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 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
| Official URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage | Version: 2.0.0 | |||
| Active as of 2025-10-01 | Computable Name: C4DICCoverage | |||
Data that reflect a payer’s coverage of the member.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
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C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15 |
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SΣ | 1..1 | Meta | Metadata about the resource |
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SΣ | 1..1 | instant | When the resource version last changed |
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Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this |
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Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage |
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?!Σ | 0..1 | uri | A set of rules under which this content was created |
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..* | (Complex) | Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension | |
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0..* | Annotation | Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension | |
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0..1 | (Complex) | Color Palette URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension | |
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0..1 | (Complex) | Logo URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension | |
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0..* | (Complex) | QR Code URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension | |
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0..* | (Complex) | Barcode URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension | |
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0..* | (Complex) | Supporting image URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | |
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0..1 | date | Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension | |
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?! | 0..* | Extension | Extensions that cannot be ignored |
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SΣ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type |
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Content/Rules for all slices | |||
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?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
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Σ | 0..1 | CodeableConcept | Description of identifier Binding: C4DIC Coverage Identifier Type (extensible) |
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SΣC | 0..1 | Identifier | Member ID |
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?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
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SΣ | 1..1 | CodeableConcept | 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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: MB | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
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SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Payer Type (extensible): US Public Health Data Consortium Source of Payment Codes |
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SΣ | 1..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
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SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
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SΣC | 1..1 | string | ID assigned to the subscriber |
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SΣ | 1..1 | Reference(C4DIC Patient) | Plan beneficiary |
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SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
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SΣ | 0..1 | string | Dependent number |
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S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required) |
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SΣ | 0..1 | Period | Coverage start and end dates |
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SΣ | 1..1 | Reference(C4DIC Organization) | Issuer of the policy |
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S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type |
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Content/Rules for all slices | |||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: C4DIC Coverage Class (required) |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Group |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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SΣ | 1..1 | string | Group Number |
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SΣ | 0..1 | string | Group Name |
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S | 0..1 | BackboneElement | Plan |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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SΣ | 1..1 | string | Plan Number |
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SΣ | 0..1 | string | Plan Name |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: division | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: network | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxbin | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxpcn | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxgroup | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxid | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxiin | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..* | BackboneElement | Patient payments for services/products |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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SΣ | 1..1 | CodeableConcept | Cost category Binding: C4DIC Copay Type (extensible) |
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SΣC | 1..1 | Money | The amount or percentage due from the beneficiary Constraints: ValueMoney-details-or-extension |
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Content/Rules for all slices | |||
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S | 0..1 | string | Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension |
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SΣ | 0..1 | decimal | Numerical value (with implicit precision) |
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SΣ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. |
Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| Coverage.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | |
| Coverage.identifier.type | extensible | C4DICCoverageIdentifierTypehttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageIdentifierTypeFrom this IG | |
| Coverage.identifier:memberid.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | |
| Coverage.identifier:memberid.type | extensible | Pattern Value: MBhttp://hl7.org/fhir/ValueSet/identifier-typeFrom the FHIR Standard | |
| Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | |
| Coverage.type | extensible | PayerType (a valid code from Source of Payment Typology (https://nahdo.org/sopt))http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 | |
| Coverage.relationship | required | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationshipFrom the FHIR Standard | |
| Coverage.class.type | required | C4DICCoverageClassVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageClassVSFrom this IG | |
| Coverage.class:group.type | extensible | Pattern Value: grouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:plan.type | extensible | Pattern Value: planhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:division.type | extensible | Pattern Value: divisionhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:network.type | extensible | Pattern Value: networkhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxbin.type | extensible | Pattern Value: rxbinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxpcn.type | extensible | Pattern Value: rxpcnhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxgroup.type | extensible | Pattern Value: rxgrouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxid.type | extensible | Pattern Value: rxidhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxiin.type | extensible | Pattern Value: rxiinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.costToBeneficiary.type | extensible | C4DICCopayTypeVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVSFrom this IG | |
| Coverage.costToBeneficiary.value[x].currency | required | Currencies(a valid code from urn:iso:std:iso:4217)http://hl7.org/fhir/ValueSet/currencies|4.0.1From the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present : identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists() |
