.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:network.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:alternatenetwork.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxbin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxpcn.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxgroup.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxid.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxiin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible C4DIC Copay Type 📦2.0.0-ballot This IG
Coverage.costToBeneficiary.​value[x].currency Base required CurrencyCode 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ValueMoney-details-or-extension error Coverage.costToBeneficiary.value[x] 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()

Differential View

This structure is derived from USCoreCoverageProfile

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* USCoreCoverageProfile(6.1.0) Insurance or medical plan or a payment agreement
... meta S 1..1 Meta Metadata about the resource
.... lastUpdated S 1..1 instant When the resource version last changed
.... Slices for profile 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:C4DIC-PlanBeneficiaries-extension 0..* (Complex) Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
.... extension:C4DIC-AdditionalCardInformation-extension 0..* Annotation, Reference(SBC Insurance Plan Profile) Additional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
.... extension:C4DIC-ColorPalette-extension 0..1 (Complex) Color Palette
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension
.... extension:C4DIC-Logo-extension 0..1 (Complex) Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
.... extension:C4DIC-QRCode-extension 0..* (Complex) QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
.... extension:C4DIC-Barcode-extension 0..* (Complex) Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
.... extension:C4DIC-SupportingImage-extension 0..* (Complex) Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
.... extension:C4DIC-CardIssueDate-extension 0..1 date Card Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... identifier 0..* Identifier (USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... type 0..1 CodeableConcept Description of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
... type 1..1 CodeableConcept (USCDI) Coverage category such as medical or accident
... subscriber S 1..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId 1..1 string (USCDI) ID assigned to the subscriber
... beneficiary 1..1 Reference(C4DIC Patient) (USCDI) Plan beneficiary
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... dependent S 0..1 string Dependent number
... relationship 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period 0..1 Period (USCDI) Coverage start and end dates
... payor 1..1 Reference(C4DIC Organization) (USCDI) Issuer of the policy
... class 0..* BackboneElement (USCDI) Additional coverage classifications
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
... Slices for class Content/Rules for all slices
.... class:group 0..1 BackboneElement (USCDI) Group
..... value 1..1 string (USCDI) Group Number
.... class:plan 0..1 BackboneElement (USCDI) Plan
..... value 1..1 string (USCDI) Plan Number
..... name 0..1 string (USCDI) Plan Name
.... class:division S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: division
.... class:network S 0..1 BackboneElement Preferred/Primary Network
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: network
.... class:alternatenetwork S 0..* BackboneElement Alternate Network(s)
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: alternatenetwork
.... class:rxbin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxbin
.... class:rxpcn S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxpcn
.... class:rxgroup S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxgroup
.... class:rxid S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxid
.... class:rxiin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxiin
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... type S 1..1 CodeableConcept Cost category
Binding: C4DIC Copay Type (extensible)
.... value[x] SC 1..1 Money The amount or percentage due from the beneficiary
Constraints: ValueMoney-details-or-extension
..... Slices for extension Content/Rules for all slices
...... extension:C4DIC-BeneficiaryCostString-extension S 0..1 string Beneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value S 0..1 decimal Numerical value (with implicit precision)
..... currency S 0..1 code ISO 4217 Currency Code

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.identifier.​type Base extensible C4DIC Coverage Identifier Type 📦2.0.0-ballot This IG
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required C4DIC Coverage Class 📦2.0.0-ballot This IG
Coverage.costToBeneficiary.​type Base extensible C4DIC Copay Type 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
ValueMoney-details-or-extension error Coverage.costToBeneficiary.value[x] 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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* USCoreCoverageProfile(6.1.0) Insurance or medical plan or a payment agreement
Constraints: us-core-15
... meta SΣ 1..1 Meta Metadata about the resource
.... lastUpdated SΣ 1..1 instant When the resource version last changed
.... Slices for profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to

Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:C4DIC-PlanBeneficiaries-extension 0..* (Complex) Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
.... extension:C4DIC-AdditionalCardInformation-extension 0..* Annotation, Reference(SBC Insurance Plan Profile) Additional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
.... extension:C4DIC-ColorPalette-extension 0..1 (Complex) Color Palette
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension
.... extension:C4DIC-Logo-extension 0..1 (Complex) Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
.... extension:C4DIC-QRCode-extension 0..* (Complex) QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
.... extension:C4DIC-Barcode-extension 0..* (Complex) Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
.... extension:C4DIC-SupportingImage-extension 0..* (Complex) Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
.... extension:C4DIC-CardIssueDate-extension 0..1 date Card Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... Slices for identifier SΣ 0..* Identifier (USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
.... identifier:memberid SΣC 0..1 Identifier (USCDI) Member ID
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept (USCDI) Member Number identifier type
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
... status ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept (USCDI) Coverage category such as medical or accident
Binding: Payer Type . (extensible): US Public Health Data Consortium Source of Payment Codes
... subscriber SΣ 1..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId SΣC 1..1 string (USCDI) ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(C4DIC Patient) (USCDI) Plan beneficiary
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... dependent SΣ 0..1 string Dependent number
... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period SΣ 0..1 Period (USCDI) Coverage start and end dates
... payor SΣ 1..1 Reference(C4DIC Organization) (USCDI) Issuer of the policy
... Slices for class S 0..* BackboneElement (USCDI) Additional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
..... value Σ 1..1 string Value associated with the type
.... class:group S 0..1 BackboneElement (USCDI) Group
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Group Number
..... name SΣ 0..1 string (USCDI) Group Name
.... class:plan S 0..1 BackboneElement (USCDI) Plan
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Plan Number
..... name SΣ 0..1 string (USCDI) Plan Name
.... class:division S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: division
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:network S 0..1 BackboneElement Preferred/Primary Network
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: network
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:alternatenetwork S 0..* BackboneElement Alternate Network(s)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: alternatenetwork
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxbin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxbin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxpcn S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxpcn
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxgroup S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxgroup
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxid S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxid
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
.... class:rxiin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxiin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Cost category
Binding: C4DIC Copay Type (extensible)
.... value[x] SΣC 1..1 Money The amount or percentage due from the beneficiary
Constraints: ValueMoney-details-or-extension
..... Slices for extension Content/Rules for all slices
...... extension:C4DIC-BeneficiaryCostString-extension S 0..1 string Beneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value SΣ 0..1 decimal Numerical value (with implicit precision)
..... currency SΣ 0..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier.​type Base extensible C4DIC Coverage Identifier Type 📦2.0.0-ballot This IG
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Payer Type . 📦20221118 VSAC v0.19
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required C4DIC Coverage Class 📦2.0.0-ballot This IG
Coverage.class:group.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:division.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:network.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:alternatenetwork.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxbin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxpcn.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxgroup.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxid.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxiin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible C4DIC Copay Type 📦2.0.0-ballot This IG
Coverage.costToBeneficiary.​value[x].currency Base required CurrencyCode 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ValueMoney-details-or-extension error Coverage.costToBeneficiary.value[x] 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()

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* USCoreCoverageProfile(6.1.0) Insurance or medical plan or a payment agreement
Constraints: us-core-15
... id Σ 0..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated SΣ 1..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... Slices for profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
Slice: Unordered, Open by pattern:$this
..... profile:supportedProfile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to

Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:C4DIC-PlanBeneficiaries-extension 0..* (Complex) Plan Beneficiaries
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension
.... extension:C4DIC-AdditionalCardInformation-extension 0..* Annotation, Reference(SBC Insurance Plan Profile) Additional Insurance Card Information
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension
.... extension:C4DIC-ColorPalette-extension 0..1 (Complex) Color Palette
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension
.... extension:C4DIC-Logo-extension 0..1 (Complex) Logo
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension
.... extension:C4DIC-QRCode-extension 0..* (Complex) QR Code
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension
.... extension:C4DIC-Barcode-extension 0..* (Complex) Barcode
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension
.... extension:C4DIC-SupportingImage-extension 0..* (Complex) Supporting image
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension
.... extension:C4DIC-CardIssueDate-extension 0..1 date Card Issue Date
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 0..* Identifier (USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: C4DIC Coverage Identifier Type (extensible)
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:memberid SΣC 0..1 Identifier (USCDI) Member ID
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept (USCDI) Member Number identifier type
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept (USCDI) Coverage category such as medical or accident
Binding: Payer Type . (extensible): US Public Health Data Consortium Source of Payment Codes
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber SΣ 1..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... subscriberId SΣC 1..1 string (USCDI) ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(C4DIC Patient) (USCDI) Plan beneficiary
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... dependent SΣ 0..1 string Dependent number
... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
... period SΣ 0..1 Period (USCDI) Coverage start and end dates
... payor SΣ 1..1 Reference(C4DIC Organization) (USCDI) Issuer of the policy
... Slices for class S 0..* BackboneElement (USCDI) Additional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: C4DIC Coverage Class (required)
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:group S 0..1 BackboneElement (USCDI) Group
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Group Number
..... name SΣ 0..1 string (USCDI) Group Name
.... class:plan S 0..1 BackboneElement (USCDI) Plan
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string (USCDI) Plan Number
..... name SΣ 0..1 string (USCDI) Plan Name
.... class:division S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: division
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:network S 0..1 BackboneElement Preferred/Primary Network
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: network
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:alternatenetwork S 0..* BackboneElement Alternate Network(s)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: alternatenetwork
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxbin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxbin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxpcn S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxpcn
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxgroup S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxgroup
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxid S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxid
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:rxiin S 0..1 BackboneElement (USCDI) Additional coverage classifications
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rxiin
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Cost category
Binding: C4DIC Copay Type (extensible)
.... value[x] SΣC 1..1 Money The amount or percentage due from the beneficiary
Constraints: ValueMoney-details-or-extension
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:C4DIC-BeneficiaryCostString-extension S 0..1 string Beneficiary Cost as String
URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension
..... value SΣ 0..1 decimal Numerical value (with implicit precision)
..... currency SΣ 0..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Coverage.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier.​type Base extensible C4DIC Coverage Identifier Type 📦2.0.0-ballot This IG
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Payer Type . 📦20221118 VSAC v0.19
Coverage.subscriber.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required C4DIC Coverage Class 📦2.0.0-ballot This IG
Coverage.class:group.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:division.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:network.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:alternatenetwork.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxbin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxpcn.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxgroup.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxid.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.class:rxiin.​type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible C4DIC Copay Type 📦2.0.0-ballot This IG
Coverage.costToBeneficiary.​value[x].currency Base required CurrencyCode 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ValueMoney-details-or-extension error Coverage.costToBeneficiary.value[x] 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()

 

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