{
"description": null,
"_filename": "StructureDefinition-InsuranceCoverage.json",
"package_name": "hl7.fhir.us.bser",
"date": "2019-03-27T07:29:43+11:00",
"derivation": "constraint",
"publisher": "Hi3 Solutions",
"fhirVersion": "3.0.1",
"name": "BSeR Coverage",
"mapping": [ {
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Mapping",
"identity": "workflow"
}, {
"uri": "http://hl7.org/v3",
"name": "RIM Mapping",
"identity": "rim"
}, {
"uri": "http://hl7.org/fhir/w5",
"name": "W5 Mapping",
"identity": "w5"
}, {
"uri": "http://www.cda-adc.ca/en/services/cdanet/",
"name": "Canadian Dental Association eclaims standard",
"identity": "cdanetv4"
}, {
"uri": "http://hl7.org/v2",
"name": "HL7 v2 Mapping",
"identity": "v2"
}, {
"uri": "http://www.pharmacists.ca/",
"name": "Canadian Pharmacy Associaiton eclaims standard",
"identity": "cpha3pharm"
} ],
"abstract": false,
"type": "Coverage",
"experimental": null,
"resourceType": "StructureDefinition",
"title": null,
"package_version": "0.2.0",
"snapshot": {
"element": [ {
"constraint": [ {
"key": "dom-2",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"xpath": "not(parent::f:contained and f:contained)",
"source": "DomainResource",
"severity": "error",
"expression": "contained.contained.empty()"
}, {
"key": "dom-1",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"xpath": "not(parent::f:contained and f:text)",
"source": "DomainResource",
"severity": "error",
"expression": "contained.text.empty()"
}, {
"key": "dom-4",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "DomainResource",
"severity": "error",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
}, {
"key": "dom-3",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource",
"xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
"source": "DomainResource",
"severity": "error",
"expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()"
} ],
"path": "Coverage",
"min": 0,
"definition": "Financial instrument which may be used to reimburse or pay for health care products and services.",
"short": "Insurance or medical plan or a payment agreement",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "Event",
"identity": "workflow"
}, {
"map": "Coverage",
"identity": "rim"
}, {
"map": "financial.support",
"identity": "w5"
} ],
"max": "*",
"id": "Coverage",
"base": {
"max": "*",
"min": 0,
"path": "Coverage"
}
}, {
"path": "Coverage.id",
"min": 0,
"definition": "MAY contain zero or one [0..1] id (CONF:4383-777).",
"short": "id",
"type": [ {
"code": "id"
} ],
"max": "1",
"id": "Coverage.id",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"path": "Coverage.meta",
"min": 0,
"definition": "MAY contain zero or one [0..1] meta (CONF:4383-776).",
"short": "meta",
"type": [ {
"code": "Meta"
} ],
"max": "1",
"id": "Coverage.meta",
"base": {
"max": "1",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"path": "Coverage.meta.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "Coverage.meta.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"path": "Coverage.meta.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to 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",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.meta.extension",
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"path": "Coverage.meta.versionId",
"min": 0,
"definition": "The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.",
"short": "Version specific identifier",
"type": [ {
"code": "id"
} ],
"max": "1",
"id": "Coverage.meta.versionId",
"comment": "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.",
"base": {
"max": "1",
"min": 0,
"path": "Meta.versionId"
},
"isSummary": true
}, {
"path": "Coverage.meta.lastUpdated",
"min": 0,
"definition": "When the resource last changed - e.g. when the version changed.",
"short": "When the resource version last changed",
"type": [ {
"code": "instant"
} ],
"max": "1",
"id": "Coverage.meta.lastUpdated",
"comment": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.",
"base": {
"max": "1",
"min": 0,
"path": "Meta.lastUpdated"
},
"isSummary": true
}, {
"path": "Coverage.meta.profile",
"min": 1,
"definition": "The meta, if present, SHALL contain exactly one [1..1] profile=\"http://hl7.org/fhir/us/bser/StructureDefinition/InsuranceCoverage\" (CONF:4383-778).",
"short": "profile",
"type": [ {
"code": "uri"
} ],
"patternString": "http://hl7.org/fhir/us/bser/StructureDefinition/InsuranceCoverage",
"max": "1",
"id": "Coverage.meta.profile",
"comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.",
"base": {
"max": "*",
"min": 0,
"path": "Meta.profile"
},
"isSummary": true
}, {
"path": "Coverage.meta.security",
"min": 0,
"definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