This structure is derived from USCoreCoverageProfile
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement | |
![]() ![]() |
S | 1..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
S | 1..1 | instant | When the resource version last changed |
![]() ![]() ![]() |
1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this | |
![]() ![]() ![]() ![]() |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage | |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..* | (Complex) | Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension | |
![]() ![]() ![]() |
0..* | Annotation | Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension | |
![]() ![]() ![]() |
0..1 | (Complex) | Color Palette URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension | |
![]() ![]() ![]() |
0..1 | (Complex) | Logo URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension | |
![]() ![]() ![]() |
0..* | (Complex) | QR Code URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension | |
![]() ![]() ![]() |
0..* | (Complex) | Barcode URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension | |
![]() ![]() ![]() |
0..* | (Complex) | Supporting image URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | |
![]() ![]() ![]() |
0..1 | date | Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension | |
![]() ![]() |
0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type | |
![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Description of identifier Binding: C4DIC Coverage Identifier Type (extensible) | |
![]() ![]() |
1..1 | code | active | cancelled | draft | entered-in-error | |
![]() ![]() |
1..1 | CodeableConcept | Coverage category such as medical or accident | |
![]() ![]() |
S | 1..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
![]() ![]() ![]() |
S | 1..1 | string | Literal reference, Relative, internal or absolute URL |
![]() ![]() |
1..1 | string | ID assigned to the subscriber | |
![]() ![]() |
1..1 | Reference(C4DIC Patient) | Plan beneficiary | |
![]() ![]() ![]() |
S | 1..1 | string | Literal reference, Relative, internal or absolute URL |
![]() ![]() |
S | 0..1 | string | Dependent number |
![]() ![]() |
1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required) | |
![]() ![]() |
0..1 | Period | Coverage start and end dates | |
![]() ![]() |
1..1 | Reference(C4DIC Organization) | Issuer of the policy | |
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications | |
![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: C4DIC Coverage Class (required) | |
![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() |
0..1 | BackboneElement | Group | |
![]() ![]() ![]() ![]() |
1..1 | string | Group Number | |
![]() ![]() ![]() |
0..1 | BackboneElement | Plan | |
![]() ![]() ![]() ![]() |
1..1 | string | Plan Number | |
![]() ![]() ![]() ![]() |
0..1 | string | Plan Name | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: division | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: network | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxbin | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxpcn | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxgroup | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxid | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxiin | |
![]() ![]() |
S | 0..* | BackboneElement | Patient payments for services/products |
![]() ![]() ![]() |
S | 1..1 | CodeableConcept | Cost category Binding: C4DIC Copay Type (extensible) |
![]() ![]() ![]() |
SC | 1..1 | Money | The amount or percentage due from the beneficiary Constraints: ValueMoney-details-or-extension |
![]() ![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() |
S | 0..1 | string | Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension |
![]() ![]() ![]() ![]() |
S | 0..1 | decimal | Numerical value (with implicit precision) |
![]() ![]() ![]() ![]() |
S | 0..1 | code | ISO 4217 Currency Code |
Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Coverage.identifier.type | extensible | C4DICCoverageIdentifierTypehttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageIdentifierTypeFrom this IG | |
| Coverage.relationship | required | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationshipFrom the FHIR Standard | |
| Coverage.class.type | required | C4DICCoverageClassVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageClassVSFrom this IG | |
| Coverage.costToBeneficiary.type | extensible | C4DICCopayTypeVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVSFrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| 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() |
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15 | ||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
SΣ | 1..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
Σ | 0..1 | id | Version specific identifier | ||||
![]() ![]() ![]() |
SΣ | 1..1 | instant | When the resource version last changed | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
![]() ![]() ![]() |
Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage | ||||
![]() ![]() ![]() |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
![]() ![]() ![]() |
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". | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
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 | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
0..* | (Complex) | Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension | |||||
![]() ![]() ![]() |
0..* | Annotation | Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension | |||||
![]() ![]() ![]() |
0..1 | (Complex) | Color Palette URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension | |||||
![]() ![]() ![]() |
0..1 | (Complex) | Logo URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension | |||||
![]() ![]() ![]() |
0..* | (Complex) | QR Code URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension | |||||
![]() ![]() ![]() |
0..* | (Complex) | Barcode URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension | |||||
![]() ![]() ![]() |
0..* | (Complex) | Supporting image URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | |||||
![]() ![]() ![]() |
0..1 | date | Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
SΣ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type | ||||
![]() ![]() ![]() |
Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | CodeableConcept | Description of identifier Binding: C4DIC Coverage Identifier Type (extensible) | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() ![]() |
SΣC | 0..1 | Identifier | Member ID | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() ![]() |
SΣ | 1..1 | CodeableConcept | 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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: MB | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() |
SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Payer Type (extensible): US Public Health Data Consortium Source of Payment Codes | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() |
SΣ | 1..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource | ||||
![]() ![]() |
SΣC | 1..1 | string | ID assigned to the subscriber | ||||
![]() ![]() |
SΣ | 1..1 | Reference(C4DIC Patient) | Plan beneficiary | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource | ||||
![]() ![]() |
SΣ | 0..1 | string | Dependent number | ||||
![]() ![]() |
S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required) | ||||
![]() ![]() |
SΣ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() |
SΣ | 1..1 | Reference(C4DIC Organization) | Issuer of the policy | ||||
![]() ![]() |
S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | ||||
![]() ![]() ![]() |
Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: C4DIC Coverage Class (required) | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Group | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
SΣ | 1..1 | string | Group Number | ||||
![]() ![]() ![]() ![]() |
SΣ | 0..1 | string | Group Name | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Plan | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
SΣ | 1..1 | string | Plan Number | ||||
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SΣ | 0..1 | string | Plan Name | ||||
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S | 0..1 | BackboneElement | Additional coverage classifications | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |||||
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0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: division | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: network | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxbin | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
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0..1 | string | Plain text representation of the concept | |||||
