CH Core (R4)
2.0.0 - STU 2

CH Core (R4), published by HL7 Switzerland. This is not an authorized publication; it is the continuous build for version 2.0.0). This version is based on the current content of https://github.com/hl7ch/ch-core/ and changes regularly. See the Directory of published versions

Resource Profile: CH Core Coverage Profile

Defining URL:http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-coverage
Version:2.0.0
Name:CHCoreCoverage
Title:CH Core Coverage Profile
Status:Active as of 2019-05-20T00:00:00+00:00
Definition:

The Coverage referenced in the CH Core profiles.

Publisher:HL7 Switzerland
Copyright:

CC-BY-SA-4.0

Source Resource:XML / JSON / Turtle

The official URL for this profile is:

http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-coverage

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Coverage

Summary

Mandatory: 0 element (2 nested mandatory elements)
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Coverage.identifier is sliced based on the value of value:system

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH Core Coverage
... identifier 0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber 0..*Identifierinsurancecardnumber
..... system 1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value 1..1stringInsurance card number of the patient (20 digits)
... policyHolder 0..1Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile)Owner of the policy
... subscriber 0..1Reference(CH Core Patient Profile | RelatedPerson)Subscriber to the policy
... payor 1..*Reference(CH Core Organization Profile | CH Core Patient Profile | RelatedPerson)Issuer of the policy

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH Core Coverage
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber Σ0..*Identifierinsurancecardnumber
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value Σ1..1stringInsurance card number of the patient (20 digits)
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ0..1CodeableConceptCoverage 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.

... policyHolder Σ0..1Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile)Owner of the policy
... subscriber Σ0..1Reference(CH Core Patient Profile | RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(CH Core Patient Profile)Plan beneficiary
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ0..1PeriodCoverage start and end dates
... payor Σ1..*Reference(CH Core Organization Profile | CH Core Patient Profile | RelatedPerson)Issuer of the policy
... class 0..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value Σ1..1stringValue associated with the type
.... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

This structure is derived from Coverage

Summary

Mandatory: 0 element (2 nested mandatory elements)
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Coverage.identifier is sliced based on the value of value:system

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH Core Coverage
... identifier 0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber 0..*Identifierinsurancecardnumber
..... system 1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value 1..1stringInsurance card number of the patient (20 digits)
... policyHolder 0..1Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile)Owner of the policy
... subscriber 0..1Reference(CH Core Patient Profile | RelatedPerson)Subscriber to the policy
... payor 1..*Reference(CH Core Organization Profile | CH Core Patient Profile | RelatedPerson)Issuer of the policy

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH Core Coverage
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber Σ0..*Identifierinsurancecardnumber
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value Σ1..1stringInsurance card number of the patient (20 digits)
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ0..1CodeableConceptCoverage 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.

... policyHolder Σ0..1Reference(CH Core Patient Profile | RelatedPerson | CH Core Organization Profile)Owner of the policy
... subscriber Σ0..1Reference(CH Core Patient Profile | RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(CH Core Patient Profile)Plan beneficiary
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ0..1PeriodCoverage start and end dates
... payor Σ1..*Reference(CH Core Organization Profile | CH Core Patient Profile | RelatedPerson)Issuer of the policy
... class 0..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value Σ1..1stringValue associated with the type
.... name Σ0..1stringHuman readable description of the type and value
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet
Coverage.languagepreferredCommonLanguages
Max Binding: AllLanguages
Coverage.identifier:insurancecardnumber.userequiredIdentifierUse
Coverage.identifier:insurancecardnumber.typeextensibleIdentifier Type Codes
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.class.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Constraints

IdPathDetailsRequirements
dom-2CoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3CoverageIf 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-4CoverageIf 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-5CoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6CoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1Coverage.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.identifier:insurancecardnumber.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifier:insurancecardnumber.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.assignerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.policyHolderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subscriberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subscriberIdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.beneficiaryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.dependentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.payorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.classAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.nameAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.orderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.networkAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiaryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exceptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exception.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.exception.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.exception.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.exception.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.exception.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exception.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subrogationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.contractAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())