{
  "description": null,
  "_filename": "KBV_PR_FOR_Coverage.json",
  "package_name": "kbv.ita.erp",
  "date": "2024-11-22",
  "derivation": "constraint",
  "publisher": "Kassenärztliche Bundesvereinigung (KBV)",
  "fhirVersion": "4.0.1",
  "name": "KBV_PR_FOR_Coverage",
  "abstract": false,
  "type": "Coverage",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "1.2.0-alpha",
  "status": "draft",
  "id": "9981420a-9932-47da-b764-4b2d98b29aab",
  "kind": "resource",
  "url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage",
  "version": "1.2.0",
  "differential": {
    "element": [ {
      "id": "Coverage",
      "path": "Coverage",
      "constraint": [ {
        "key": "-for-angabeIKzustaendigeKrankenkasseEGKPflicht",
        "human": "Das IK der zustaendigen Krankenkasse ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
        "severity": "error",
        "expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies payor.identifier.exists()"
      }, {
        "key": "-for-angabeVersichertenartPflicht",
        "human": "Die Versichertenart ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
        "severity": "error",
        "expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/versichertenart').exists()"
      }, {
        "key": "-for-angabeBesonderePersonengruppePflicht",
        "human": "Die Besondere Personengruppe ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
        "severity": "error",
        "expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/besondere-personengruppe').exists()"
      }, {
        "key": "-for-angabeIKKostentraegerVerbot",
        "human": "Nur wenn der Kostentraeger vom Typ BG oder UK ist, dann kann das IK des Kostentraegers uebertragen werden",
        "severity": "error",
        "expression": "(type.coding.code='GKV' or type.coding.code='SKT' or type.coding.code='SEL' or type.coding.code='PKV') implies payor.identifier.extension('https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK').exists().not()"
      }, {
        "key": "-for-angabeDMPPflicht",
        "human": "Das DMP-Kennzeichen ist nicht vorhanden, dieses ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
        "severity": "error",
        "expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen').exists()"
      } ],
      "definition": "Das Versicherungsverhältnis, welches genutzt werden kann, um die Kosten für die Behandlungskosten zu tragen."
    }, {
      "id": "Coverage.id",
      "min": 1,
      "path": "Coverage.id",
      "mustSupport": true
    }, {
      "id": "Coverage.meta",
      "min": 1,
      "path": "Coverage.meta",
      "mustSupport": true
    }, {
      "id": "Coverage.meta.versionId",
      "max": "0",
      "path": "Coverage.meta.versionId"
    }, {
      "id": "Coverage.meta.lastUpdated",
      "max": "0",
      "path": "Coverage.meta.lastUpdated"
    }, {
      "id": "Coverage.meta.source",
      "max": "0",
      "path": "Coverage.meta.source"
    }, {
      "id": "Coverage.meta.profile",
      "min": 1,
      "path": "Coverage.meta.profile",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "$this",
          "type": "value"
        } ]
      },
      "mustSupport": true
    }, {
      "id": "Coverage.meta.profile:forProfile",
      "max": "1",
      "min": 1,
      "path": "Coverage.meta.profile",
      "sliceName": "forProfile",
      "mustSupport": true,
      "fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage|1.2"
    }, {
      "id": "Coverage.meta.security",
      "max": "0",
      "path": "Coverage.meta.security"
    }, {
      "id": "Coverage.meta.tag",
      "max": "0",
      "path": "Coverage.meta.tag"
    }, {
      "id": "Coverage.implicitRules",
      "max": "0",
      "path": "Coverage.implicitRules"
    }, {
      "id": "Coverage.language",
      "max": "0",
      "path": "Coverage.language"
    }, {
      "id": "Coverage.text",
      "max": "0",
      "path": "Coverage.text"
    }, {
      "id": "Coverage.contained",
      "max": "0",
      "path": "Coverage.contained"
    }, {
      "id": "Coverage.extension",
      "max": "4",
      "path": "Coverage.extension",
      "slicing": {
        "rules": "closed",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "mustSupport": true
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe",
      "max": "1",
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://fhir.de/StructureDefinition/gkv/besondere-personengruppe" ]
      } ],
      "sliceName": "BesonderePersonengruppe",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe.value[x]",
      "min": 1,
      "path": "Coverage.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe.value[x].system",
      "path": "Coverage.extension.value[x].system",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe.value[x].version",
      "max": "0",
      "path": "Coverage.extension.value[x].version"
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe.value[x].code",
      "path": "Coverage.extension.value[x].code",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe.value[x].display",
      "max": "0",
      "path": "Coverage.extension.value[x].display"
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe.value[x].userSelected",
      "max": "0",
      "path": "Coverage.extension.value[x].userSelected"
    }, {
      "id": "Coverage.extension:DMPKennzeichen",
      "max": "1",
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen" ]
      } ],
      "sliceName": "DMPKennzeichen",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:DMPKennzeichen.value[x]",