"short": "Security Labels applied to this resource",
"type": [ {
"code": "Coding"
} ],
"binding": {
"strength": "extensible",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "SecurityLabels"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "Security Labels from the Healthcare Privacy and Security Classification System.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/security-labels"
}
},
"max": "*",
"id": "Coverage.meta.security",
"comment": "The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.",
"base": {
"max": "*",
"min": 0,
"path": "Meta.security"
},
"isSummary": true
}, {
"path": "Coverage.meta.tag",
"min": 0,
"definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
"short": "Tags applied to this resource",
"type": [ {
"code": "Coding"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Tags"
} ],
"description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\"",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/common-tags"
}
},
"max": "*",
"id": "Coverage.meta.tag",
"comment": "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.",
"base": {
"max": "*",
"min": 0,
"path": "Meta.tag"
},
"isSummary": true
}, {
"path": "Coverage.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "Coverage.implicitRules",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.implicitRules"
},
"isSummary": true
}, {
"path": "Coverage.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"short": "Language of the resource content",
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "extensible",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages"
}
},
"max": "1",
"id": "Coverage.language",
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"base": {
"max": "1",
"min": 0,
"path": "Resource.language"
}
}, {
"path": "Coverage.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"short": "Text summary of the resource, for human interpretation",
"mapping": [ {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"id": "Coverage.text",
"condition": [ "dom-1" ],
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.",
"base": {
"max": "1",
"min": 0,
"path": "DomainResource.text"
}
}, {
"path": "Coverage.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"short": "Contained, inline Resources",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"id": "Coverage.contained",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
}
}, {
"path": "Coverage.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order 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 is allowed to 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",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.extension",
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
}
}, {
"path": "Coverage.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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 is allowed to 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.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.modifierExtension",
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
}
}, {
"path": "Coverage.identifier",
"requirements": "This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.",
"min": 0,
"definition": "SHOULD contain zero or one [0..1] identifier (CONF:4383-155).",
"short": "identifier",
"mapping": [ {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "C02",
"identity": "cdanetv4"
}, {
"map": "IN1-2",
"identity": "v2"
}, {
"map": "C.32, C.33, C.39",
"identity": "cpha3pharm"
}, {
"map": "id",
"identity": "w5"
} ],
"type": [ {
"code": "Identifier"
} ],
"max": "1",
"id": "Coverage.identifier",
"base": {
"max": "*",
"min": 0,
"path": "Coverage.identifier"
},
"isSummary": true
}, {
"path": "Coverage.status",
"min": 1,
"definition": "SHALL contain exactly one [1..1] status, which SHALL be selected from ValueSet Fm-status http://hl7.org/fhir/ValueSet/fm-status DYNAMIC (CONF:4383-151).",
"isModifier": true,
"short": "status",
"mapping": [ {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "status",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-status"
}
},
"max": "1",
"id": "Coverage.status",
"comment": "This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.status"
},
"isSummary": true
}, {
"path": "Coverage.type",
"requirements": "The order of application of coverages is dependent on the types of coverage.",
"min": 1,
"definition": "SHALL contain exactly one [1..1] type, which SHALL be selected from ValueSet Coverage-type http://hl7.org/fhir/ValueSet/coverage-type DYNAMIC (CONF:4383-152).",
"short": "type",
"mapping": [ {
"map": "IN1-15",
"identity": "v2"
}, {
"map": "class",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "required",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/coverage-type"
