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

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

Messages

ErrorStructureDefinition.urlValues for url differ: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage' vs 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage'
ErrorStructureDefinition.versionValues for version differ: '7.0.0' vs '2.0.0-ballot'
InformationStructureDefinition.nameValues for name differ: 'USCoreCoverageProfile' vs 'PCTCoverage'
InformationStructureDefinition.titleValues for title differ: 'US Core Coverage Profile' vs 'PCT Coverage'
InformationStructureDefinition.dateValues for date differ: '2023-10-17' vs '2024-07-02T05:31:41+00:00'
InformationStructureDefinition.publisherValues for publisher differ: 'HL7 International / Cross-Group Projects' vs 'HL7 International / Financial Management'
ErrorStructureDefinition.baseDefinitionValues for baseDefinition differ: 'http://hl7.org/fhir/StructureDefinition/Coverage' vs 'http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage'
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.shortValues for short differ: 'Additional content defined by implementations' vs 'Extension'
InformationStructureDefinition.definitionValues for definition differ: 'May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.' vs 'An Extension'
InformationCoverage.extensionElement minimum cardinalities differ: '0' vs '1'
InformationStructureDefinition.shortValues for short differ: 'Member ID and other identifiers' vs 'Also known as Member identifier'
InformationStructureDefinition.commentValues for comment differ: 'The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.' vs 'This must be filled in when known'
InformationCoverage.identifierElement maximum cardinalities differ: '2147483647' vs '1'
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: 'Subscriber to the policy' vs '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.'
InformationStructureDefinition.shortValues for short differ: 'ID assigned to the subscriber' vs 'Subscriber ID'
InformationStructureDefinition.requirementsValues for requirements differ: 'The insurer requires this identifier on correspondance and claims (digital and otherwise).' vs 'The subscriber Id is a number that is needed by the payer to associate the attestation with the member in their system.'
InformationCoverage.subscriberIdElement minimum cardinalities differ: '0' vs '1'
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.'
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.'
WarningCoverage.relationshipElements differ in definition for mustSupport: 'true' vs 'false'
WarningCoverage.periodElements differ in definition for mustSupport: 'true' vs 'false'
InformationCoverage.periodElement minimum cardinalities differ: '0' vs '1'
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'
InformationCoverage.classElement minimum cardinalities differ: '0' vs '1'
InformationCoverage.class.nameElement minimum cardinalities differ: '0' vs '1'

Metadata

NameValueComments
.abstractfalse
    .baseDefinitionhttp://hl7.org/fhir/StructureDefinition/Coveragehttp://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage
    • Values Differ
    .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'
    .date2023-10-172024-07-02T05:31:41+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.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
    .experimentalfalse
    • Removed the item 'false'
    .fhirVersion4.0.1
      .jurisdiction
        ..jurisdiction[0]urn:iso:std:iso:3166#US
          .kindresource
            .nameUSCoreCoverageProfilePCTCoverage
            • Values Differ
            .publisherHL7 International / Cross-Group ProjectsHL7 International / Financial Management
            • Values Differ
            .purpose
              .statusactive
                .titleUS Core Coverage ProfilePCT Coverage
                • Values Differ
                .typeCoverage
                  .urlhttp://hl7.org/fhir/us/core/StructureDefinition/us-core-coveragehttp://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage
                  • Values Differ
                  .version7.0.02.0.0-ballot
                  • 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..*HRexCoverageInsurance or medical plan or a payment agreement
                  hrex-cov-1: 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
                              1..*ExtensionExtension
                              Slice: Unordered, Open by value:url
                              • Element minimum cardinalities differ: '0' vs '1'
                              ... 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..1IdentifierAlso known as Member identifier
                                • Element maximum cardinalities differ: '2147483647' vs '1'
                                .... 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
                                .... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
                                Binding: ?? (required): Identifies the purpose for this identifier, if known .

                                • Added this element
                                .... type Σ0..1CodeableConceptDescription of identifier
                                Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                • Added this element
                                .... system Σ0..1uriThe namespace for the identifier value
                                Example General: http://www.acme.com/identifiers/patient
                                • Added this element
                                .... value SΣ1..1stringThe value that is unique within the system.
                                Example General: 123456
                                • Added this element
                                .... period Σ0..1PeriodTime period when id is/was valid for use
                                • Added this element
                                .... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
                                • Added this element
                                ... 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(US Core Patient Profile | HRex Organization Profile | RelatedPerson)Owner of the policy
                                  ... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policyΣ0..1Reference(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.
                                    .... 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 Σ0..1IdentifierLogical reference, when literal reference is not known
                                    • Added this element
                                    .... display Σ1..1stringProvide 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.
                                    • Added this element
                                    ... subscriberId SΣC0..1stringID assigned to the subscriberSΣ1..1stringSubscriber ID
                                    • Element minimum cardinalities differ: '0' vs '1'
                                    ... beneficiary SΣ1..1Reference(US Core Patient Profile)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)
                                      1..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'
                                      ... period SΣ0..1PeriodCoverage start and end datesΣ1..1PeriodCoverage start and end dates
                                      • Elements differ in definition for mustSupport: 'true' vs 'false'
                                      • Element minimum cardinalities differ: '0' vs '1'
                                      ... payor SΣ1..1Reference(US Core Organization Profile S | US Core Patient Profile | US Core RelatedPerson Profile)Issuer of the policy
                                      SΣ1..1Reference(PCT Organization)Issuer of the policy
                                        ... Slices for class S0..*BackboneElementAdditional coverage classifications
                                        Slice: Unordered, Open by pattern:type
                                        1..*BackboneElementAdditional coverage classifications
                                        Slice: Unordered, Open by pattern:type
                                        • Elements differ in definition for mustSupport: 'true' vs 'false'
                                        • Element minimum cardinalities differ: '0' vs '1'
                                        .... 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 valueΣ1..1stringHuman readable description of the type and value
                                                  • Element minimum cardinalities differ: '0' vs '1'
                                                  ... 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: ?? (required)
                                                                .... 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