      "min": 1,
      "path": "Coverage.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:DMPKennzeichen.value[x].system",
      "path": "Coverage.extension.value[x].system",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:DMPKennzeichen.value[x].version",
      "max": "0",
      "path": "Coverage.extension.value[x].version"
    }, {
      "id": "Coverage.extension:DMPKennzeichen.value[x].code",
      "path": "Coverage.extension.value[x].code",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:DMPKennzeichen.value[x].display",
      "max": "0",
      "path": "Coverage.extension.value[x].display"
    }, {
      "id": "Coverage.extension:DMPKennzeichen.value[x].userSelected",
      "max": "0",
      "path": "Coverage.extension.value[x].userSelected"
    }, {
      "id": "Coverage.extension:Versichertenart",
      "max": "1",
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://fhir.de/StructureDefinition/gkv/versichertenart" ]
      } ],
      "sliceName": "Versichertenart",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:Versichertenart.value[x]",
      "min": 1,
      "path": "Coverage.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:Versichertenart.value[x].system",
      "path": "Coverage.extension.value[x].system",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:Versichertenart.value[x].version",
      "max": "0",
      "path": "Coverage.extension.value[x].version"
    }, {
      "id": "Coverage.extension:Versichertenart.value[x].code",
      "path": "Coverage.extension.value[x].code",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:Versichertenart.value[x].display",
      "max": "0",
      "path": "Coverage.extension.value[x].display"
    }, {
      "id": "Coverage.extension:Versichertenart.value[x].userSelected",
      "max": "0",
      "path": "Coverage.extension.value[x].userSelected"
    }, {
      "id": "Coverage.extension:WOP",
      "max": "1",
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://fhir.de/StructureDefinition/gkv/wop" ]
      } ],
      "sliceName": "WOP",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:WOP.value[x]",
      "min": 1,
      "path": "Coverage.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:WOP.value[x].system",
      "path": "Coverage.extension.value[x].system",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:WOP.value[x].version",
      "max": "0",
      "path": "Coverage.extension.value[x].version"
    }, {
      "id": "Coverage.extension:WOP.value[x].code",
      "path": "Coverage.extension.value[x].code",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:WOP.value[x].display",
      "max": "0",
      "path": "Coverage.extension.value[x].display"
    }, {
      "id": "Coverage.extension:WOP.value[x].userSelected",
      "max": "0",
      "path": "Coverage.extension.value[x].userSelected"
    }, {
      "id": "Coverage.identifier",
      "max": "0",
      "path": "Coverage.identifier",
      "short": "Primaerer Identifier der Versicherung",
      "definition": "Ein gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet.",
      "mustSupport": true
    }, {
      "id": "Coverage.status",
      "path": "Coverage.status",
      "fixedCode": "active",
      "mustSupport": true
    }, {
      "id": "Coverage.type",
      "min": 1,
      "path": "Coverage.type",
      "short": "Kostenträgertyp",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.kbv.de/ValueSet/KBV_VS_FOR_Payor_type"
      },
      "definition": "Art des Kostenträgers",
      "mustSupport": true
    }, {
      "id": "Coverage.type.coding",
      "max": "1",
      "min": 1,
      "path": "Coverage.type.coding",
      "mustSupport": true
    }, {
      "id": "Coverage.type.coding.system",
      "min": 1,
      "path": "Coverage.type.coding.system",
      "mustSupport": true
    }, {
      "id": "Coverage.type.coding.version",
      "max": "0",
      "path": "Coverage.type.coding.version"
    }, {
      "id": "Coverage.type.coding.code",
      "min": 1,
      "path": "Coverage.type.coding.code",
      "mustSupport": true
    }, {
      "id": "Coverage.type.coding.display",
      "max": "0",
      "path": "Coverage.type.coding.display"
    }, {
      "id": "Coverage.type.coding.userSelected",
      "max": "0",
      "path": "Coverage.type.coding.userSelected"
    }, {
      "id": "Coverage.type.text",
      "max": "0",
      "path": "Coverage.type.text"
    }, {
      "id": "Coverage.policyHolder",
      "max": "0",
      "path": "Coverage.policyHolder"
    }, {
      "id": "Coverage.subscriber",
      "max": "0",
      "path": "Coverage.subscriber"
    }, {
      "id": "Coverage.subscriberId",
      "max": "0",
      "path": "Coverage.subscriberId"
    }, {
      "id": "Coverage.beneficiary",
      "path": "Coverage.beneficiary",
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Patient|1.2" ]
      } ],
      "short": "Begünstigte Person",
      "mustSupport": true
    }, {
      "id": "Coverage.beneficiary.reference",
      "min": 1,
      "path": "Coverage.beneficiary.reference",
      "definition": "An dieser Stelle wird die Referenz zum Patienten hinterlegt.",
      "mustSupport": true
    }, {
      "id": "Coverage.beneficiary.type",
      "max": "0",
      "path": "Coverage.beneficiary.type"
    }, {
      "id": "Coverage.beneficiary.identifier",
      "max": "0",
      "path": "Coverage.beneficiary.identifier"
    }, {
      "id": "Coverage.beneficiary.display",
      "max": "0",
