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

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage	http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0	Values Differ
copyright
date	2023-03-30T13:34:22+00:00	2025-09-09T20:58:22+00:00	Values Differ
description	PCT Coverage is a profile for capturing data that reflect a payer’s coverage that was effective as of the proposed date of service or the date of admission of the GFE.	PCT Coverage is a profile for capturing data that reflect a payer's coverage that was effective as of the proposed date of service or the date of admission of the GFE.	Values Differ
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	PCTCoverage
publisher	HL7 International - Financial Management Work Group	HL7 International / Financial Management	Values Differ
purpose
status	active
title	PCT Coverage
type	Coverage
url	http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage
version	1.0.0	2.0.0	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..*	HRexCoverage	Insurance or medical plan or a payment agreement	C	0..*	USCoreCoverageProfile(7.0.0)	Insurance or medical plan or a payment agreement Constraints: pct-coverage-1, pct-coverage-2
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		1..*	Extension	Extension Slice: Unordered, Open by value:url	Element minimum cardinalities differ: '0' vs '1'
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..1	Identifier	Also known as Member identifier	SΣ	0..*	Identifier	Member ID and other identifiers Slice: Unordered, Open by pattern:type	Element maximum cardinalities differ: '1' vs '2147483647'
id		0..1	string	Unique id for inter-element referencing					Removed this element
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url					Removed this element
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .					Removed this element
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.					Removed this element
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient					Removed this element
value	SΣ	1..1	string	The value that is unique within the system. Example General: 123456					Removed this element
period	Σ	0..1	Period	Time period when id is/was valid for use					Removed this element
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)					Removed this element
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.	?!SΣ	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.	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident. A coverage.type of `81` (Self-pay) MAY be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs. 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(US Core Patient Profile | HRex Organization Profile | RelatedPerson)	Owner of the policy	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(US Core Patient Profile)	Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown.	Σ	0..1	Reference(Patient | RelatedPerson)	Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown.
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	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL	ΣC	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	Σ	0..1	Identifier	Logical reference, when literal reference is not known	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	1..1	string	Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber’s prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference.	Σ	0..1	string	Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber's prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference.	Element minimum cardinalities differ: '1' vs '0'
subscriberId	SΣ	1..1	string	Subscriber ID	SΣC	1..1	string	ID assigned to the subscriber
id						0..1	string	xml:id (or equivalent in JSON)	Added this element
Slices for extension						0..*	Extension	Extension Slice: Unordered, Open by value:url	Added this element
value						0..1	string	Primitive value for string Max Length:1048576	Added this element
beneficiary	SΣ	1..1	Reference(HRex Patient Demographics)	Plan beneficiary	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	Patient or Plan Beneficiary
dependent	SΣ	0..1	string	Dependent number	Σ	0..1	string	Dependent number	Elements differ in definition for mustSupport: 'true' vs 'false'
relationship		1..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'
period	Σ	1..1	Period	Coverage start and end dates	SΣ	0..1	Period	Coverage start and end dates	Elements differ in definition for mustSupport: 'false' vs 'true' Element minimum cardinalities differ: '1' vs '0'
payor	SΣ	1..1	Reference(PCT Organization)	Issuer of the policy	SΣ	1..1	Reference(PCT Organization | US Core Patient Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0))	Issuer of the policy. For Self-pay or uninsured this should be a reference to a patient or related person resource	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|7.0.0]])
Slices for class		1..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by pattern:type	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by pattern:type	Elements differ in definition for mustSupport: 'false' vs 'true' Element minimum cardinalities differ: '1' vs '0'
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	1..1	string	Human readable description of the type and value	Σ	1..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: ?? (required)	Σ	0..1	CodeableConcept	Cost category Binding: ?? (required)
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