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

Left:US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage)
Right:RTPBC Coverage (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage)

Messages

ErrorStructureDefinition.urlValues for url differ: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage' vs 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage'
ErrorStructureDefinition.versionValues for version differ: '8.0.0' vs '2.0.0'
InformationStructureDefinition.nameValues for name differ: 'USCoreCoverageProfile' vs 'RtpbcCoverage'
InformationStructureDefinition.titleValues for title differ: 'US Core Coverage Profile' vs 'RTPBC Coverage'
InformationStructureDefinition.dateValues for date differ: '2023-10-17' vs '2020-05-23T00:00:00-05:00'
InformationStructureDefinition.publisherValues for publisher differ: 'HL7 International / Cross-Group Projects' vs 'HL7 International / Pharmacy'
InformationStructureDefinition.shortValues for short differ: 'Member ID and other identifiers' vs 'Business Identifier for the coverage'
WarningCoverage.identifierElements differ in definition for mustSupport: 'true' vs 'false'
InformationStructureDefinition.commentValues for comment differ: '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.' vs 'This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.'
WarningCoverage.statusElements differ in definition for mustSupport: 'true' vs 'false'
WarningCoverage.typeElements differ in definition for mustSupport: 'true' vs 'false'
InformationStructureDefinition.shortValues for short differ: 'ID assigned to the subscriber' vs 'Health Plan Cardholder ID'
InformationStructureDefinition.commentValues for comment differ: 'The identifier assigned by the Payer on the subscriber's ID card' vs 'Either *PBM Member ID* (.class.type = 'rxid') or *Subscriber ID* must be populated'
InformationStructureDefinition.commentValues for comment differ: 'Relationship of the member to the person insured (subscriber)' vs 'Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.'
WarningCoverage.relationshipElements differ in definition for mustSupport: 'true' vs 'false'
InformationCoverage.relationshipElement minimum cardinalities differ: '1' vs '0'
WarningCoverage.periodElements differ in definition for mustSupport: 'true' vs 'false'
InformationStructureDefinition.shortValues for short differ: 'Issuer of the policy' vs 'Payer ID'
InformationStructureDefinition.commentValues for comment differ: 'Issuer of the Policy' vs '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.'
InformationStructureDefinition.shortValues for short differ: 'Additional coverage classifications' vs 'Pharmacy coverage identifiers'
InformationStructureDefinition.definitionValues for definition differ: 'A suite of underwriter specific classifiers.' vs 'Identifiers used by the payer/PBM to located the patient's coverage. IIN (BIN) number, Processor Control Number (PCN), pharmacy benefit Group ID and patient's PBM Member ID.'
InformationStructureDefinition.commentValues for comment differ: 'For example may be used to identify a class of coverage or employer group, Policy, Plan.' vs 'Populate with identifiers retrieved from an eligibility service or other source agreed between trading partners'

Metadata

NameValueComments
.abstractfalse
    .baseDefinitionhttp://hl7.org/fhir/StructureDefinition/Coverage
      .copyrightUsed by permission of HL7 International, all rights reserved Creative Commons License
      • Removed the item 'Used by permission of HL7 International, all rights reserved Creative Commons License'
      .date2023-10-172020-05-23T00:00:00-05:00
      • Values Differ
      .descriptionThe 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.This profile constrains the Coverage resource for carrying the pharmacy benefit information required in the consumer real-time pharmacy benefit check process
      • Values Differ
      .experimentalfalse
        .fhirVersion4.0.1
          .jurisdiction
            ..jurisdiction[0]urn:iso:std:iso:3166#US
              .kindresource
                .nameUSCoreCoverageProfileRtpbcCoverage
                • Values Differ
                .publisherHL7 International / Cross-Group ProjectsHL7 International / Pharmacy
                • Values Differ
                .purpose
                  .statusactive
                    .titleUS Core Coverage ProfileRTPBC Coverage
                    • Values Differ
                    .typeCoverage
                      .urlhttp://hl7.org/fhir/us/core/StructureDefinition/us-core-coveragehttp://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage
                      • Values Differ
                      .version8.0.02.0.0
                      • Values Differ