      "path": "Coverage.beneficiary.display"
    }, {
      "id": "Coverage.dependent",
      "max": "0",
      "path": "Coverage.dependent"
    }, {
      "id": "Coverage.relationship",
      "max": "0",
      "path": "Coverage.relationship"
    }, {
      "id": "Coverage.period",
      "path": "Coverage.period",
      "constraint": [ {
        "key": "-for-begrenzungDate",
        "human": "Beschränkung auf die Angaben JJJJ-MM-TT",
        "severity": "error",
        "expression": "end.toString().length() = 10"
      } ],
      "mustSupport": true
    }, {
      "id": "Coverage.period.start",
      "max": "0",
      "path": "Coverage.period.start"
    }, {
      "id": "Coverage.period.end",
      "min": 1,
      "path": "Coverage.period.end",
      "short": "Versicherungsschutz Ende",
      "definition": "Angabe zum Versicherungsschutz Ende",
      "mustSupport": true
    }, {
      "id": "Coverage.payor",
      "max": "1",
      "path": "Coverage.payor",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.reference",
      "max": "0",
      "path": "Coverage.payor.reference"
    }, {
      "id": "Coverage.payor.type",
      "max": "0",
      "path": "Coverage.payor.type"
    }, {
      "id": "Coverage.payor.identifier",
      "path": "Coverage.payor.identifier",
      "type": [ {
        "code": "Identifier",
        "profile": [ "http://fhir.de/StructureDefinition/identifier-iknr" ]
      } ],
      "short": "IKs",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.extension",
      "max": "1",
      "path": "Coverage.payor.identifier.extension",
      "slicing": {
        "rules": "closed",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID",
      "max": "1",
      "path": "Coverage.payor.identifier.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK" ]
      } ],
      "sliceName": "alternativeID",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]",
      "path": "Coverage.payor.identifier.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier",
      "path": "Coverage.payor.identifier.extension.value[x]",
      "sliceName": "valueIdentifier",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.use",
      "path": "Coverage.payor.identifier.extension.value[x].use",
      "mustSupport": false
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type",
      "path": "Coverage.payor.identifier.extension.value[x].type",
      "mustSupport": false
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding",
      "path": "Coverage.payor.identifier.extension.value[x].type.coding",
      "mustSupport": false
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding.system",
      "path": "Coverage.payor.identifier.extension.value[x].type.coding.system",
      "mustSupport": false
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding.code",
      "path": "Coverage.payor.identifier.extension.value[x].type.coding.code",
      "mustSupport": false
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.system",
      "path": "Coverage.payor.identifier.extension.value[x].system",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.value",
      "path": "Coverage.payor.identifier.extension.value[x].value",
      "constraint": [ {
        "key": "-for-laengeIK",
        "human": "Die IK-Nummer muss 9-stellig numerisch sein.",
        "severity": "error",
        "expression": "matches('^[0-9]{9}$')"
      } ],
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.type.coding.version",
      "max": "0",
      "path": "Coverage.payor.identifier.type.coding.version"
    }, {
      "id": "Coverage.payor.identifier.type.coding.display",
      "max": "0",
      "path": "Coverage.payor.identifier.type.coding.display"
    }, {
      "id": "Coverage.payor.identifier.type.coding.userSelected",
      "max": "0",
      "path": "Coverage.payor.identifier.type.coding.userSelected"
    }, {
      "id": "Coverage.payor.identifier.type.text",
      "max": "0",
      "path": "Coverage.payor.identifier.type.text"
    }, {
      "id": "Coverage.payor.identifier.system",
      "path": "Coverage.payor.identifier.system",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.value",
      "path": "Coverage.payor.identifier.value",
      "constraint": [ {
        "key": "-for-laengeIK",
        "human": "Die IK-Nummer muss 9-stellig numerisch sein.",
        "severity": "error",
        "expression": "matches('^[0-9]{9}$')"
      } ],
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.period",
      "max": "0",
      "path": "Coverage.payor.identifier.period"
    }, {
      "id": "Coverage.payor.identifier.assigner",
      "max": "0",
      "path": "Coverage.payor.identifier.assigner"
    }, {
      "id": "Coverage.payor.display",
      "min": 1,
      "path": "Coverage.payor.display",
      "short": "Kostenträgername",
      "maxLength": 45,
      "mustSupport": true
    }, {
      "id": "Coverage.class",
      "max": "0",
      "path": "Coverage.class"
    }, {
      "id": "Coverage.order",
      "max": "0",
      "path": "Coverage.order"
    }, {
      "id": "Coverage.network",
      "max": "0",
      "path": "Coverage.network"
    }, {
      "id": "Coverage.costToBeneficiary",
      "max": "0",
      "path": "Coverage.costToBeneficiary"
    }, {
      "id": "Coverage.subrogation",
      "max": "0",
      "path": "Coverage.subrogation"
    }, {
      "id": "Coverage.contract",
      "max": "0",
      "path": "Coverage.contract"
    } ]
  },
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage"
}