DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 United States of America flag

DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pdex-formulary/ and changes regularly. See the Directory of published versions

Resource Profile: InsurancePlanCoverage - Mappings

Page standards status: Trial-use

Mappings for the insurance-plan-coverage resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

InsurancePlanCoverage
CoverageEvent
   identifierEvent.identifier
   identifier (memberid)Event.identifier
   statusEvent.status
   beneficiaryEvent.subject
   periodEvent.occurrence[x]

Mappings for RIM Mapping (http://hl7.org/v3)

InsurancePlanCoverage
CoverageEntity. Role, or Act, Coverage
   textAct.text?
   containedN/A
   extension (insurancePlan)n/a, N/A
   modifierExtensionN/A
   identifier.id
   identifier (memberid).id
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   statusAct.status
   periodAct.effectiveTime
   class
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (group)
      idn/a
      extensionn/a
      modifierExtensionN/A
   class (plan)
      idn/a
      extension (valueIdentifier)n/a, N/A
      modifierExtensionN/A
   costToBeneficiary
      idn/a
      extensionn/a
      modifierExtensionN/A
      exception
         idn/a
         extensionn/a
         modifierExtensionN/A
   contractn/a

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

InsurancePlanCoverage
Coverage
   identifierFiveWs.identifier
   identifier (memberid)FiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   policyHolderFiveWs.subject[x], FiveWs.subject
   subscriberFiveWs.subject[x], FiveWs.subject
   subscriberIdFiveWs.subject[x], FiveWs.subject
   beneficiaryFiveWs.subject[x], FiveWs.subject
   periodFiveWs.done[x]
   payorFiveWs.author

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

InsurancePlanCoverage
Coverage
   identifierC02
   identifier (memberid)C02
   policyHolderD01 through D09
   subscriberD01 through D09
   subscriberIdD01 through D09
   beneficiaryD01 through D09
   dependentC17
   relationshipC03
   payorA05
   class
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (group)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   class (plan)
      valueC11 (Division,Section)
      nameC11 (Division,Section)
   networkD10
   costToBeneficiary
      value[x]C11 (Division,Section)
   contractD01 through D09

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

InsurancePlanCoverage
Coverage
   identifierIN1-2
   identifier (memberid)IN1-2
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   typeIN1-15
   policyHolderIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIN1-16, 18, 19-name of insured, address, date of birth
   subscriberIdIN1-16, 18, 19-name of insured, address, date of birth
   beneficiaryIN1-16, 18, 19-name of insured, address, date of birth
   dependent- No exact HL7 v2 equivalent concept seems to exist;
   periodIN1-12 / IN1-13
   payorIN1-3
   class
      valueIN1-8
      nameIN1-8
   class (group)
      valueIN1-8
      nameIN1-8
   class (plan)
      valueIN1-8
      nameIN1-8
   order- No exact HL7 v2 equivalent concept seems to exist;
   costToBeneficiary
      value[x]IN1-8
   contractIN1-16, 18, 19

Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

InsurancePlanCoverage
Coverage
   identifierC.32, C.33, C.39
   identifier (memberid)C.32, C.33, C.39
   policyHolderC.35
   subscriberC.35
   subscriberIdC.35
   beneficiaryC.35
   payorC.30
   class
      valueC.31
      nameC.31
   class (group)
      valueC.31
      nameC.31
   class (plan)
      valueC.31
      nameC.31
   costToBeneficiary
      value[x]C.31
   contractC.35