Introduction

This profile is used to represent de-identified Coverage information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes Coverage.period.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Coverage resource text element may contain information such as the Coverage date, beneficiary information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original Coverage resource id should not be included in the De-identified Coverage instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original Coverage. All resource references to the Coverage submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

• beneficiary
• Payor

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

• period

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	UDS Plus Coverage
id	S	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
text		0..0
contained		0..0
Slices for extension				Content/Rules for all slices
capitatedMemberMonths	S	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
feeForServiceMemberMonths	S	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
status	S	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active
type	S	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
policyHolder
display		0..0
beneficiary	S	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
display		0..0
period	SC	0..1	Period	Coverage start and end dates uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
payor	S	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
display		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type	extensible	UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	UDS Plus Coverage
id	SΣ	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
capitatedMemberMonths	S	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
feeForServiceMemberMonths	S	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
beneficiary	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
period	SΣC	0..1	Period	Coverage start and end dates uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
payor	SΣ	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	extensible	UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	UDS Plus Coverage
id	SΣ	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
capitatedMemberMonths	S	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
feeForServiceMemberMonths	S	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣC	0..1	Period	Coverage start and end dates uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
payor	SΣ	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
class		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	extensible	UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes from this IG
Coverage.policyHolder.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.beneficiary.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	UDS Plus Coverage
id	S	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
text		0..0
contained		0..0
Slices for extension				Content/Rules for all slices
capitatedMemberMonths	S	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
feeForServiceMemberMonths	S	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
status	S	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active
type	S	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
policyHolder
display		0..0
beneficiary	S	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
display		0..0
period	SC	0..1	Period	Coverage start and end dates uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
payor	S	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
display		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type	extensible	UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	UDS Plus Coverage
id	SΣ	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
capitatedMemberMonths	S	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
feeForServiceMemberMonths	S	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
beneficiary	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
period	SΣC	0..1	Period	Coverage start and end dates uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
payor	SΣ	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	extensible	UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	UDS Plus Coverage
id	SΣ	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
capitatedMemberMonths	S	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
feeForServiceMemberMonths	S	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	SΣC	0..1	Period	Coverage start and end dates uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
payor	SΣ	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
class		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.status	required	Fixed Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	extensible	UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes from this IG
Coverage.policyHolder.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.beneficiary.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

This structure is derived from Coverage

Summary

Mandatory: 1 element
Must-Support: 8 elements
Fixed: 1 element
Prohibited: 5 elements

Structures

This structure refers to these other structures:

• De-Identified UDS Plus Patient (http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-patient)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• De-Identified UDS Plus RelatedPerson (http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-relatedperson)

Extensions

This structure refers to these extensions:

• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension

Maturity: 2