## Profile Comparison between http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage vs http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage

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)

### Messages

Error | StructureDefinition.version | Values for version differ: '2.1.0' vs '2.2.0-ballot'
Information | StructureDefinition.date | Values for date differ: '2024-12-20T21:11:16+00:00' vs '2026-01-30T16:26:59+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'

### Metadata

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 | Values Differ
copyright |  |
date | 2024-12-20T21:11:16+00:00 | 2026-01-30T16:26:59+00:00 | Values Differ
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 | 2.2.0-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 | 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 | Σ | 0..1 | id | 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
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 | S Σ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type | S Σ | 0..* | Identifier | Member ID and other identifiers Slice: Unordered, Open by pattern:type |
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active |
type | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: ?? (extensible): US Public Health Data Consortium Source of Payment Codes |
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
subscriber | S Σ | 0..1 | Reference(PAS Subscriber Patient) | Subscriber to the policy | S Σ | 0..1 | Reference(PAS Subscriber Patient(2.2.0-ballot)) | Subscriber to the policy |
subscriberId | S Σ C | 0..1 | string | ID assigned to the subscriber | S Σ C | 0..1 | string | ID assigned to the subscriber |
beneficiary | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | Plan beneficiary | S Σ | 1..1 | Reference(PAS Beneficiary Patient(2.2.0-ballot)) | Plan beneficiary |
dependent | Σ | 0..1 | string | Dependent number | Σ | 0..1 | string | Dependent number |
relationship | S | 1..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: ?? (extensible) | S | 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 | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this | Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by value:$this |
text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept |
period | S Σ | 0..1 | Period | Coverage start and end dates | S Σ | 0..1 | Period | Coverage start and end dates |
payor | S Σ | 1..1 | Reference(PAS Insurer Organization) | Issuer of the policy | S Σ | 1..1 | Reference(PAS Insurer Organization(2.2.0-ballot)) | Issuer of the policy |
Slices for class | S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | S | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern: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): The policy classifications, eg. Group, Plan, Class, etc. | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: ?? (extensible): The policy classifications, eg. Group, Plan, Class, etc. |
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