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

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Coverage
copyright	Used 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'
date	2023-10-17	2026-03-16T10:49:09+00:00	Values Differ
description	The 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.	The UDS+ profile establishes the core elements, extensions, vocabularies and value sets for representing Coverage for UDS+ program.	Values Differ
experimental	false
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	USCoreCoverageProfile	DeIdentifiedUDSPlusCoverage	Values Differ
publisher	HL7 International / Cross-Group Projects	HL7 International / Cross Group Projects	Values Differ
purpose
status	active
title	US Core Coverage Profile	DeIdentified UDS Plus Coverage	Values Differ
type	Coverage
url	http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage	http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-coverage	Values Differ
version	9.0.0-ballot	0.1.0	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..*	Coverage	Insurance or medical plan or a payment agreement Constraints: us-core-15		0..*	Coverage	UDS Plus Coverage
id	Σ	0..1	id	Logical id of this artifact	SΣ	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.	Elements differ in definition for mustSupport: 'false' vs 'true'
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..0		Cannot include any text in the resource as part of the de-identified data. This profile does not constrain the narrative in regard to content, language, or traceability to data elements	Element maximum cardinalities differ: '1' vs '0'
contained		0..*	Resource	Contained, inline Resources		0..0		Cannot include any contained resources in the resource as part of the de-identified data.	Element maximum cardinalities differ: '2147483647' vs '0'
extension		0..*	Extension	Additional content defined by implementations		2..*	Extension	Extension Slice: Unordered, Open by value:url	Element minimum cardinalities differ: '0' vs '2'
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..*	Identifier	Member ID and other identifiers Slice: Unordered, Open by value:type	Σ	0..*	Identifier	Business Identifier for the coverage	Elements differ in definition for mustSupport: 'true' vs 'false'
status	?!SΣ	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. Fixed Value: active
type	SΣ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: ?? (extensible): Centers for Disease Control and Prevention National Center for Health Statistics Source of Payment Codes	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: ?? (extensible): The set of codes to be used for UDS+ reporting.	Element minimum cardinalities differ: '0' vs '1'
id						0..1	string	Unique id for inter-element referencing	Added this element
Slices for extension						0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url	Added this element
coding					Σ	0..*	Coding	Code defined by a terminology system	Added this element
text					Σ	0..0		Plain text representation of the concept	Added this element
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	SΣC	0..1	string	ID assigned to the subscriber	Σ	0..1	string	ID assigned to the subscriber	Elements differ in definition for mustSupport: 'true' vs 'false'
beneficiary	SΣ	1..1	Reference(US Core Patient Profile)	Plan beneficiary	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
id						0..1	string	Unique id for inter-element referencing	Added this element
Slices for extension						0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url	Added this element
reference					ΣC	0..1	string	Literal reference, Relative, internal or absolute URL	Added this element
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).	Added this element
identifier					Σ	0..1	Identifier	Logical reference, when literal reference is not known	Added this element
display					Σ	0..0		Text alternative for the resource	Added this element
dependent	Σ	0..1	string	Dependent number	Σ	0..1	string	Dependent number
relationship	S	1..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: ?? (extensible)		0..1	CodeableConcept	Beneficiary 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' Element minimum cardinalities differ: '1' vs '0'
period	SΣ	0..1	Period	Coverage start and end dates	SΣ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(US Core Organization Profile S | US Core Patient Profile | US Core RelatedPerson Profile)	Issuer of the policy	SΣ	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy	Element maximum cardinalities differ: '1' vs '2147483647' Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-patient], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization], CanonicalType[http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-relatedperson]])
id						0..1	string	Unique id for inter-element referencing	Added this element
Slices for extension						0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url	Added this element
reference					ΣC	0..1	string	Literal reference, Relative, internal or absolute URL	Added this element
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).	Added this element
identifier					Σ	0..1	Identifier	Logical reference, when literal reference is not known	Added this element
display					Σ	0..0		Text alternative for the resource	Added this element
Slices for class	S	0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type		0..*	BackboneElement	Additional coverage classifications	Elements differ in definition for mustSupport: 'true' vs 'false'
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	0..1	string	Human readable description of the type and value	Σ	0..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: ?? (extensible): The types of services to which patient copayments are specified.	Σ	0..1	CodeableConcept	Cost category Binding: ?? (extensible): The types of services to which patient copayments are specified.
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