}
},
"max": "1",
"id": "Coverage.type",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.type"
},
"isSummary": true
}, {
"path": "Coverage.policyHolder",
"min": 0,
"definition": "The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer.",
"short": "Owner of the policy",
"mapping": [ {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
} ],
"max": "1",
"id": "Coverage.policyHolder",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.policyHolder"
},
"isSummary": true
}, {
"path": "Coverage.subscriber",
"min": 1,
"definition": "SHALL contain exactly one [1..1] =\"BSeR Related Person\"BSeR Related Person (identifier: http://hl7.org/fhir/us/bser/StructureDefinition/PatientRelatedPerson) (CONF:4383-148).",
"short": "subscriber",
"mapping": [ {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/us/bser/StructureDefinition/PatientRelatedPerson"
} ],
"patternString": "BSeR Related Person",
"max": "1",
"id": "Coverage.subscriber",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.subscriber"
},
"isSummary": true
}, {
"path": "Coverage.subscriberId",
"min": 0,
"definition": "The insurer assigned ID for the Subscriber.",
"short": "ID assigned to the Subscriber",
"mapping": [ {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.subscriberId",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.subscriberId"
},
"isSummary": true
}, {
"path": "Coverage.beneficiary",
"min": 1,
"definition": "SHALL contain exactly one [1..1] =\"BSeR Patient\"BSeR Patient (identifier: http://hl7.org/fhir/us/bser/StructureDefinition/PatientRole) (CONF:4383-149).",
"short": "beneficiary",
"mapping": [ {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/us/bser/StructureDefinition/PatientRole"
} ],
"patternString": "BSeR Patient",
"max": "1",
"id": "Coverage.beneficiary",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.beneficiary"
},
"isSummary": true
}, {
"path": "Coverage.relationship",
"requirements": "To determine relationship between the patient and the subscriber.",
"min": 0,
"definition": "The relationship of beneficiary (patient) to the subscriber.",
"short": "Beneficiary relationship to the Subscriber",
"mapping": [ {
"map": "C03",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Relationship"
} ],
"description": "The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/policyholder-relationship"
}
},
"max": "1",
"id": "Coverage.relationship",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.relationship"
}
}, {
"path": "Coverage.period",
"min": 0,
"definition": "SHOULD contain zero or one [0..1] period (CONF:4383-153).",
"short": "period",
"mapping": [ {
"map": "Event.occurrence",
"identity": "workflow"
}, {
"map": "IN1-12 / IN1-13",
"identity": "v2"
}, {
"map": "when.done",
"identity": "w5"
} ],
"type": [ {
"code": "Period"
} ],
"max": "1",
"id": "Coverage.period",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.period"
},
"isSummary": true
}, {
"path": "Coverage.period.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "Coverage.period.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"path": "Coverage.period.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to 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",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.period.extension",
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"path": "Coverage.period.start",
"min": 1,
"definition": "The period, if present, SHALL contain exactly one [1..1] start (CONF:4383-156).",
"short": "start",
"mapping": [ {
"map": "DR.1",
"identity": "v2"
}, {
"map": "./low",
"identity": "rim"
} ],
"type": [ {
"code": "dateTime"
} ],
"max": "1",
"id": "Coverage.period.start",
"condition": [ "per-1" ],
"comment": "If the low element is missing, the meaning is that the low boundary is not known.",
"base": {
"max": "1",
"min": 0,
"path": "Period.start"
},
"isSummary": true
}, {
"path": "Coverage.period.end",
"min": 0,
"definition": "The period, if present, MAY contain zero or one [0..1] end (CONF:4383-157).",
"short": "end",
"mapping": [ {
"map": "DR.2",
"identity": "v2"
}, {
"map": "./high",
"identity": "rim"
} ],
"type": [ {
"code": "dateTime"
} ],
"meaningWhenMissing": "If the end of the period is missing, it means that the period is ongoing",
"max": "1",
"id": "Coverage.period.end",
"condition": [ "per-1" ],
"comment": "The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.",
"base": {
"max": "1",
"min": 0,
"path": "Period.end"
},
"isSummary": true
}, {
"path": "Coverage.payor",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"definition": "SHALL contain exactly one [1..1] =\"BSeR Organization\"BSeR Organization (identifier: http://hl7.org/fhir/us/bser/StructureDefinition/OrganizationEntity) (CONF:4383-150).",
