HL7® FHIR® New Zealand Base Implementation Guide
2.1.2 - Draft
HL7® FHIR® New Zealand Base Implementation Guide, published by HL7 New Zealand. This is not an authorized publication; it is the continuous build for version 2.1.2. This version is based on the current content of https://github.com/HL7NZ/nzbase/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org.nz/fhir/StructureDefinition/NzCoverage | Version: 1.0.0 | |||
Draft as of 2023-11-23 |
Realm: |
Computable Name: NzCoverage |
Coverage resource for use in NZ (Trial use)
Trial use profile on Coverage for NZ use. Primarily changing the type valueset. Inclusion of the profile in future IG versions will depend on Implementer feedback.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (extensible) | |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: Coverage Category (extensible) | |
![]() |
Path | Conformance | ValueSet |
Coverage.type | extensible | CoverageType (a valid code from Coverage type) |
Coverage.class.type | extensible | CoverageCategory (a valid code from Coverage category) |
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (extensible) |
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() ![]() | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
![]() |
Path | Conformance | ValueSet |
Coverage.status | required | FinancialResourceStatusCodes |
Coverage.type | extensible | CoverageType (a valid code from Coverage type) |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
![]() ![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!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 | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (extensible) | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Dependent number | ||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() ![]() | Σ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() ![]() | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
![]() ![]() ![]() | 0..* | 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: Coverage Category (extensible) | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Insurer network | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient payments for services/products | |||||
![]() ![]() ![]() ![]() | 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 | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
![]() ![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||||||
![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Exceptions for patient payments | |||||
![]() ![]() ![]() ![]() ![]() | 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 | 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 | ||||
![]() ![]() ![]() | 0..1 | boolean | Reimbursement to insurer | |||||
![]() ![]() ![]() | 0..* | Reference(Contract) | Contract details | |||||
![]() |
Path | Conformance | ValueSet | ||||
Coverage.language | preferred | CommonLanguages
| ||||
Coverage.status | required | FinancialResourceStatusCodes | ||||
Coverage.type | extensible | CoverageType (a valid code from Coverage type) | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
Coverage.class.type | extensible | CoverageCategory (a valid code from Coverage category) | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
This structure is derived from Coverage
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (extensible) | |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: Coverage Category (extensible) | |
![]() |
Path | Conformance | ValueSet |
Coverage.type | extensible | CoverageType (a valid code from Coverage type) |
Coverage.class.type | extensible | CoverageCategory (a valid code from Coverage category) |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (extensible) |
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() ![]() | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
![]() |
Path | Conformance | ValueSet |
Coverage.status | required | FinancialResourceStatusCodes |
Coverage.type | extensible | CoverageType (a valid code from Coverage type) |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
![]() ![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!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 | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (extensible) | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() ![]() | Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Dependent number | ||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() ![]() | Σ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() ![]() | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
![]() ![]() ![]() | 0..* | 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: Coverage Category (extensible) | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() ![]() | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Insurer network | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient payments for services/products | |||||
![]() ![]() ![]() ![]() | 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 | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
![]() ![]() ![]() ![]() ![]() | Quantity(SimpleQuantity) | |||||||
![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Exceptions for patient payments | |||||
![]() ![]() ![]() ![]() ![]() | 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 | 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 | ||||
![]() ![]() ![]() | 0..1 | boolean | Reimbursement to insurer | |||||
![]() ![]() ![]() | 0..* | Reference(Contract) | Contract details | |||||
![]() |
Path | Conformance | ValueSet | ||||
Coverage.language | preferred | CommonLanguages
| ||||
Coverage.status | required | FinancialResourceStatusCodes | ||||
Coverage.type | extensible | CoverageType (a valid code from Coverage type) | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
Coverage.class.type | extensible | CoverageCategory (a valid code from Coverage category) | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
This structure is derived from Coverage
Other representations of profile: CSV, Excel, Schematron