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Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
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S | 0..1 | BackboneElement | Additional coverage classifications | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
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0..1 | string | Version of the system - if relevant | |||||
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxpcn | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
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0..1 | string | Plain text representation of the concept | |||||
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Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
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S | 0..1 | BackboneElement | Additional coverage classifications | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
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0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxgroup | |||||
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0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
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Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxid | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxiin | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
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Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
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Σ | 0..1 | string | Insurer network | ||||
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S | 0..* | BackboneElement | Patient payments for services/products | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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SΣ | 1..1 | CodeableConcept | Cost category Binding: C4DIC Copay Type (extensible) | ||||
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SΣC | 1..1 | Money | The amount or percentage due from the beneficiary Constraints: ValueMoney-details-or-extension | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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S | 0..1 | string | Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension | ||||
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SΣ | 0..1 | decimal | Numerical value (with implicit precision) | ||||
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SΣ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
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0..* | BackboneElement | Exceptions for patient payments | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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. | ||||
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Σ | 0..1 | Period | The effective period of the exception | ||||
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0..1 | boolean | Reimbursement to insurer | |||||
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0..* | Reference(Contract) | Contract details | |||||
Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Coverage.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels|4.0.1From the FHIR Standard | ||||
| Coverage.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tags|4.0.1From the FHIR Standard | ||||
| Coverage.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| Coverage.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | ||||
| Coverage.identifier.type | extensible | C4DICCoverageIdentifierTypehttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageIdentifierTypeFrom this IG | ||||
| Coverage.identifier:memberid.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | ||||
| Coverage.identifier:memberid.type | extensible | Pattern Value: MBhttp://hl7.org/fhir/ValueSet/identifier-typeFrom the FHIR Standard | ||||
| Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | ||||
| Coverage.type | extensible | PayerType (a valid code from Source of Payment Typology (https://nahdo.org/sopt))http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 | ||||
| Coverage.subscriber.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1From the FHIR Standard | ||||
| Coverage.beneficiary.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1From the FHIR Standard | ||||
| Coverage.relationship | required | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationshipFrom the FHIR Standard | ||||
| Coverage.class.type | required | C4DICCoverageClassVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageClassVSFrom this IG | ||||
| Coverage.class:group.type | extensible | Pattern Value: grouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:plan.type | extensible | Pattern Value: planhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:division.type | extensible | Pattern Value: divisionhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:network.type | extensible | Pattern Value: networkhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxbin.type | extensible | Pattern Value: rxbinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxpcn.type | extensible | Pattern Value: rxpcnhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxgroup.type | extensible | Pattern Value: rxgrouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxid.type | extensible | Pattern Value: rxidhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxiin.type | extensible | Pattern Value: rxiinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.costToBeneficiary.type | extensible | C4DICCopayTypeVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVSFrom this IG | ||||
| Coverage.costToBeneficiary.value[x].currency | required | Currencies(a valid code from urn:iso:std:iso:4217)http://hl7.org/fhir/ValueSet/currencies|4.0.1From the FHIR Standard | ||||
| Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exceptionFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present : identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists() |
This structure is derived from USCoreCoverageProfile
Summary
Mandatory: 9 elements(1 nested mandatory element)
Must-Support: 19 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
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C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15 |
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SΣ | 1..1 | Meta | Metadata about the resource |
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SΣ | 1..1 | instant | When the resource version last changed |
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Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this |
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Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage |
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?!Σ | 0..1 | uri | A set of rules under which this content was created |
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..* | (Complex) | Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension | |
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0..* | Annotation | Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension | |
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0..1 | (Complex) | Color Palette URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension | |
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0..1 | (Complex) | Logo URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension | |
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0..* | (Complex) | QR Code URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension | |
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0..* | (Complex) | Barcode URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension | |
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0..* | (Complex) | Supporting image URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | |
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0..1 | date | Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension | |
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?! | 0..* | Extension | Extensions that cannot be ignored |
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SΣ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type |
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Content/Rules for all slices | |||
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?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
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Σ | 0..1 | CodeableConcept | Description of identifier Binding: C4DIC Coverage Identifier Type (extensible) |
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SΣC | 0..1 | Identifier | Member ID |
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?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
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SΣ | 1..1 | CodeableConcept | 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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: MB | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