"short": "payor",
"mapping": [ {
"map": "A05",
"identity": "cdanetv4"
}, {
"map": "IN1-3",
"identity": "v2"
}, {
"map": "C.30",
"identity": "cpha3pharm"
}, {
"map": "who.author",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/us/bser/StructureDefinition/OrganizationEntity"
} ],
"patternString": "BSeR Organization",
"max": "1",
"id": "Coverage.payor",
"base": {
"max": "*",
"min": 0,
"path": "Coverage.payor"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping",
"min": 0,
"definition": "SHOULD contain zero or one [0..1] grouping (CONF:4383-154).",
"short": "grouping",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Group"
} ],
"max": "1",
"id": "Coverage.grouping",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping"
}
}, {
"path": "Coverage.grouping.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "Coverage.grouping.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"path": "Coverage.grouping.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to 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",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.grouping.extension",
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"path": "Coverage.grouping.modifierExtension",
"min": 0,
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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 is allowed to 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.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "Coverage.grouping.modifierExtension",
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Coverage.grouping.group",
"min": 0,
"definition": "Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify an employer group. May also be referred to as a Policy or Group ID.",
"short": "An identifier for the group",
"mapping": [ {
"map": "C11 (Division,Section)",
"identity": "cdanetv4"
}, {
"map": "IN1-8",
"identity": "v2"
}, {
"map": "C.31",
"identity": "cpha3pharm"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.group",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.group"
},
"isSummary": true
}, {
"path": "Coverage.grouping.groupDisplay",
"min": 0,
"definition": "A short description for the group.",
"short": "Display text for an identifier for the group",
"mapping": [ {
"map": "C11 (Division,Section)",
"identity": "cdanetv4"
}, {
"map": "IN1-8",
"identity": "v2"
}, {
"map": "C.31",
"identity": "cpha3pharm"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.groupDisplay",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.groupDisplay"
},
"isSummary": true
}, {
"path": "Coverage.grouping.subGroup",
"min": 0,
"definition": "Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer group.",
"short": "An identifier for the subsection of the group",
"mapping": [ {
"map": "IN1-8",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subGroup",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subGroup"
},
"isSummary": true
}, {
"path": "Coverage.grouping.subGroupDisplay",
"min": 0,
"definition": "A short description for the subgroup.",
"short": "Display text for the subsection of the group",
"mapping": [ {
"map": "IN1-8",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subGroupDisplay",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subGroupDisplay"
},
"isSummary": true
}, {
"path": "Coverage.grouping.plan",
"min": 0,
"definition": "Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division ID.",
"short": "An identifier for the plan",
"mapping": [ {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.plan",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.plan"
},
"isSummary": true
}, {
"path": "Coverage.grouping.planDisplay",
"min": 0,
"definition": "The grouping, if present, SHOULD contain zero or one [0..1] planDisplay (CONF:4383-158).",
"short": "planDisplay",
"mapping": [ {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.planDisplay",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.planDisplay"
},
"isSummary": true
}, {
"path": "Coverage.grouping.subPlan",
"min": 0,
"definition": "Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employees.",
"short": "An identifier for the subsection of the plan",
"mapping": [ {
"map": "IN1-10",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subPlan",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subPlan"
},
"isSummary": true
}, {
"path": "Coverage.grouping.subPlanDisplay",
"min": 0,
"definition": "A short description for the subplan.",
"short": "Display text for the subsection of the plan",
"mapping": [ {
"map": "IN1-10",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subPlanDisplay",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subPlanDisplay"
},
"isSummary": true
}, {