                      Structure

                      NameL FlagsL Card.L TypeL Description & ConstraintsR FlagsR Card.R TypeR Description & ConstraintsCommentsdoco
                      .. Coverage C0..*CoverageInsurance or medical plan or a payment agreement
                      Constraints: us-core-15
                      0..*CoverageInsurance or medical plan or a payment agreement
                        ... id Σ0..1idLogical id of this artifactΣ0..1idLogical id of this artifact
                          ... meta Σ0..1MetaMetadata about the resourceΣ0..1MetaMetadata about the resource
                            ... implicitRules ?!Σ0..1uriA set of rules under which this content was created?!Σ0..1uriA set of rules under which this content was created
                              ... text 0..1NarrativeText 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..1NarrativeText 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..*ResourceContained, inline Resources
                                0..*ResourceContained, inline Resources
                                  ... extension 0..*ExtensionAdditional content defined by implementations
                                  0..*ExtensionAdditional content defined by implementations
                                    ... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
                                    ?!0..*ExtensionExtensions that cannot be ignored
                                      ... Slices for identifier SΣ0..*IdentifierMember ID and other identifiers
                                      Slice: Unordered, Open by value:type
                                      Σ0..*IdentifierBusiness Identifier for the coverage
                                      • Elements differ in definition for mustSupport: 'true' vs 'false'
                                      ... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
                                      Binding: ?? (required): A code specifying the state of the resource instance.
                                      ?!Σ1..1codeactive | cancelled | draft | entered-in-error
                                      Binding: ?? (required): A code specifying the state of the resource instance.
                                      • Elements differ in definition for mustSupport: 'true' vs 'false'
                                      ... type SΣ0..1CodeableConceptCoverage category such as medical or accident
                                      Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes
                                      Σ0..1CodeableConceptCoverage 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.
                                      • Elements differ in definition for mustSupport: 'true' vs 'false'
                                      ... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policyΣ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
                                        ... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policyΣ0..1Reference(Patient | RelatedPerson)Subscriber to the policy
                                          ... subscriberId SΣC0..1stringID assigned to the subscriberSΣ0..1stringHealth Plan Cardholder ID
                                            ... beneficiary SΣ1..1Reference(US Core Patient Profile)Plan beneficiarySΣ1..1Reference(Patient)Plan beneficiary
                                              ... dependent Σ0..1stringDependent numberΣ0..1stringDependent number
                                                ... relationship S1..1CodeableConceptBeneficiary relationship to the subscriber
                                                Binding: ?? (extensible)
                                                0..1CodeableConceptBeneficiary relationship to the subscriber
                                                Binding: ?? (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
                                                • Elements differ in definition for mustSupport: 'true' vs 'false'
                                                • Element minimum cardinalities differ: '1' vs '0'
                                                ... period SΣ0..1PeriodCoverage start and end datesΣ0..1PeriodCoverage start and end dates
                                                • Elements differ in definition for mustSupport: 'true' vs 'false'
                                                ... payor SΣ1..1Reference(US Core Organization Profile S | US Core Patient Profile | US Core RelatedPerson Profile)Issuer of the policy
                                                SΣ1..1Reference(Organization | Patient | RelatedPerson)Payer ID
                                                  .... id 0..1stringUnique id for inter-element referencing
                                                  • Added this element
                                                  .... Slices for extension 0..*ExtensionAdditional content defined by implementations
                                                  Slice: Unordered, Open by value:url
                                                  • Added this element
                                                  .... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
                                                  • Added this element
                                                  .... type Σ0..1uriType the reference refers to (e.g. "Patient")
                                                  Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
                                                  • Added this element
                                                  .... identifier SΣ0..1IdentifierPayer ID
                                                  • Added this element
                                                  .... display Σ0..1stringText alternative for the resource
                                                  • Added this element
                                                  ... Slices for class S0..*BackboneElementAdditional coverage classifications
                                                  Slice: Unordered, Open by value:type
                                                  S0..*BackboneElementPharmacy coverage identifiers
                                                  Slice: Unordered, Open by value:type
                                                    .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                      .... extension 0..*ExtensionAdditional content defined by implementations
                                                      0..*ExtensionAdditional content defined by implementations
                                                        .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                        ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                          .... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
                                                          Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc.
                                                          Σ1..1CodeableConceptType of class such as 'group' or 'plan'
                                                          Binding: ?? (extensible): Coverage Class Codes
                                                            .... value Σ1..1stringValue associated with the typeΣ1..1stringValue associated with the type
                                                              .... name Σ0..1stringHuman readable description of the type and valueΣ0..1stringHuman readable description of the type and value
                                                                ... order Σ0..1positiveIntRelative order of the coverageΣ0..1positiveIntRelative order of the coverage
                                                                  ... network Σ0..1stringInsurer networkΣ0..1stringInsurer network
                                                                    ... costToBeneficiary 0..*BackboneElementPatient payments for services/products
                                                                    0..*BackboneElementPatient payments for services/products
                                                                      .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                        .... extension 0..*ExtensionAdditional content defined by implementations
                                                                        0..*ExtensionAdditional content defined by implementations
                                                                          .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                          ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                            .... type Σ0..1CodeableConceptCost category
                                                                            Binding: ?? (extensible): The types of services to which patient copayments are specified.
                                                                            Σ0..1CodeableConceptCost category
                                                                            Binding: ?? (extensible): The types of services to which patient copayments are specified.
                                                                              .... value[x] Σ1..1??, MoneyThe amount or percentage due from the beneficiaryΣ1..1??, MoneyThe amount or percentage due from the beneficiary
                                                                                .... exception 0..*BackboneElementExceptions for patient payments
                                                                                0..*BackboneElementExceptions for patient payments
                                                                                  ..... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                    ..... extension 0..*ExtensionAdditional content defined by implementations
                                                                                    0..*ExtensionAdditional content defined by implementations
                                                                                      ..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                      ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                        ..... type Σ1..1CodeableConceptException category
                                                                                        Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays.
                                                                                        Σ1..1CodeableConceptException category
                                                                                        Binding: ?? (example): The types of exceptions from the part or full value of financial obligations such as copays.
                                                                                          ..... period Σ0..1PeriodThe effective period of the exceptionΣ0..1PeriodThe effective period of the exception
                                                                                            ... subrogation 0..1booleanReimbursement to insurer0..1booleanReimbursement to insurer
                                                                                              ... contract 0..*Reference(Contract)Contract details
                                                                                              0..*Reference(Contract)Contract details

                                                                                                doco Documentation for this format