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SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Payer Type (extensible): US Public Health Data Consortium Source of Payment Codes |
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SΣ | 1..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
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SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
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SΣC | 1..1 | string | ID assigned to the subscriber |
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SΣ | 1..1 | Reference(C4DIC Patient) | Plan beneficiary |
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SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
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SΣ | 0..1 | string | Dependent number |
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S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required) |
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SΣ | 0..1 | Period | Coverage start and end dates |
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SΣ | 1..1 | Reference(C4DIC Organization) | Issuer of the policy |
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S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type |
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Content/Rules for all slices | |||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: C4DIC Coverage Class (required) |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Group |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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SΣ | 1..1 | string | Group Number |
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SΣ | 0..1 | string | Group Name |
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S | 0..1 | BackboneElement | Plan |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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SΣ | 1..1 | string | Plan Number |
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SΣ | 0..1 | string | Plan Name |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: division | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: network | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxbin | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxpcn | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxgroup | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxid | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..1 | BackboneElement | Additional coverage classifications |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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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 |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
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0..1 | string | Version of the system - if relevant | |
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1..1 | code | Symbol in syntax defined by the system Fixed Value: rxiin | |
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0..1 | string | Representation defined by the system | |
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0..1 | boolean | If this coding was chosen directly by the user | |
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0..1 | string | Plain text representation of the concept | |
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Σ | 1..1 | string | Value associated with the type |
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S | 0..* | BackboneElement | Patient payments for services/products |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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SΣ | 1..1 | CodeableConcept | Cost category Binding: C4DIC Copay Type (extensible) |
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SΣC | 1..1 | Money | The amount or percentage due from the beneficiary Constraints: ValueMoney-details-or-extension |
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Content/Rules for all slices | |||
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S | 0..1 | string | Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension |
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SΣ | 0..1 | decimal | Numerical value (with implicit precision) |
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SΣ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. |
Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| Coverage.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | |
| Coverage.identifier.type | extensible | C4DICCoverageIdentifierTypehttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageIdentifierTypeFrom this IG | |
| Coverage.identifier:memberid.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | |
| Coverage.identifier:memberid.type | extensible | Pattern Value: MBhttp://hl7.org/fhir/ValueSet/identifier-typeFrom the FHIR Standard | |
| Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | |
| Coverage.type | extensible | PayerType (a valid code from Source of Payment Typology (https://nahdo.org/sopt))http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 | |
| Coverage.relationship | required | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationshipFrom the FHIR Standard | |
| Coverage.class.type | required | C4DICCoverageClassVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageClassVSFrom this IG | |
| Coverage.class:group.type | extensible | Pattern Value: grouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:plan.type | extensible | Pattern Value: planhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:division.type | extensible | Pattern Value: divisionhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:network.type | extensible | Pattern Value: networkhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxbin.type | extensible | Pattern Value: rxbinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxpcn.type | extensible | Pattern Value: rxpcnhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxgroup.type | extensible | Pattern Value: rxgrouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxid.type | extensible | Pattern Value: rxidhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.class:rxiin.type | extensible | Pattern Value: rxiinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | |
| Coverage.costToBeneficiary.type | extensible | C4DICCopayTypeVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVSFrom this IG | |
| Coverage.costToBeneficiary.value[x].currency | required | Currencies(a valid code from urn:iso:std:iso:4217)http://hl7.org/fhir/ValueSet/currencies|4.0.1From the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present : identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists() |
Differential View
This structure is derived from USCoreCoverageProfile
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement | |
![]() ![]() |
S | 1..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
S | 1..1 | instant | When the resource version last changed |
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1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this | |
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1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage | |
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..* | (Complex) | Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension | |
![]() ![]() ![]() |
0..* | Annotation | Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension | |
![]() ![]() ![]() |
0..1 | (Complex) | Color Palette URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension | |
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0..1 | (Complex) | Logo URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension | |
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0..* | (Complex) | QR Code URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension | |
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0..* | (Complex) | Barcode URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension | |
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0..* | (Complex) | Supporting image URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | |
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0..1 | date | Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension | |
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0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type | |
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Content/Rules for all slices | |||
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0..1 | CodeableConcept | Description of identifier Binding: C4DIC Coverage Identifier Type (extensible) | |
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1..1 | code | active | cancelled | draft | entered-in-error | |