"path": "Coverage.grouping.class",
"min": 0,
"definition": "Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage such as a level of deductables or co-payment.",
"short": "An identifier for the class",
"mapping": [ {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.class",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.class"
},
"isSummary": true
}, {
"path": "Coverage.grouping.classDisplay",
"min": 0,
"definition": "A short description for the class.",
"short": "Display text for the class",
"mapping": [ {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.classDisplay",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.classDisplay"
},
"isSummary": true
}, {
"path": "Coverage.grouping.subClass",
"min": 0,
"definition": "Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a subclass of coverage such as a sub-level of deductables or co-payment.",
"short": "An identifier for the subsection of the class",
"mapping": [ {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subClass",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subClass"
},
"isSummary": true
}, {
"path": "Coverage.grouping.subClassDisplay",
"min": 0,
"definition": "A short description for the subclass.",
"short": "Display text for the subsection of the subclass",
"mapping": [ {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subClassDisplay",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subClassDisplay"
},
"isSummary": true
}, {
"path": "Coverage.dependent",
"requirements": "For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary.",
"min": 0,
"definition": "A unique identifier for a dependent under the coverage.",
"short": "Dependent number",
"mapping": [ {
"map": "C17",
"identity": "cdanetv4"
}, {
"map": "- No exact HL7 v2 equivalent concept seems to exist;",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.dependent",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.dependent"
},
"isSummary": true
}, {
"path": "Coverage.sequence",
"requirements": "Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'.",
"min": 0,
"definition": "An optional counter for a particular instance of the identified coverage which increments upon each renewal.",
"short": "The plan instance or sequence counter",
"mapping": [ {
"map": "D11",
"identity": "cdanetv4"
}, {
"map": "No HL7 v2 equivalent concept seems to exist",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.sequence",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.sequence"
},
"isSummary": true
}, {
"path": "Coverage.order",
"min": 0,
"definition": "The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care.",
"short": "Relative order of the coverage",
"mapping": [ {
"map": "- No exact HL7 v2 equivalent concept seems to exist;",
"identity": "v2"
} ],
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "Coverage.order",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.order"
},
"isSummary": true
}, {
"path": "Coverage.network",
"min": 0,
"definition": "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.",
"short": "Insurer network",
"mapping": [ {
"map": "D10",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.network",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.network"
},
"isSummary": true
}, {
"path": "Coverage.contract",
"min": 0,
"definition": "The policy(s) which constitute this insurance coverage.",
"short": "Contract details",
"mapping": [ {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Contract"
} ],
"max": "*",
"id": "Coverage.contract",
"base": {
"max": "*",
"min": 0,
"path": "Coverage.contract"
}
} ]
},
"status": "draft",
"id": "7bbc470d-3d5d-4cb5-a723-6ba333b16305",
"kind": "resource",
"url": "http://hl7.org/fhir/us/bser/StructureDefinition/InsuranceCoverage",
"context": [ "Coverage" ],
"version": "0.2.0",
"differential": {
"element": [ {
"id": "Coverage",
"path": "Coverage"
}, {
"id": "Coverage.id",
"max": "1",
"min": 0,
"path": "Coverage.id",
"short": "id",
"definition": "MAY contain zero or one [0..1] id (CONF:4383-777)."
}, {
"id": "Coverage.meta",
"max": "1",
"min": 0,
"path": "Coverage.meta",
"short": "meta",
"definition": "MAY contain zero or one [0..1] meta (CONF:4383-776)."
}, {
"id": "Coverage.meta.profile",
"max": "1",
"min": 1,
"path": "Coverage.meta.profile",
"short": "profile",
"definition": "The meta, if present, SHALL contain exactly one [1..1] profile=\"http://hl7.org/fhir/us/bser/StructureDefinition/InsuranceCoverage\" (CONF:4383-778).",
"patternString": "http://hl7.org/fhir/us/bser/StructureDefinition/InsuranceCoverage"
}, {
"id": "Coverage.identifier",
"max": "1",
"min": 0,
"path": "Coverage.identifier",
"short": "identifier",
"definition": "SHOULD contain zero or one [0..1] identifier (CONF:4383-155)."
