| Left: | US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage) |
| Right: | US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage) |
| Error | StructureDefinition.version | Values for version differ: '6.1.0' vs '10.0.0-ballot' |
| Information | StructureDefinition.date | Values for date differ: '2022-09-24' vs '2023-10-17' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Cross-Group Projects' vs 'HL7 International / Cross-Group Projects' |
| Information | Coverage.language | Example/preferred bindings differ at Coverage.language using binding from USCoreCoverageProfile |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Member ID and other identifiers' vs 'Member ID and other identifiers' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) active | cancelled | draft | entered-in-error' vs 'active | cancelled | draft | entered-in-error' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Coverage category such as medical or accident' vs 'Coverage category such as medical or accident' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) ID assigned to the subscriber' vs 'ID assigned to the subscriber' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Plan beneficiary' vs 'Plan beneficiary' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Beneficiary relationship to the subscriber' vs 'Beneficiary relationship to the subscriber' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Coverage start and end dates' vs 'Coverage start and end dates' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Issuer of the policy' vs 'Issuer of the policy' |
| Information | StructureDefinition.short | Values for short differ: '(USCDI) Additional coverage classifications' vs 'Additional coverage classifications' |
| Name | Value | Comments | |
|---|---|---|---|
 abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/Coverage | ||
| copyright | Used by permission of HL7 International, all rights reserved Creative Commons License |
| |
| date | 2022-09-24 | 2023-10-17 |
|
| description | The US Core Coverage Profile is based upon the core FHIR Coverage Resource and implements the US Core Data for Interoperability (USCDI) v3 Health Insurance Information requirements. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Coverage resource to record, search, and fetch the "data related to an individual's insurance coverage for health care". It identifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases. | The US Core Coverage Profile inherits from the FHIR [Coverage](https://hl7.org/fhir/R4/coverage.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the US Core Data for Interoperability (USCDI) *Health Insurance Information* Data Class. It sets minimum expectations for the Coverage resource to record, search, and fetch data related to an individual's insurance coverage for health care. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. |
|
| experimental | false | ||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
 jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | USCoreCoverageProfile | ||
| publisher | HL7 International - Cross-Group Projects | HL7 International / Cross-Group Projects |
|
| purpose | |||
| status | active | ||
| title | US Core Coverage Profile | ||
| type | Coverage | ||
| url | http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage | ||
| version | 6.1.0 | 10.0.0-ballot |
|
| 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 | (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern: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 | (USCDI) 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 | (USCDI) 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): Centers for Disease Control and Prevention National Center for Health Statistics Source of Payment Codes | |||||||||||
| policyHolder | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | 0..1 | Reference(Patient | RelatedPerson | Organization) | 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 | (USCDI) ID assigned to the subscriber | C | 0..1 | string | ID assigned to the subscriber | |||||||||
| beneficiary | 1..1 | Reference(US Core Patient Profile) | (USCDI) Plan beneficiary | 1..1 | Reference(US Core Patient Profile) | Plan beneficiary | |||||||||||
| dependent | 0..1 | string | Dependent number | 0..1 | string | Dependent number | |||||||||||
| relationship | 1..1 | CodeableConcept | (USCDI) Beneficiary relationship to the subscriber Binding: ?? (extensible) | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) | |||||||||||
| period | 0..1 | Period | (USCDI) Coverage start and end dates | 0..1 | Period | Coverage start and end dates | |||||||||||
| payor | 1..1 | Reference(US Core Organization Profile | US Core Patient Profile | US Core RelatedPerson Profile) | (USCDI) Issuer of the policy | 1..1 | Reference(US Core Organization Profile | US Core Patient Profile | US Core RelatedPerson Profile) | Issuer of the policy | |||||||||||
| Slices for class | 0..* | BackboneElement | (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | 0..* | BackboneElement | Additional coverage classifications 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 | |||||||||||
 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 | |||||||||||||||||