description: PCT Coverage is a profile for capturing data that reflect a payer’s coverage that was effective as of the proposed date of service or the date of admission of the GFE.
package_name: hl7.fhir.us.davinci
derivation: constraint
name: PCTCoverage
type: Coverage
elements:
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: 1
      slices:
        coverage-kind:
          match: {url: null}
          schema:
            type: Extension
            url: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
            index: 1
            elements:
              value:
                choices: []
                index: 3
            required: [value]
        self-pay-declared:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared', index: 4}
          min: 0
          max: 1
  subscriber:
    short: Required if subscriber is a person that is not the beneficiary. When date of birth or gender are not known, omit Patient.birthDate and set Patient.gender to unknown.
    index: 5
    elements:
      display: {short: 'Provide the name of the subscriber in Coverage.subscriber.display concatenating the subscriber’s prefix, given name, family name and suffix (in this order), each separated by a single space. If discrete name parts are required, a Patient resource SHALL be pointed to in Coverage.subscriber.reference.', index: 6}
    required: [display]
  subscriberId: {index: 7}
  relationship: {index: 8}
  period: {index: 9}
  payor:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization']
    index: 10
  class:
    index: 11
    elements:
      name: {index: 12}
    required: [name]
    slicing:
      rules: open
      ordered: false
      description: Slice based on value pattern
      discriminator:
      - {path: type, type: pattern}
      min: 1
      slices:
        group:
          match: {type: null}
          schema:
            index: 13
            elements:
              name: {index: 14}
            required: [name]
        plan:
          match:
            type:
              coding:
              - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            mustSupport: true
            index: 15
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 16
                elements:
                  coding: {index: 17}
                required: [coding]
  costToBeneficiary:
    elements:
      type:
        binding: {strength: required, valueSet: 'http://terminology.hl7.org/ValueSet/coverage-copay-type'}
        index: 18
package_version: pct-2.0.0-ballot
extensions:
  coverage-kind:
    url: http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind
    type: Extension
    index: 1
    elements:
      value:
        choices: []
        index: 3
    required: [value]
  self-pay-declared: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared', min: 0, max: 1, type: Extension, mustSupport: true, index: 4}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage
base: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage
version: 2.0.0-ballot
required: [class, subscriberId, relationship, extension, period]