## Profile Comparison between http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage vs http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage

Left: | RTPBC Coverage (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage)
Right: | RTPBC Coverage (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage)

### Messages

Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '2.0.0-ballot'
Information | StructureDefinition.date | Values for date differ: '2020-05-23T00:00:00-05:00' vs '2020-12-02T00:00:00-05:00'
Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Pharmacy' vs 'HL7 International / Pharmacy'
Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/StructureDefinition/Coverage' vs 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage'
Information | Coverage.language | Example/preferred bindings differ at Coverage.language using binding from RtpbcCoverage
Information | StructureDefinition.short | Values for short differ: 'Business Identifier for the coverage' vs 'Member ID and other identifiers'
Warning | Coverage.identifier | Elements differ in definition for mustSupport: 'false' vs 'true'
Information | StructureDefinition.comment | Values for comment differ: 'This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.' vs 'The `Coverage.status` alone does not indicate whether an individual's coverage is terminated or that the individual is not covered. The `Coverage.period` needs to be considered as well.'
Warning | Coverage.status | Elements differ in definition for mustSupport: 'false' vs 'true'
Warning | Coverage.type | Elements differ in definition for mustSupport: 'false' vs 'true'
Information | StructureDefinition.comment | Values for comment differ: 'Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.' vs 'Relationship of the member to the person insured (subscriber)'
Warning | Coverage.relationship | Elements differ in definition for mustSupport: 'false' vs 'true'
Information | Coverage.relationship | Element minimum cardinalities differ: '0' vs '1'
Warning | Coverage.period | Elements differ in definition for mustSupport: 'false' vs 'true'
Information | StructureDefinition.short | Values for short differ: 'Payer ID' vs 'Issuer of the policy'
Information | StructureDefinition.comment | Values for comment differ: 'May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.' vs 'Issuer of the Policy'

### Metadata

Name | Value | Comments
--- | --- | ---
abstract | false |
baseDefinition | http://hl7.org/fhir/StructureDefinition/Coverage | http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage | Values Differ
copyright |  |
date | 2020-05-23T00:00:00-05:00 | 2020-12-02T00:00:00-05:00 | Values Differ
description | This profile constrains the Coverage resource for carrying the pharmacy benefit information required in the consumer real-time pharmacy benefit check process |
experimental | false |
fhirVersion | 4.0.1 |
jurisdiction |  |
jurisdiction[0] | urn:iso:std:iso:3166#US |
kind | resource |
name | RtpbcCoverage |
publisher | HL7 International - Pharmacy | HL7 International / Pharmacy | Values Differ
purpose |  |
status | active |
title | RTPBC Coverage |
type | Coverage |
url | http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage |
version | 1.0.0 | 2.0.0-ballot | Values Differ

### Structure

Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement | C | 0..* | USCoreCoverageProfile | Insurance or medical plan or a payment agreement |
id | Σ | 0..1 | string | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 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.
Additional Bindings | Purpose
?? | Max Binding
|  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
| Example/preferred bindings differ at Coverage.language using binding from RtpbcCoverage
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 |
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | S Σ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by value:type | Elements differ in definition for mustSupport: 'false' vs 'true'
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | Elements differ in definition for mustSupport: 'false' vs 'true'
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes | Elements differ in definition for mustSupport: 'false' vs 'true'
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
subscriberId | S Σ | 0..1 | string | Health Plan Cardholder ID | S Σ C | 0..1 | string | Health Plan Cardholder ID |
beneficiary | S Σ | 1..1 | Reference(Patient) | Plan beneficiary | S Σ | 1..1 | Reference(US Core Patient Profile) | Plan beneficiary |
dependent | Σ | 0..1 | string | Dependent number | Σ | 0..1 | string | Dependent number |
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) | Elements differ in definition for mustSupport: 'false' vs 'true' Element minimum cardinalities differ: '0' vs '1'
period | Σ | 0..1 | Period | Coverage start and end dates | S Σ | 0..1 | Period | Coverage start and end dates | Elements differ in definition for mustSupport: 'false' vs 'true'
payor | S Σ | 1..1 | Reference(Organization | Patient | RelatedPerson) | Payer ID | S Σ | 1..1 | Reference(US Core Organization Profile S | US Core Patient Profile | US Core RelatedPerson Profile) | Issuer of the policy |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | S Σ | 0..1 | Identifier | Payer ID | S Σ | 0..1 | Identifier | Payer ID |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . |
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
value | S Σ | 1..1 | string | Payer ID Value Example General: 123456 | S Σ | 1..1 | string | Payer ID Value Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use | Σ | 0..1 | Period | Time period when id is/was valid for use |
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
Slices for class | S | 0..* | BackboneElement | Pharmacy coverage identifiers Slice: Unordered, Open by value:type | S | 0..* | BackboneElement | Pharmacy coverage identifiers 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 | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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: ?? (extensible): Coverage Class Codes | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): Coverage Class Codes |
value | Σ | 1..1 | string | Value associated with the type | Σ | 1..1 | string | Value associated with the type |
name | Σ | 0..1 | string | Human readable description of the type and value | Σ | 0..1 | string | Human readable description of the type and value |
order | Σ | 0..1 | positiveInt | Relative order of the coverage | Σ | 0..1 | positiveInt | Relative order of the coverage |
network | Σ | 0..1 | string | Insurer network | Σ | 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 | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
type | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. | Σ | 0..1 | CodeableConcept | Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified. |
value[x] | Σ | 1..1 | ??, Money | The amount or percentage due from the beneficiary | Σ | 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 | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays. | Σ | 1..1 | CodeableConcept | Exception category Binding: ?? (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 | Σ | 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