HL7 PT FHIR Implementation Guide: Example IG Release 1 | STU1, published by HL7 Portugal. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-pt/core/ and changes regularly. See the Directory of published versions

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Resource Profile: PT_Coverage - Mappings

Active as of 2024-09-23

Mappings for the PTCoverage resource profile.

Mappings for ()

PT_Coverage
Coverage
policyHolder
display	Organization/IN1-3.1; IN2-25; [ORG-2.1; MSH-6; ORC-17.1; ORC-21.3 or ORC-21.10]
payor
display	Organization/IN1-3.1; IN2-25

Mappings for ()

PT_Coverage
Coverage
policyHolder
display	Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO
subscriber
display	Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO
payor
display	Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO

Mappings for ()

PT_Coverage
Coverage
policyHolder
display	RelatedPerson/NK1-33.1
subscriber
display	RelatedPerson/NK1-33.1
payor
display	RelatedPerson/NK1-33.1

Mappings for ()

PT_Coverage
Coverage
identifier	IN1-2
system	IN1-2.3
value	IN1-2.1
status	IN1-45, but if this HL7 field is not sent, pay attention to the period element. When you only have period.start, should be "active". When it has passed (period.end), should be "cancelled".
type	IN1-15
coding
code	IN1-15.1
beneficiary
display	Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO
relationship
coding
system	IN1-17.3
code	IN1-17.1
display	IN1-17.2
text	Translation to [PT] of the display field
period
start	IN1-12
end	IN1-13
class	ZID-2; ZID-3; ZID-6
type
coding
system	ZID-2.3; ZID-3.3; ZID-6.3
code	ZID-2.1; ZID-3.1; ZID-6.1
display	ZID-2.2; ZID-3.2; ZID-6.2
text	if necessary - Translation to [PT] of the display field
value	ZID-2.4; ZID-3.4; ZID-6.4
name	ZID-2.5; ZID-3.5; ZID-6.5
order	IN1-1 = 1 (priority)
costToBeneficiary	IN1-37
type	IN1-37.2
coding
code	IN1-37.2.1
value[x]	IN1-37.1.1

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

PT_Coverage
Coverage	Event
identifier	Event.identifier
status	Event.status
beneficiary	Event.subject
period	Event.occurrence[x]

Mappings for RIM Mapping (http://hl7.org/v3)

PT_Coverage
Coverage	Entity. Role, or Act, Coverage
text	Act.text?
contained	N/A
modifierExtension	N/A
identifier	.id
id	n/a
extension	n/a
use	Role.code or implied by context
type	Role.code or implied by context
system	II.root or Role.id.root
value	II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period	Role.effectiveTime or implied by context
assigner	II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
status	Act.status
type
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
policyHolder
id	n/a
extension	n/a
reference	N/A
type	N/A
identifier	.identifier
display	N/A
subscriber
id	n/a
extension	n/a
reference	N/A
type	N/A
identifier	.identifier
display	N/A
beneficiary
id	n/a
extension	n/a
reference	N/A
type	N/A
identifier	.identifier
display	N/A
relationship
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
period	Act.effectiveTime
id	n/a
extension	n/a
start	./low
end	./high
payor
id	n/a
extension	n/a
reference	N/A
type	N/A
identifier	.identifier
display	N/A
class
id	n/a
extension	n/a
modifierExtension	N/A
type
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
costToBeneficiary
id	n/a
extension	n/a
modifierExtension	N/A
type
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
exception
id	n/a
extension	n/a
modifierExtension	N/A
contract	n/a

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

PT_Coverage
Coverage
identifier	FiveWs.identifier
status	FiveWs.status
type	FiveWs.class
policyHolder	FiveWs.subject[x], FiveWs.subject
subscriber	FiveWs.subject[x], FiveWs.subject
subscriberId	FiveWs.subject[x], FiveWs.subject
beneficiary	FiveWs.subject[x], FiveWs.subject
period	FiveWs.done[x]
payor	FiveWs.author

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

PT_Coverage
Coverage
identifier	C02
policyHolder	D01 through D09
subscriber	D01 through D09
subscriberId	D01 through D09
beneficiary	D01 through D09
dependent	C17
relationship	C03
payor	A05
class
value	C11 (Division,Section)
name	C11 (Division,Section)
network	D10
costToBeneficiary
value[x]	C11 (Division,Section)
contract	D01 through D09

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

PT_Coverage
Coverage
identifier	IN1-2
use	N/A
type	CX.5
system	CX.4 / EI-2-4
value	CX.1 / EI.1
period	CX.7 + CX.8
assigner	CX.4 / (CX.4,CX.9,CX.10)
type	IN1-15
coding	C*E.1-8, C*E.10-22
system	C*E.3
version	C*E.7
code	C*E.1
display	C*E.2 - but note this is not well followed
userSelected	Sometimes implied by being first
text	C*E.9. But note many systems use C*E.2 for this
policyHolder	IN1-16, 18, 19-name of insured, address, date of birth
subscriber	IN1-16, 18, 19-name of insured, address, date of birth
subscriberId	IN1-16, 18, 19-name of insured, address, date of birth
beneficiary	IN1-16, 18, 19-name of insured, address, date of birth
dependent	- No exact HL7 v2 equivalent concept seems to exist;
relationship
coding	C*E.1-8, C*E.10-22
system	C*E.3
version	C*E.7
code	C*E.1
display	C*E.2 - but note this is not well followed
userSelected	Sometimes implied by being first
text	C*E.9. But note many systems use C*E.2 for this
period	IN1-12 / IN1-13
start	DR.1
end	DR.2
payor	IN1-3
class
type
coding	C*E.1-8, C*E.10-22
system	C*E.3
version	C*E.7
code	C*E.1
display	C*E.2 - but note this is not well followed
userSelected	Sometimes implied by being first
text	C*E.9. But note many systems use C*E.2 for this
value	IN1-8
name	IN1-8
order	- No exact HL7 v2 equivalent concept seems to exist;
costToBeneficiary
type
coding	C*E.1-8, C*E.10-22
system	C*E.3
version	C*E.7
code	C*E.1
display	C*E.2 - but note this is not well followed
userSelected	Sometimes implied by being first
text	C*E.9. But note many systems use C*E.2 for this
value[x]	IN1-8
contract	IN1-16, 18, 19

Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

PT_Coverage
Coverage
identifier	C.32, C.33, C.39
policyHolder	C.35
subscriber	C.35
subscriberId	C.35
beneficiary	C.35
payor	C.30
class
value	C.31
name	C.31
costToBeneficiary
value[x]	C.31
contract	C.35