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1..1 | CodeableConcept | Coverage category such as medical or accident | |
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S | 1..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
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S | 1..1 | string | Literal reference, Relative, internal or absolute URL |
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1..1 | string | ID assigned to the subscriber | |
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1..1 | Reference(C4DIC Patient) | Plan beneficiary | |
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S | 1..1 | string | Literal reference, Relative, internal or absolute URL |
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S | 0..1 | string | Dependent number |
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1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required) | |
![]() ![]() |
0..1 | Period | Coverage start and end dates | |
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1..1 | Reference(C4DIC Organization) | Issuer of the policy | |
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0..* | BackboneElement | Additional coverage classifications | |
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1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: C4DIC Coverage Class (required) | |
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Content/Rules for all slices | |||
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0..1 | BackboneElement | Group | |
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1..1 | string | Group Number | |
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0..1 | BackboneElement | Plan | |
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1..1 | string | Plan Number | |
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0..1 | string | Plan Name | |
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S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: division | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: network | |
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S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxbin | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxpcn | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxgroup | |
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxid | |
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S | 0..1 | BackboneElement | Additional coverage classifications |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxiin | |
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S | 0..* | BackboneElement | Patient payments for services/products |
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S | 1..1 | CodeableConcept | Cost category Binding: C4DIC Copay Type (extensible) |
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SC | 1..1 | Money | The amount or percentage due from the beneficiary Constraints: ValueMoney-details-or-extension |
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Content/Rules for all slices | |||
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S | 0..1 | string | Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension |
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S | 0..1 | decimal | Numerical value (with implicit precision) |
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S | 0..1 | code | ISO 4217 Currency Code |
Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Coverage.identifier.type | extensible | C4DICCoverageIdentifierTypehttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageIdentifierTypeFrom this IG | |
| Coverage.relationship | required | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationshipFrom the FHIR Standard | |
| Coverage.class.type | required | C4DICCoverageClassVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageClassVSFrom this IG | |
| Coverage.costToBeneficiary.type | extensible | C4DICCopayTypeVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVSFrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| 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
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15 | ||||
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Σ | 0..1 | id | Logical id of this artifact | ||||
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SΣ | 1..1 | Meta | Metadata about the resource | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 0..1 | id | Version specific identifier | ||||
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SΣ | 1..1 | instant | When the resource version last changed | ||||
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Σ | 0..1 | uri | Identifies where the resource comes from | ||||
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Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this | ||||
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Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage | ||||
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Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
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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". | ||||
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?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
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0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
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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 | |||||
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0..* | Resource | Contained, inline Resources | |||||
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
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0..* | (Complex) | Plan Beneficiaries URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension | |||||
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0..* | Annotation | Additional Insurance Card Information URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension | |||||
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0..1 | (Complex) | Color Palette URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension | |||||
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0..1 | (Complex) | Logo URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension | |||||
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0..* | (Complex) | QR Code URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension | |||||
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0..* | (Complex) | Barcode URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension | |||||
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0..* | (Complex) | Supporting image URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension | |||||
![]() ![]() ![]() |
0..1 | date | Card Issue Date URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
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SΣ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type | ||||
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Content/Rules for all slices | |||||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
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Σ | 0..1 | CodeableConcept | Description of identifier Binding: C4DIC Coverage Identifier Type (extensible) | ||||
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Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
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Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
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Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
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Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
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SΣC | 0..1 | Identifier | Member ID | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() ![]() |
SΣ | 1..1 | CodeableConcept | 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 | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: MB | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
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?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
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SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Payer Type (extensible): US Public Health Data Consortium Source of Payment Codes | ||||
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Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
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SΣ | 1..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
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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). | ||||
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Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
