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

Left:US Core Coverage Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage)
Right:HRex Coverage Profile (http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage)

Messages

ErrorStructureDefinition.urlValues for url differ: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage' vs 'http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage'
ErrorStructureDefinition.versionValues for version differ: '7.0.0' vs '1.1.0-cibuild'
InformationStructureDefinition.nameValues for name differ: 'USCoreCoverageProfile' vs 'HRexCoverage'
InformationStructureDefinition.titleValues for title differ: 'US Core Coverage Profile' vs 'HRex Coverage Profile'
InformationStructureDefinition.dateValues for date differ: '2023-10-17' vs '2024-09-09T22:06:59+00:00'
InformationStructureDefinition.publisherValues for publisher differ: 'HL7 International / Cross-Group Projects' vs 'HL7 International / Clinical Interoperability Council'
InformationStructureDefinition.definitionValues for definition differ: 'Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.' vs 'This is the Coverage profile which is used to provide insurance information for scheduling an appointment and/or registering a patient.'
InformationStructureDefinition.commentValues for comment differ: 'For example: may be an individual, corporation or the subscriber's employer.' vs 'When the Coverage pertains to organizations such as Children and Family Services, `policyHolder` should reference Organization (or another suitable entity) representing them. It acts as the holder of the policy and is responsible for the management and oversight of the coverage.'
WarningCoverage.policyHolderElements differ in definition for mustSupport: 'false' vs 'true'
InformationStructureDefinition.shortValues for short differ: 'ID assigned to the subscriber' vs 'Subscriber ID'
InformationStructureDefinition.commentValues for comment differ: 'Identifier for a member assigned by the Payer.' vs 'When the Coverage pertains to Children and Family Services, `beneficiary` should reference individual members under the policy (such as children or family members) that are entitled to claim benefits.'
InformationStructureDefinition.requirementsValues for requirements differ: 'This is the party who receives treatment for which the costs are reimbursed under the coverage.' vs 'This would usually be the US Core Patient Resource for which the service was performed, however US Core requires an identifier, and that won't necessarily be available/relevant when coverage is being between payers'
WarningCoverage.dependentElements differ in definition for mustSupport: 'false' vs 'true'
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.'
InformationStructureDefinition.commentValues for comment differ: 'Date that the contract became effective and Date that the contract was terminated or coverage changed.' vs 'Date that the contract became effective and date that the contract was terminated or coverage changed.'
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. When sending payer, it may either be a reference to a record stored on a mutually accessible registry, or the Reference.display and Reference.identifier elements can be used to convey the payer's name and identifer.'
WarningCoverage.classElements differ in definition for mustSupport: 'true' vs 'false'

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'
      .date2023-10-172024-09-09T22:06:59+00:00
      • 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.The HRex Coverage Profile defines the constraints for representing a member's healthcare insurance information to the Payer. Coverage instances complying with this profile, sometimes together with the Patient which this profile references via `beneficiary`, allows a payer to identify a member in their system. It aligns with the equivalent US Core profile, but diverges in that it does not require Patient.identifier for the beneficiary
      • Values Differ
      .experimentalfalse
        .fhirVersion4.0.1
          .jurisdiction
            ..jurisdiction[0]urn:iso:std:iso:3166#US
              .kindresource
                .nameUSCoreCoverageProfileHRexCoverage
                • Values Differ
                .publisherHL7 International / Cross-Group ProjectsHL7 International / Clinical Interoperability Council
                • Values Differ
                .purpose
                  .statusactive
                    .titleUS Core Coverage ProfileHRex Coverage Profile
                    • Values Differ
                    .typeCoverage
                      .urlhttp://hl7.org/fhir/us/core/StructureDefinition/us-core-coveragehttp://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage
                      • Values Differ
                      .version7.0.01.1.0-cibuild
                      • 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
                      us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present
                      C0..*CoverageInsurance or medical plan or a payment agreement
                      us-core-15: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present
                        ... 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 interpretation0..1NarrativeText summary of the resource, for human interpretation
                                ... 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 pattern:type
                                      SΣ0..*IdentifierMember ID and other identifiers
                                      Slice: Unordered, Open by value:type
                                        ... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
                                        Binding: ?? (required): A code specifying the state of the resource instance.

                                        ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
                                        Binding: ?? (required): A code specifying the state of the resource instance.

                                          ... type SΣ0..1CodeableConceptCoverage category such as medical or accident
                                          Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes

                                          SΣ0..1CodeableConceptCoverage category such as medical or accident
                                          Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes

                                            ... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policySΣ0..1Reference(US Core Patient Profile(6.1.0) | HRex Organization Profile | US Core RelatedPerson Profile(6.1.0))Owner of the policy
                                            • Elements differ in definition for mustSupport: 'false' vs 'true'
                                            ... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policyΣ0..1Reference(Patient | RelatedPerson)Subscriber to the policy
                                              ... subscriberId SΣC0..1stringID assigned to the subscriberSΣC0..1stringSubscriber ID
                                                ... beneficiary SΣ1..1Reference(US Core Patient Profile(7.0.0))Plan beneficiarySΣ1..1Reference(HRex Patient Demographics)Plan beneficiary
                                                  ... dependent Σ0..1stringDependent numberSΣ0..1stringDependent number
                                                  • Elements differ in definition for mustSupport: 'false' vs 'true'
                                                  ... relationship S1..1CodeableConceptBeneficiary relationship to the subscriber
                                                  Binding: ?? (extensible)
                                                  S1..1CodeableConceptBeneficiary relationship to the subscriber
                                                  Binding: ?? (required)
                                                    ... period SΣ0..1PeriodCoverage start and end datesSΣ0..1PeriodCoverage start and end dates
                                                      ... payor SΣ1..1Reference(US Core Organization Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0))Issuer of the policy
                                                      SΣ1..1Reference(HRex Organization Profile)Issuer of the policy
                                                        ... Slices for class S0..*BackboneElementAdditional coverage classifications
                                                        Slice: Unordered, Open by pattern:type
                                                        0..*BackboneElementAdditional coverage classifications
                                                        Slice: Unordered, Open by pattern:type
                                                        • Elements differ in definition for mustSupport: 'true' vs 'false'
                                                        .... 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): The policy classifications, eg. Group, Plan, Class, etc.

                                                                .... 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