Common CQL Artifacts for FHIR (US-Based), published by HL7 International / Clinical Decision Support. 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/us-cql-ig/ and changes regularly. See the Directory of published versions

Coverage Patterns

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USCore defines the USCore Coverage profile to record insurance coverage information for a patient.

Modifier Elements

The base Coverage resource defines the following modifier elements:

• status

In general, applications should ensure that the status element for a Coverage resource is appropriately set for their use case. Note that for many applications, such as prior authorization, Coverage resources would be expected to have a status of active in order to be considered.

The US Core Coverage profile does not introduce any modifier extensions.

Search Parameters

In general, the Coverage under consideration will be established by application context, so although US Core does define search parameters for Coverage based on Patient, no special considerations are discussed here.

NOTE: For discussion on how to manage search parameters with terminology, see the Terminology Considerations discussion in the Architectural Guidance topic.

NOTE: For discussion on how to manage optional search parameters, see the Performant Data Access discussion in the Architectural Guidance topic.

Cross-Version Considerations

There are no significant backwards-compatibility issues between versions for the Coverage profile.

Common Elements and Functions

Member or Subscriber ID

​The USCore Coverage Profile defines a slice on identifier called memberid that can be used to access the patient's member id. The US Core Elements library provides the .memberID() fluent function for this purpose, along with .policyNumber() for accessing the subscriber id:

define "Covered Member ID":
  Coverage.memberID()

In addition, the profile defines an invariant that either the memberid slice or subscriberId must be present.