abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisherpurposestatustitletypeurlversion- Values Differ
| Left: | HRex Member Match Coverage Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage) |
| Right: | HRex Member Match Coverage Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage) |
| Error | StructureDefinition.version | Values for version differ: '1.1.0' vs '1.2.0' |
| Information | StructureDefinition.date | Values for date differ: '2024-12-10T16:50:09+00:00' vs '2026-03-24T17:12:23+11:00' |
| Information | Coverage.language | Example/preferred bindings differ at Coverage.language using binding from HRexCoverage |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/Coverage | ||
| copyright | |||
| date | 2024-12-10T16:50:09+00:00 | 2026-03-24T17:12:23+11:00 |
|
| description | The HRex Coverage Profile defines the constraints for representing a member's healthcare insurance information to the Payer for member match purposes. Coverage instances complying with this profile, sometimes together with the Patient which this profile references via `beneficiary`, allows a payer to identify a member in their system. It aligns with the equivalent US Core profile, but diverges in that it does not require Patient.identifier for the beneficiary. | ||
| experimental | false | ||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | HRexCoverage | ||
| publisher | HL7 International / Clinical Interoperability Council | ||
| purpose | |||
| status | active | ||
| title | HRex Member Match Coverage Profile | ||
| type | Coverage | ||
| url | http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage | ||
| version | 1.1.0 | 1.2.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Coverage | C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: us-core-15 | C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: us-core-15 | |||||||||
 id | 0..1 | id | Logical id of this artifact | 0..1 | id | Logical id of this artifact | |||||||||||
| meta | 0..1 | Meta | Metadata about the resource | 0..1 | Meta | Metadata about the resource | |||||||||||
| implicitRules | 0..1 | uri | A set of rules under which this content was created | 0..1 | uri | A set of rules under which this content was created | |||||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
|
| ||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
 extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | 0..* | Extension | Extensions that cannot be ignored | 0..* | Extension | Extensions that cannot be ignored | |||||||||||
| Slices for identifier | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||||||||
| status | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||||
| type | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes | |||||||||||
| policyHolder | 0..1 | Reference(US Core Patient Profile(7.0.0) | HRex Organization Profile(1.1.0) | US Core RelatedPerson Profile(7.0.0)) | Owner of the policy | 0..1 | Reference(US Core Patient Profile(7.0.0) | HRex Organization Profile(1.2.0) | US Core RelatedPerson Profile(7.0.0)) | Owner of the policy | |||||||||||
| subscriber | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |||||||||||
| subscriberId | C | 0..1 | string | Subscriber ID | C | 0..1 | string | Subscriber ID | |||||||||
| beneficiary | 1..1 | Reference(HRex Member Match Patient(1.1.0)) | Plan beneficiary | 1..1 | Reference(HRex Member Match Patient(1.2.0)) | Plan beneficiary | |||||||||||
| dependent | 0..1 | string | Dependent number | 0..1 | string | Dependent number | |||||||||||
| relationship | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (required) | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (required) | |||||||||||
| period | 0..1 | Period | Coverage start and end dates | 0..1 | Period | Coverage start and end dates | |||||||||||
| payor | 1..1 | Reference(HRex Organization Profile(1.1.0)) | Issuer of the policy | 1..1 | Reference(HRex Organization Profile(1.2.0)) | Issuer of the policy | |||||||||||
 Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. | |||||||||||
| value | 1..1 | string | Value associated with the type | 1..1 | string | Value associated with the type | |||||||||||
| name | 0..1 | string | Human readable description of the type and value | 0..1 | string | Human readable description of the type and value | |||||||||||
| order | 0..1 | positiveInt | Relative order of the coverage | 0..1 | positiveInt | Relative order of the coverage | |||||||||||
| network | 0..1 | string | Insurer network | 0..1 | string | Insurer network | |||||||||||
| costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | 0..* | BackboneElement | Patient payments for services/products | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. | |||||||||||
| value[x] | 1..1 | ??  , Money | The amount or percentage due from the beneficiary | 1..1 | ?? , Money | The amount or percentage due from the beneficiary | |||||||||||
 exception | 0..* | BackboneElement | Exceptions for patient payments | 0..* | BackboneElement | Exceptions for patient payments | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| type | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. | |||||||||||
| period | 0..1 | Period | The effective period of the exception | 0..1 | Period | The effective period of the exception | |||||||||||
| subrogation | 0..1 | boolean | Reimbursement to insurer | 0..1 | boolean | Reimbursement to insurer | |||||||||||
| contract | 0..* | Reference(Contract) | Contract details | 0..* | Reference(Contract) | Contract details | |||||||||||
| Documentation for this format | |||||||||||||||||