{
  "description": "Übergabe von Informationen zum Kostenträger/ Krankenversicherungsverhältnis vom PVS an die VoS.",
  "_filename": "StructureDefinition-KBV-PR-VoS-Coverage.json",
  "package_name": "kbv.ita.vos",
  "date": "2025-10-01",
  "derivation": "constraint",
  "publisher": "Kassenärztliche Bundesvereinigung",
  "fhirVersion": "4.0.1",
  "name": "KBV_PR_VoS_Coverage",
  "abstract": false,
  "type": "Coverage",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": "KBV_PR_VoS_Coverage",
  "package_version": "2.2.0-kommentierung",
  "status": "draft",
  "id": "f11d9374-4db1-443f-bfee-51faefc4ce3d",
  "kind": "resource",
  "url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
  "version": "2.2.0",
  "differential": {
    "element": [ {
      "id": "Coverage",
      "path": "Coverage",
      "short": "Kostenträger",
      "constraint": [ {
        "key": "-for-angabeIKzustaendigeKrankenkasseEGK",
        "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.",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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-angabeVersichertenart",
        "human": "Die Versichertenart ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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.",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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-angabeDMP",
        "human": "Das DMP-Kennzeichen ist nicht vorhanden, dieses ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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": "Angaben zum Versicherungsverhältnis der behandelten Person"
    }, {
      "id": "Coverage.id",
      "min": 1,
      "path": "Coverage.id",
      "mustSupport": true
    }, {
      "id": "Coverage.meta",
      "min": 1,
      "path": "Coverage.meta",
      "mustSupport": true
    }, {
      "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:vosProfile",
      "max": "1",
      "min": 1,
      "path": "Coverage.meta.profile",
      "sliceName": "vosProfile",
      "mustSupport": true,
      "fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage|2.2.0"
    }, {
      "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.contained",
      "max": "0",
      "path": "Coverage.contained"
    }, {
      "id": "Coverage.extension",
      "max": "7",
      "path": "Coverage.extension",
      "slicing": {
        "rules": "closed",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Coverage.extension:einlesedatumKarte",
      "max": "1",
      "min": 0,
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://fhir.de/StructureDefinition/gkv/einlesedatum-karte" ]
      } ],
      "sliceName": "einlesedatumKarte",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:BesonderePersonengruppe",
      "max": "1",
      "min": 0,
      "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",
      "min": 0,
      "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",
      "min": 0,
      "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",
      "min": 0,
      "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.extension:zuzahlungsstatus",
      "max": "1",
      "min": 0,
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus" ]
      } ],
      "sliceName": "zuzahlungsstatus",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:zuzahlungsstatus.extension",
      "path": "Coverage.extension.extension",
      "slicing": {
        "rules": "closed",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Coverage.extension:zuzahlungsstatus.extension:status",
      "path": "Coverage.extension.extension",
      "sliceName": "status",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:zuzahlungsstatus.extension:status.value[x]",
      "path": "Coverage.extension.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:SKT-Zusatzangabe",
      "max": "1",
      "min": 0,
      "path": "Coverage.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.kbv.de/StructureDefinition/KBV_EX_VoS_SKT" ]
      } ],
      "sliceName": "SKT-Zusatzangabe",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:SKT-Zusatzangabe.value[x]",
      "path": "Coverage.extension.value[x]",
      "mustSupport": true
    }, {
      "id": "Coverage.extension:SKT-Zusatzangabe.value[x]:valueString",
      "path": "Coverage.extension.value[x]",
      "type": [ {
        "code": "string"
      } ],
      "sliceName": "valueString",
      "mustSupport": true
    }, {
      "id": "Coverage.identifier",
      "max": "0",
      "path": "Coverage.identifier",
      "short": "Primaerer Identifier der Versicherung",
      "definition": "Ein gesetzliches Versicherungsverhaeltnis 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_VoS_Patient|2.2.0" ]
      } ],
      "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",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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": "Institutionskennzeichen (IKs)",
      "definition": "Dieses Feld enthält das Institutionskennzeichen (IK) der zuständigen Krankenkasse z.B. laut elektronischer Gesundheitskarte (eGK). Siehe hierzu die Übertragungsregel nach der 'Technische Anlage zur Anlage 4a BMV-Ä' Kapitel 2.2 'USE-CASES.",
      "mustSupport": true
    }, {
      "id": "Coverage.payor.identifier.extension",
      "path": "Coverage.payor.identifier.extension",
      "slicing": {
        "rules": "closed",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Coverage.payor.identifier.extension:alternativeID",
      "max": "1",
      "min": 0,
      "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.extension",
      "max": "0",
      "path": "Coverage.payor.identifier.extension.extension"
    }, {
      "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.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.",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "severity": "error",
        "expression": "matches('^[0-9]{9}$')"
      } ],
      "mustSupport": true
    }, {
      "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.",
        "source": "https://fhir.kbv.de/StructureDefinition/KBV_PR_VoS_Coverage",
        "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 zur Bedruckung",
      "definition": "Diese Angabe beinhaltet den Bedruckungsnamen des Kostenträgers. Der korrekte Name ergibt sich aus den definierten Bedruckungsregeln laut 'Technische Anlage zur Anlage 4a BMV-Ä' Kapitel '2.3 Bedruckungs des Personalienfeldes und des verkürzten Personalienfeldes'.",
      "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"
}