}, {
"id": "Coverage.status",
"max": "1",
"min": 1,
"path": "Coverage.status",
"type": [ {
"code": "code"
} ],
"short": "status",
"binding": {
"strength": "required",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-status"
}
},
"definition": "SHALL contain exactly one [1..1] status, which SHALL be selected from ValueSet Fm-status http://hl7.org/fhir/ValueSet/fm-status DYNAMIC (CONF:4383-151)."
}, {
"id": "Coverage.type",
"max": "1",
"min": 1,
"path": "Coverage.type",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "type",
"binding": {
"strength": "required",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/coverage-type"
}
},
"definition": "SHALL contain exactly one [1..1] type, which SHALL be selected from ValueSet Coverage-type http://hl7.org/fhir/ValueSet/coverage-type DYNAMIC (CONF:4383-152)."
}, {
"id": "Coverage.subscriber",
"max": "1",
"min": 1,
"path": "Coverage.subscriber",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/us/bser/StructureDefinition/PatientRelatedPerson"
} ],
"short": "subscriber",
"definition": "SHALL contain exactly one [1..1] =\"BSeR Related Person\"BSeR Related Person (identifier: http://hl7.org/fhir/us/bser/StructureDefinition/PatientRelatedPerson) (CONF:4383-148).",
"patternString": "BSeR Related Person"
}, {
"id": "Coverage.beneficiary",
"max": "1",
"min": 1,
"path": "Coverage.beneficiary",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/us/bser/StructureDefinition/PatientRole"
} ],
"short": "beneficiary",
"definition": "SHALL contain exactly one [1..1] =\"BSeR Patient\"BSeR Patient (identifier: http://hl7.org/fhir/us/bser/StructureDefinition/PatientRole) (CONF:4383-149).",
"patternString": "BSeR Patient"
}, {
"id": "Coverage.period",
"max": "1",
"min": 0,
"path": "Coverage.period",
"short": "period",
"definition": "SHOULD contain zero or one [0..1] period (CONF:4383-153)."
}, {
"id": "Coverage.period.start",
"max": "1",
"min": 1,
"path": "Coverage.period.start",
"short": "start",
"definition": "The period, if present, SHALL contain exactly one [1..1] start (CONF:4383-156)."
}, {
"id": "Coverage.period.end",
"max": "1",
"min": 0,
"path": "Coverage.period.end",
"short": "end",
"definition": "The period, if present, MAY contain zero or one [0..1] end (CONF:4383-157)."
}, {
"id": "Coverage.payor",
"max": "1",
"min": 1,
"path": "Coverage.payor",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/us/bser/StructureDefinition/OrganizationEntity"
} ],
"short": "payor",
"definition": "SHALL contain exactly one [1..1] =\"BSeR Organization\"BSeR Organization (identifier: http://hl7.org/fhir/us/bser/StructureDefinition/OrganizationEntity) (CONF:4383-150).",
"patternString": "BSeR Organization"
}, {
"id": "Coverage.grouping",
"max": "1",
"min": 0,
"path": "Coverage.grouping",
"short": "grouping",
"definition": "SHOULD contain zero or one [0..1] grouping (CONF:4383-154)."
}, {
"id": "Coverage.grouping.planDisplay",
"max": "1",
"min": 0,
"path": "Coverage.grouping.planDisplay",
"short": "planDisplay",
"definition": "The grouping, if present, SHOULD contain zero or one [0..1] planDisplay (CONF:4383-158)."
} ]
},
"contact": [ {
"name": "AbdulMalik Shakir",
"telecom": [ {
"use": "work",
"value": "6266444491",
"system": "phone"
}, {
"use": "work",
"value": "abdulmalik.shakir@hi3solutions.com",
"system": "email"
} ]
} ],
"contextType": "resource",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage"
}