abstractbaseDefinition- Values Differ
copyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisherpurposestatustitletypeurlversion- Values Differ
| Left: | PAS Coverage (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage) |
| Right: | PAS Coverage (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage) |
| Error | StructureDefinition.version | Values for version differ: '2.1.0' vs '2.2.1' |
| Information | StructureDefinition.date | Values for date differ: '2024-12-20T21:11:16+00:00' vs '2026-10-09T18:42:41+00:00' |
| Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage' vs 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0' |
| Information | Coverage.identifier | Element minimum cardinalities differ: '0' vs '1' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage | http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0 |
|
| copyright | |||
| date | 2024-12-20T21:11:16+00:00 | 2026-10-09T18:42:41+00:00 |
|
| description | PAS constraints on Coverage resource mandating support for insurance elements relevant to the prior authorization request | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | PASCoverage | ||
| publisher | HL7 International / Financial Management | ||
| purpose | |||
| status | active | ||
| title | PAS Coverage | ||
| type | Coverage | ||
| url | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage | ||
| version | 2.1.0 | 2.2.1 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Coverage | C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement This profile also complies with the profile US Core Coverage Profile (6.1.0) Constraints: self-beneficiary | C | 0..* | USCoreCoverageProfile(7.0.0) | Insurance or medical plan or a payment agreement This profile also complies with the profile US Core Coverage Profile (6.1.0) | |||||||||
 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 | 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 | 1..* | Identifier | 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 |
| ||||||||||
| status | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | |||||||||||
| type | 0..1 | CodeableConcept | 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): US Public Health Data Consortium 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(PAS Subscriber Patient) | Subscriber to the policy | 0..1 | Reference(PAS Subscriber Patient(2.2.1)) | Subscriber to the policy | |||||||||||
| subscriberId | C | 0..1 | string | ID assigned to the subscriber | C | 0..1 | string | ID assigned to the subscriber | |||||||||
| beneficiary | 1..1 | Reference(PAS Beneficiary Patient) | Plan beneficiary | 1..1 | Reference(PAS Beneficiary Patient(2.2.1)) | Plan beneficiary | |||||||||||
| dependent | 0..1 | string | Dependent number | 0..1 | string | Dependent number | |||||||||||
 relationship | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) | |||||||||||
 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 | |||||||||||
| Slices for coding | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||||||||
| text | 0..1 | string | Plain text representation of the concept | 0..1 | string | Plain text representation of the concept | |||||||||||
| period | 0..1 | Period | Coverage start and end dates | 0..1 | Period | Coverage start and end dates | |||||||||||
| payor | 1..1 | Reference(PAS Insurer Organization) | Issuer of the policy | 1..1 | Reference(PAS Insurer Organization(2.2.1)) | Issuer of the policy | |||||||||||
| Slices for class | 0..* | BackboneElement | 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 pattern: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 | |||||||||||||||||