De-Identified, Anonymized FHIR Profiles Library
0.1.0 - STU1 Release 1 - Standard for Trial-Use

De-Identified, Anonymized FHIR Profiles Library, published by HL7 International / Cross Group Projects. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-dapl/ and changes regularly. See the Directory of published versions

## Resource Profile: DeIdentified UDS Plus Coverage

Official URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-coverage | Version: 0.1.0
Standards status: Trial-use | Maturity Level: 1 | Computable Name: DeIdentifiedUDSPlusCoverage

The UDS+ profile establishes the core elements, extensions, vocabularies and value sets for representing Coverage for UDS+ program.

All canonical (Official) URLs will be changed in the future and are not available currently on the web.

### Introduction

This profile is used to represent de-identified Coverage information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes Coverage.period.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Coverage resource text element may contain information such as the Coverage date, beneficiary information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original Coverage resource id should not be included in the De-identified Coverage instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original Coverage. All resource references to the Coverage submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

- beneficiary
- Payor

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

- period

Usages:

- Examples for this Profile: Coverage/de-identified-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | UDS Plus Coverage
id | S Σ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA.
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:capitatedMemberMonths | S | 1..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
extension:feeForServiceMemberMonths | S | 1..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
beneficiary | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Uds Plus Insurance Codes | 📦0.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Coverage

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | UDS Plus Coverage
id | S | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA.
text |  | 0..0 |  | Cannot include any text in the resource as part of the de-identified data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the de-identified data.
Slices for extension |  |  |  | Content/Rules for all slices
extension:capitatedMemberMonths | S | 1..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
extension:feeForServiceMemberMonths | S | 1..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
text |  | 0..0 |  | Plain text representation of the concept
beneficiary | S | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary
display |  | 0..0 |  | Text alternative for the resource
period | S | 0..1 | Period | Coverage start and end dates
payor | S | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy
display |  | 0..0 |  | Text alternative for the resource
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Coverage.type | Base | extensible | Uds Plus Insurance Codes | 📦0.1.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | UDS Plus Coverage
id | S Σ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA.
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.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:capitatedMemberMonths | S | 1..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
extension:feeForServiceMemberMonths | S | 1..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
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 | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 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
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 | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 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
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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Uds Plus Insurance Codes | 📦0.1.0 | This IG
Coverage.beneficiary.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std.
Coverage.payor.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Coverage

Summary

Mandatory: 3 elements
Must-Support: 8 elements
Fixed: 1 element
Prohibited: 5 elements

Structures

This structure refers to these other structures:

- De-Identified UDS Plus Patient (http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-patient)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- De-Identified UDS Plus RelatedPerson (http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-relatedperson)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
- http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension

Maturity: 1

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | UDS Plus Coverage
id | S Σ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA.
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:capitatedMemberMonths | S | 1..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
extension:feeForServiceMemberMonths | S | 1..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
beneficiary | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Uds Plus Insurance Codes | 📦0.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from Coverage

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | UDS Plus Coverage
id | S | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA.
text |  | 0..0 |  | Cannot include any text in the resource as part of the de-identified data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the de-identified data.
Slices for extension |  |  |  | Content/Rules for all slices
extension:capitatedMemberMonths | S | 1..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
extension:feeForServiceMemberMonths | S | 1..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
text |  | 0..0 |  | Plain text representation of the concept
beneficiary | S | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary
display |  | 0..0 |  | Text alternative for the resource
period | S | 0..1 | Period | Coverage start and end dates
payor | S | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy
display |  | 0..0 |  | Text alternative for the resource
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Coverage.type | Base | extensible | Uds Plus Insurance Codes | 📦0.1.0 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | UDS Plus Coverage
id | S Σ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA.
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.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:capitatedMemberMonths | S | 1..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
extension:feeForServiceMemberMonths | S | 1..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active
type | S Σ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
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 | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 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
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 | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 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
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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Uds Plus Insurance Codes | 📦0.1.0 | This IG
Coverage.beneficiary.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std.
Coverage.payor.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Coverage

Summary

Mandatory: 3 elements
Must-Support: 8 elements
Fixed: 1 element
Prohibited: 5 elements

Structures

This structure refers to these other structures:

- De-Identified UDS Plus Patient (http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-patient)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- De-Identified UDS Plus RelatedPerson (http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-relatedperson)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
- http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension

Maturity: 1

Other representations of profile: CSV, Excel, Schematron