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

• 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
Coverage.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.Slices for extension				Content/Rules for all slices
Coverage.Slices for extension.extension:capitatedMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
Coverage.Slices for extension.extension:feeForServiceMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ 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. Fixed Value: active
Coverage.type	S This element must be supported. Σ This element is included in summaries.	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.
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
Coverage.period	S This element must be supported. Σ This element is included in summaries. C	0..1	Period	Coverage start and end dates Constraints: uds-plus-cov-1, uds-plus-cov-1a, uds-plus-cov-1b, uds-plus-cov-2, uds-plus-cov-2a, uds-plus-cov-2b
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	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	📦2.0.0	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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-1a	error	Coverage.period	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-cov-1b	error	Coverage.period	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-cov-2a	error	Coverage.period	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-cov-2b	error	Coverage.period	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	UDS Plus Coverage
Coverage.id	S This element must be supported.	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
Coverage.text		0..0		Cannot include any text in the resource as part of the de-identified data.
Coverage.contained		0..0		Cannot include any contained resources in the resource as part of the de-identified data.
Coverage.Slices for extension				Content/Rules for all slices
Coverage.Slices for extension.extension:capitatedMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
Coverage.Slices for extension.extension:feeForServiceMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
Coverage.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active
Coverage.type	S This element must be supported.	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.
Coverage.policyHolder
Coverage.policyHolder.display		0..0		Text alternative for the resource
Coverage.beneficiary	S This element must be supported.	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
Coverage.beneficiary.display		0..0		Text alternative for the resource
Coverage.period	S This element must be supported. C	0..1	Period	Coverage start and end dates Constraints: uds-plus-cov-1, uds-plus-cov-1a, uds-plus-cov-1b, uds-plus-cov-2, uds-plus-cov-2a, uds-plus-cov-2b
Coverage.payor	S This element must be supported.	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
Coverage.payor.display		0..0		Text alternative for the resource
Coverage.costToBeneficiary		0..0		Patient payments for services/products
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type	Base	extensible	Uds Plus Insurance Codes	📦2.0.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-1a	error	Coverage.period	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-cov-1b	error	Coverage.period	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-cov-2a	error	Coverage.period	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-cov-2b	error	Coverage.period	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	UDS Plus Coverage
Coverage.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Coverage.Slices for extension.extension:capitatedMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
Coverage.Slices for extension.extension:feeForServiceMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for the coverage
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ 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. Fixed Value: active
Coverage.type	S This element must be supported. Σ This element is included in summaries.	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.
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
Coverage.policyHolder.id		0..1	string	Unique id for inter-element referencing
Coverage.policyHolder.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.policyHolder.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Coverage.policyHolder.type	Σ This element is included in summaries.	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).
Coverage.policyHolder.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.subscriber	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
Coverage.subscriberId	Σ This element is included in summaries.	0..1	string	ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
Coverage.beneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.beneficiary.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.beneficiary.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Coverage.beneficiary.type	Σ This element is included in summaries.	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).
Coverage.beneficiary.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period	S This element must be supported. Σ This element is included in summaries. C	0..1	Period	Coverage start and end dates Constraints: uds-plus-cov-1, uds-plus-cov-1a, uds-plus-cov-1b, uds-plus-cov-2, uds-plus-cov-2a, uds-plus-cov-2b
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
Coverage.payor.id		0..1	string	Unique id for inter-element referencing
Coverage.payor.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.payor.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Coverage.payor.type	Σ This element is included in summaries.	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).
Coverage.payor.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.class		0..*	BackboneElement	Additional coverage classifications
Coverage.class.id		0..1	string	Unique id for inter-element referencing
Coverage.class.extension		0..*	Extension	Additional content defined by implementations
Coverage.class.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.class.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.class.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.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	📦2.0.0	This IG
Coverage.policyHolder.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-1a	error	Coverage.period	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-cov-1b	error	Coverage.period	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-cov-2a	error	Coverage.period	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-cov-2b	error	Coverage.period	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	UDS Plus Coverage
Coverage.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.Slices for extension				Content/Rules for all slices
Coverage.Slices for extension.extension:capitatedMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
Coverage.Slices for extension.extension:feeForServiceMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ 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. Fixed Value: active
Coverage.type	S This element must be supported. Σ This element is included in summaries.	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.
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
Coverage.period	S This element must be supported. Σ This element is included in summaries. C	0..1	Period	Coverage start and end dates Constraints: uds-plus-cov-1, uds-plus-cov-1a, uds-plus-cov-1b, uds-plus-cov-2, uds-plus-cov-2a, uds-plus-cov-2b
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	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	📦2.0.0	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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-1a	error	Coverage.period	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-cov-1b	error	Coverage.period	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-cov-2a	error	Coverage.period	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-cov-2b	error	Coverage.period	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	UDS Plus Coverage
Coverage.id	S This element must be supported.	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
Coverage.text		0..0		Cannot include any text in the resource as part of the de-identified data.
Coverage.contained		0..0		Cannot include any contained resources in the resource as part of the de-identified data.
Coverage.Slices for extension				Content/Rules for all slices
Coverage.Slices for extension.extension:capitatedMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
Coverage.Slices for extension.extension:feeForServiceMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
Coverage.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active
Coverage.type	S This element must be supported.	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.
Coverage.policyHolder
Coverage.policyHolder.display		0..0		Text alternative for the resource
Coverage.beneficiary	S This element must be supported.	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
Coverage.beneficiary.display		0..0		Text alternative for the resource
Coverage.period	S This element must be supported. C	0..1	Period	Coverage start and end dates Constraints: uds-plus-cov-1, uds-plus-cov-1a, uds-plus-cov-1b, uds-plus-cov-2, uds-plus-cov-2a, uds-plus-cov-2b
Coverage.payor	S This element must be supported.	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
Coverage.payor.display		0..0		Text alternative for the resource
Coverage.costToBeneficiary		0..0		Patient payments for services/products
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type	Base	extensible	Uds Plus Insurance Codes	📦2.0.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-1a	error	Coverage.period	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-cov-1b	error	Coverage.period	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-cov-2a	error	Coverage.period	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-cov-2b	error	Coverage.period	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	UDS Plus Coverage
Coverage.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Coverage identifier created by the health center to send data to HRSA.
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Coverage.Slices for extension.extension:capitatedMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
Coverage.Slices for extension.extension:feeForServiceMemberMonths	S This element must be supported.	0..1	Quantity	Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for the coverage
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ 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. Fixed Value: active
Coverage.type	S This element must be supported. Σ This element is included in summaries.	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.
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
Coverage.policyHolder.id		0..1	string	Unique id for inter-element referencing
Coverage.policyHolder.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.policyHolder.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Coverage.policyHolder.type	Σ This element is included in summaries.	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).
Coverage.policyHolder.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.subscriber	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
Coverage.subscriberId	Σ This element is included in summaries.	0..1	string	ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Plan beneficiary
Coverage.beneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.beneficiary.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.beneficiary.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Coverage.beneficiary.type	Σ This element is included in summaries.	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).
Coverage.beneficiary.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period	S This element must be supported. Σ This element is included in summaries. C	0..1	Period	Coverage start and end dates Constraints: uds-plus-cov-1, uds-plus-cov-1a, uds-plus-cov-1b, uds-plus-cov-2, uds-plus-cov-2a, uds-plus-cov-2b
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	1..*	Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson)	Issuer of the policy
Coverage.payor.id		0..1	string	Unique id for inter-element referencing
Coverage.payor.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.payor.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Coverage.payor.type	Σ This element is included in summaries.	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).
Coverage.payor.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.class		0..*	BackboneElement	Additional coverage classifications
Coverage.class.id		0..1	string	Unique id for inter-element referencing
Coverage.class.extension		0..*	Extension	Additional content defined by implementations
Coverage.class.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.class.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.class.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.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	📦2.0.0	This IG
Coverage.policyHolder.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
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()
uds-plus-cov-1	error	Coverage.period	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-1a	error	Coverage.period	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-cov-1b	error	Coverage.period	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-cov-2	error	Coverage.period	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-cov-2a	error	Coverage.period	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-cov-2b	error	Coverage.period	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'

This structure is derived from Coverage

Summary

Mandatory: 1 element
Must-Support: 8 elements
Fixed: 1 element
Prohibited: 6 elements

Structures

This structure refers to these other structures:

• De-Identified UDS Plus Patient (http://fhir.org/guides/hrsa/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://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-relatedperson)

Extensions

This structure refers to these extensions:

• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension

Maturity: 2