A.1.3 - Health insurance and payment information - Definitions

HL7 Europe Laboratory Report
0.2.0-ci - ci-build 150

HL7 Europe Laboratory Report, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.2.0-ci built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/laboratory/ and changes regularly. See the Directory of published versions

Logical Model: PayerLabEhn - Detailed Descriptions

Page standards status: Informative

Maturity Level: 2

Definitions for the Payer logical model.

Differential Elements Table
Key Elements Table
Snapshot Elements Table

Guidance on how to interpret the contents of this table can be found here

0. Payer
Definition	Health insurance and payment information. Section A1.3 of the eHN guideline.
Short	A.1.3 - Health insurance and payment information
Logical Model	Instances of this logical model are not marked to be the target of a Reference
2. Payer.insurance
Definition	Health insurance information is not always required, however, in some jurisdictions, the insurance number is also used as the patient identifier. It is necessary not just for identification but also forms access to funding for care.
Short	A.1.3.1 Health insurance information
Control	0..1
Type	BackboneElement
4. Payer.insurance.identifier
Definition	Unique health insurance company identification code.
Short	A.1.3.1.1 Health insurance code
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..*
Type	Identifier
6. Payer.insurance.name
Definition	Full, official name of the healthcare insurance provider.
Short	A.1.3.1.2 Health insurance name
Control	0..*
Type	string
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
8. Payer.insurance.subjectIdentifier
Definition	Number or code under which the insured person is registered at the insurance provider.
Short	A.1.3.1.3 Health insurance number
Control	0..*
Type	Identifier

Guidance on how to interpret the contents of this table can be found here

0. Payer
Definition	Health insurance and payment information. Section A1.3 of the eHN guideline.
Short	A.1.3 - Health insurance and payment information
Control	0..*
Is Modifier	false
Logical Model	Instances of this logical model are not marked to be the target of a Reference
2. Payer.insurance
Definition	Health insurance information is not always required, however, in some jurisdictions, the insurance number is also used as the patient identifier. It is necessary not just for identification but also forms access to funding for care.
Short	A.1.3.1 Health insurance information
Control	0..1
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
4. Payer.insurance.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short	Extensions that cannot be ignored even if unrecognized
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Payer.insurance.identifier
Definition	Unique health insurance company identification code.
Short	A.1.3.1.1 Health insurance code
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..*
Type	Identifier
8. Payer.insurance.name
Definition	Full, official name of the healthcare insurance provider.
Short	A.1.3.1.2 Health insurance name
Control	0..*
Type	string
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
10. Payer.insurance.subjectIdentifier
Definition	Number or code under which the insured person is registered at the insurance provider.
Short	A.1.3.1.3 Health insurance number
Control	0..*
Type	Identifier

Guidance on how to interpret the contents of this table can be found here

0. Payer
Definition	Health insurance and payment information. Section A1.3 of the eHN guideline.
Short	A.1.3 - Health insurance and payment information
Control	0..*
Is Modifier	false
Logical Model	Instances of this logical model are not marked to be the target of a Reference
2. Payer.insurance
Definition	Health insurance information is not always required, however, in some jurisdictions, the insurance number is also used as the patient identifier. It is necessary not just for identification but also forms access to funding for care.
Short	A.1.3.1 Health insurance information
Control	0..1
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
4. Payer.insurance.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short	Unique id for inter-element referencing
Control	0..1
Type	string
Is Modifier	false
XML Format	In the XML format, this property is represented as an attribute.
Summary	false
6. Payer.insurance.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short	Additional content defined by implementations
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control	0..*
Type	Extension
Is Modifier	false
Summary	false
Alternate Names	extensions, user content
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing	This element introduces a set of slices on `Payer.insurance.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
8. Payer.insurance.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short	Extensions that cannot be ignored even if unrecognized
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control	0..*
Type	Extension
Is Modifier	true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary	true
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names	extensions, user content, modifiers
Invariants	ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
10. Payer.insurance.identifier
Definition	Unique health insurance company identification code.
Short	A.1.3.1.1 Health insurance code
Note	This is a business identifier, not a resource identifier (see discussion)
Control	0..*
Type	Identifier
12. Payer.insurance.name
Definition	Full, official name of the healthcare insurance provider.
Short	A.1.3.1.2 Health insurance name
Control	0..*
Type	string
Primitive Value	This primitive element may be present, or absent, or replaced by an extension
14. Payer.insurance.subjectIdentifier
Definition	Number or code under which the insured person is registered at the insurance provider.
Short	A.1.3.1.3 Health insurance number
Control	0..*
Type	Identifier

Links: Table of Contents | QA Report

Propose a change external