NHDR Implementation Guide Release 1.0
0.1.0 - ci-build

NHDR Implementation Guide Release 1.0, published by NHDR. 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/UP-Manila-SILab/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions

Resource Profile: PH Coverage

Official URL: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage Version: 0.1.0
Standards status: Draft Computable Name: PH_Coverage

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.

Usages:

  • This Profile is not used by any profiles in this Specification

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.

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(PH Organization | PH Patient) Issuer of the policy

doco 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.class.type Base extensible Coverage Class 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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.meta
Coverage.meta.Slices for extension Content/Rules for all slices
Coverage.meta.Slices for extension.extension:hfRecordedDate 0..1 dateTime The recorded date indicating when the record was uploaded by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
Coverage.meta.Slices for extension.extension:hfLastUpdated 0..* dateTime The date indicating when the record was last updated by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
Coverage.meta.lastUpdated 0..1 instant When the resource was uploaded to the NHDR.
Coverage.implicitRules 0..0 A set of rules under which this content was created
Coverage.language 0..0 Language of the resource content
Coverage.contained 0..0 Contained, inline Resources
Coverage.extension 0..0 Extension
Coverage.modifierExtension 0..0 Extension
Coverage.subscriber 0..0 Subscriber to the policy
Coverage.subscriberId 0..0 ID assigned to the subscriber
Coverage.dependent 0..0 Dependent number
Coverage.relationship 0..0 Beneficiary relationship to the subscriber
Coverage.period 0..0 Coverage start and end dates
Coverage.payor 1..* Reference(PH Organization | PH Patient) Issuer of the policy
Coverage.class 0..0 Additional coverage classifications
Coverage.order 0..0 Relative order of the coverage
Coverage.network 0..0 Insurer network
Coverage.costToBeneficiary
Coverage.costToBeneficiary.id 0..0 Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..0 Extension
Coverage.costToBeneficiary.modifierExtension 0..0 Extension
Coverage.costToBeneficiary.type 0..1 CodeableConcept Cost category
Binding: Coverage Copay Type (required)
Coverage.costToBeneficiary.value[x] 1..1 Money The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.exception 0..0 Exceptions for patient payments
Coverage.subrogation 0..0 Reimbursement to insurer
Coverage.contract 0..0 Contract details

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.costToBeneficiary.​type Base required Coverage Copay Type 📦0.1.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element is included in summaries. 0..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.meta.id 0..1 string Unique id for inter-element referencing
Coverage.meta.Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Coverage.meta.Slices for extension.extension:hfRecordedDate 0..1 dateTime The recorded date indicating when the record was uploaded by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
Coverage.meta.Slices for extension.extension:hfLastUpdated 0..* dateTime The date indicating when the record was last updated by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
Coverage.meta.versionId This element is included in summaries. 0..1 id Version specific identifier
Coverage.meta.lastUpdated This element is included in summaries. 0..1 instant When the resource was uploaded to the NHDR.
Coverage.meta.source This element is included in summaries. 0..1 uri Identifies where the resource comes from
Coverage.meta.profile This element is included in summaries. 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
Coverage.meta.security This element is included in summaries. 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Coverage.meta.tag This element is included in summaries. 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Coverage.identifier This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element is included in summaries. 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Coverage.policyHolder This element is included in summaries. 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(PH Organization | PH Patient) Issuer of the policy
Coverage.costToBeneficiary 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: Coverage Copay Type (required)
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 Money The amount or percentage due from the beneficiary

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base required Coverage Copay Type 📦0.1.0 This IG
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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(PH Organization | PH Patient) Issuer of the policy

doco 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.class.type Base extensible Coverage Class 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()

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.meta
Coverage.meta.Slices for extension Content/Rules for all slices
Coverage.meta.Slices for extension.extension:hfRecordedDate 0..1 dateTime The recorded date indicating when the record was uploaded by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
Coverage.meta.Slices for extension.extension:hfLastUpdated 0..* dateTime The date indicating when the record was last updated by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
Coverage.meta.lastUpdated 0..1 instant When the resource was uploaded to the NHDR.
Coverage.implicitRules 0..0 A set of rules under which this content was created
Coverage.language 0..0 Language of the resource content
Coverage.text 0..0 Text summary of the resource, for human interpretation
Coverage.contained 0..0 Contained, inline Resources
Coverage.extension 0..0 Extension
Coverage.modifierExtension 0..0 Extension
Coverage.subscriber 0..0 Subscriber to the policy
Coverage.subscriberId 0..0 ID assigned to the subscriber
Coverage.dependent 0..0 Dependent number
Coverage.relationship 0..0 Beneficiary relationship to the subscriber
Coverage.period 0..0 Coverage start and end dates
Coverage.payor 1..* Reference(PH Organization | PH Patient) Issuer of the policy
Coverage.class 0..0 Additional coverage classifications
Coverage.order 0..0 Relative order of the coverage
Coverage.network 0..0 Insurer network
Coverage.costToBeneficiary
Coverage.costToBeneficiary.id 0..0 Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..0 Extension
Coverage.costToBeneficiary.modifierExtension 0..0 Extension
Coverage.costToBeneficiary.type 0..1 CodeableConcept Cost category
Binding: Coverage Copay Type (required)
Coverage.costToBeneficiary.value[x] 1..1 Money The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.exception 0..0 Exceptions for patient payments
Coverage.subrogation 0..0 Reimbursement to insurer
Coverage.contract 0..0 Contract details

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.costToBeneficiary.​type Base required Coverage Copay Type 📦0.1.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element is included in summaries. 0..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.meta.id 0..1 string Unique id for inter-element referencing
Coverage.meta.Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Coverage.meta.Slices for extension.extension:hfRecordedDate 0..1 dateTime The recorded date indicating when the record was uploaded by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
Coverage.meta.Slices for extension.extension:hfLastUpdated 0..* dateTime The date indicating when the record was last updated by the health facility.
URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
Coverage.meta.versionId This element is included in summaries. 0..1 id Version specific identifier
Coverage.meta.lastUpdated This element is included in summaries. 0..1 instant When the resource was uploaded to the NHDR.
Coverage.meta.source This element is included in summaries. 0..1 uri Identifies where the resource comes from
Coverage.meta.profile This element is included in summaries. 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
Coverage.meta.security This element is included in summaries. 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Coverage.meta.tag This element is included in summaries. 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Coverage.identifier This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element is included in summaries. 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Coverage.policyHolder This element is included in summaries. 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
Coverage.beneficiary This element is included in summaries. 1..1 Reference(Patient) Plan beneficiary
Coverage.payor This element is included in summaries. 1..* Reference(PH Organization | PH Patient) Issuer of the policy
Coverage.costToBeneficiary 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: Coverage Copay Type (required)
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 Money The amount or percentage due from the beneficiary

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base required Coverage Copay Type 📦0.1.0 This IG
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()

 

Other representations of profile: CSV, Excel, Schematron