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Σ | 0..1 | string | Text alternative for the resource | ||||
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SΣC | 1..1 | string | ID assigned to the subscriber | ||||
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SΣ | 1..1 | Reference(C4DIC Patient) | Plan beneficiary | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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SΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() |
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). | ||||
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Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
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Σ | 0..1 | string | Text alternative for the resource | ||||
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SΣ | 0..1 | string | Dependent number | ||||
![]() ![]() |
S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required) | ||||
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SΣ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() |
SΣ | 1..1 | Reference(C4DIC Organization) | Issuer of the policy | ||||
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S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | ||||
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Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: C4DIC Coverage Class (required) | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
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S | 0..1 | BackboneElement | Group | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
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SΣ | 1..1 | string | Group Number | ||||
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SΣ | 0..1 | string | Group Name | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Plan | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: plan | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
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0..1 | string | Plain text representation of the concept | |||||
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SΣ | 1..1 | string | Plan Number | ||||
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SΣ | 0..1 | string | Plan Name | ||||
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S | 0..1 | BackboneElement | Additional coverage classifications | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |||||
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0..1 | string | Version of the system - if relevant | |||||
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1..1 | code | Symbol in syntax defined by the system Fixed Value: division | |||||
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0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
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S | 0..1 | BackboneElement | Additional coverage classifications | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: network | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxbin | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
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0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxpcn | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
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S | 0..1 | BackboneElement | Additional coverage classifications | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
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0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxgroup | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
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Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxid | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() |
S | 0..1 | BackboneElement | Additional coverage classifications | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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 | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: rxiin | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
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Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
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Σ | 0..1 | string | Insurer network | ||||
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S | 0..* | BackboneElement | Patient payments for services/products | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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SΣ | 1..1 | CodeableConcept | Cost category Binding: C4DIC Copay Type (extensible) | ||||
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SΣC | 1..1 | Money | The amount or percentage due from the beneficiary Constraints: ValueMoney-details-or-extension | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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S | 0..1 | string | Beneficiary Cost as String URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension | ||||
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SΣ | 0..1 | decimal | Numerical value (with implicit precision) | ||||
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SΣ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
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0..* | BackboneElement | Exceptions for patient payments | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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. | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Period | The effective period of the exception | ||||
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0..1 | boolean | Reimbursement to insurer | |||||
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0..* | Reference(Contract) | Contract details | |||||
Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Coverage.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels|4.0.1From the FHIR Standard | ||||
| Coverage.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tags|4.0.1From the FHIR Standard | ||||
| Coverage.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| Coverage.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | ||||
| Coverage.identifier.type | extensible | C4DICCoverageIdentifierTypehttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageIdentifierTypeFrom this IG | ||||
| Coverage.identifier:memberid.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1From the FHIR Standard | ||||
| Coverage.identifier:memberid.type | extensible | Pattern Value: MBhttp://hl7.org/fhir/ValueSet/identifier-typeFrom the FHIR Standard | ||||
| Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | ||||
| Coverage.type | extensible | PayerType (a valid code from Source of Payment Typology (https://nahdo.org/sopt))http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 | ||||
| Coverage.subscriber.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1From the FHIR Standard | ||||
| Coverage.beneficiary.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types|4.0.1From the FHIR Standard | ||||
| Coverage.relationship | required | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationshipFrom the FHIR Standard | ||||
| Coverage.class.type | required | C4DICCoverageClassVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCoverageClassVSFrom this IG | ||||
| Coverage.class:group.type | extensible | Pattern Value: grouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:plan.type | extensible | Pattern Value: planhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:division.type | extensible | Pattern Value: divisionhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:network.type | extensible | Pattern Value: networkhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxbin.type | extensible | Pattern Value: rxbinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxpcn.type | extensible | Pattern Value: rxpcnhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxgroup.type | extensible | Pattern Value: rxgrouphttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxid.type | extensible | Pattern Value: rxidhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.class:rxiin.type | extensible | Pattern Value: rxiinhttp://hl7.org/fhir/ValueSet/coverage-classFrom the FHIR Standard | ||||
| Coverage.costToBeneficiary.type | extensible | C4DICCopayTypeVShttp://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVSFrom this IG | ||||
| Coverage.costToBeneficiary.value[x].currency | required | Currencies(a valid code from urn:iso:std:iso:4217)http://hl7.org/fhir/ValueSet/currencies|4.0.1From the FHIR Standard | ||||
| Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exceptionFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present : identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists() |
This structure is derived from USCoreCoverageProfile
Summary
Mandatory: 9 elements(1 nested mandatory element)
Must-Support: 19 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron