Birth And Fetal Death (BFDR) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-bfdr/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org/fhir/us/bfdr/StructureDefinition/Coverage-principal-payer-delivery | Version: 2.0.0 | |||
Active as of 2024-10-11 | Computable Name: CoveragePrincipalPayerDelivery | |||
Other Identifiers: OID:2.16.840.1.113883.4.642.40.13.42.26 |
This Coverage profile represents the principal payer for this delivery.
Use Case | # | Description | IJE Name | Field | Type | Value Set/Comments |
---|---|---|---|---|---|---|
Natality | 153 | Principal source of Payment for this delivery | PAY | type | codeable | BirthAndFetalDeathFinancialClassVS |
Item # | Form Field | FHIR Profile Field | Reference |
---|---|---|---|
38 | Principal Source of Payment for This Delivery | type | Certificate of Live Birth |
21 | Principal source of payment for this delivery | type | Facility Worksheet for the Live Birth Certificate |
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | Coverage | |||
type | 1..1 | CodeableConcept | The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: Birth and Fetal Death Financial Class (required): Birth and Fetal Death Financial Class (NCHS) | |
payor | ||||
Slices for extension | Content/Rules for all slices | |||
dataAbsentReason | 0..1 | code | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Coverage.type | required | BirthAndFetalDeathFinancialClassVShttp://hl7.org/fhir/us/bfdr/ValueSet/ValueSet-birth-and-fetal-death-financial-class from this IG |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
type | Σ | 1..1 | CodeableConcept | The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: Birth and Fetal Death Financial Class (required): Birth and Fetal Death Financial Class (NCHS) |
beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
payor | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
Slices for extension | Content/Rules for all slices | |||
dataAbsentReason | 0..1 | code | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Coverage.type | required | BirthAndFetalDeathFinancialClassVShttp://hl7.org/fhir/us/bfdr/ValueSet/ValueSet-birth-and-fetal-death-financial-class from this IG |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
type | Σ | 1..1 | CodeableConcept | The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: Birth and Fetal Death Financial Class (required): Birth and Fetal Death Financial Class (NCHS) | ||||
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
dependent | Σ | 0..1 | string | Dependent number | ||||
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
period | Σ | 0..1 | Period | Coverage start and end dates | ||||
payor | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
id | 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 | |||||
dataAbsentReason | 0..1 | code | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) | |||||
reference | 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: ResourceType (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 | ||||
display | Σ | 0..1 | string | Text alternative for the resource | ||||
class | 0..* | BackboneElement | Additional coverage classifications | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
network | Σ | 0..1 | string | Insurer network | ||||
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (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 | ||||
subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
contract | 0..* | Reference(Contract) | Contract details | |||||
Documentation for this format |
Path | Conformance | ValueSet | URI | |||
Coverage.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Coverage.type | required | BirthAndFetalDeathFinancialClassVShttp://hl7.org/fhir/us/bfdr/ValueSet/ValueSet-birth-and-fetal-death-financial-class from this IG | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard | ||||
Coverage.payor.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodeshttp://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard |
This structure is derived from Coverage
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | Coverage | |||
type | 1..1 | CodeableConcept | The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: Birth and Fetal Death Financial Class (required): Birth and Fetal Death Financial Class (NCHS) | |
payor | ||||
Slices for extension | Content/Rules for all slices | |||
dataAbsentReason | 0..1 | code | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Coverage.type | required | BirthAndFetalDeathFinancialClassVShttp://hl7.org/fhir/us/bfdr/ValueSet/ValueSet-birth-and-fetal-death-financial-class from this IG |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
type | Σ | 1..1 | CodeableConcept | The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: Birth and Fetal Death Financial Class (required): Birth and Fetal Death Financial Class (NCHS) |
beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
payor | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
Slices for extension | Content/Rules for all slices | |||
dataAbsentReason | 0..1 | code | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Coverage.type | required | BirthAndFetalDeathFinancialClassVShttp://hl7.org/fhir/us/bfdr/ValueSet/ValueSet-birth-and-fetal-death-financial-class from this IG |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
type | Σ | 1..1 | CodeableConcept | The value set contains the list of values used to indicate the principle source of payment for the labor and delivery (from codesystem https://nahdo.org/sopt). Binding: Birth and Fetal Death Financial Class (required): Birth and Fetal Death Financial Class (NCHS) | ||||
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
dependent | Σ | 0..1 | string | Dependent number | ||||
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
period | Σ | 0..1 | Period | Coverage start and end dates | ||||
payor | Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
id | 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 | |||||
dataAbsentReason | 0..1 | code | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) | |||||
reference | 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: ResourceType (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 | ||||
display | Σ | 0..1 | string | Text alternative for the resource | ||||
class | 0..* | BackboneElement | Additional coverage classifications | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
network | Σ | 0..1 | string | Insurer network | ||||
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (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 | ||||
subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
contract | 0..* | Reference(Contract) | Contract details | |||||
Documentation for this format |
Path | Conformance | ValueSet | URI | |||
Coverage.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Coverage.type | required | BirthAndFetalDeathFinancialClassVShttp://hl7.org/fhir/us/bfdr/ValueSet/ValueSet-birth-and-fetal-death-financial-class from this IG | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard | ||||
Coverage.payor.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodeshttp://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard |
This structure is derived from Coverage
Other representations of profile: CSV, Excel, Schematron