CH ORF (R4)
2.0.0-ballot - ballot
This page is part of the CH ORF (R4) (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
Official URL: http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage | Version: 2.0.0-ballot | |||
Active as of 2023-06-29 | Computable Name: ChOrfCoverage | |||
Copyright/Legal: CC0-1.0 |
Profile to specify how the coverage is represented. This provides an organization or the individual, which will pay for services requested.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH ORF Coverage | |
contained | S | 0..* | Resource | Contained, inline Resources |
identifier | S | 0..* | Identifier | Business Identifier for the coverage |
type | S | 1..1 | CodeableConcept | Description of identifier Binding: Coverage Identifier Type (required) |
coding | S | 1..* | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
text | S | 0..1 | string | Plain text representation of the concept |
value | S | 1..1 | string | The value that is unique |
status | S | 1..1 | code | active | cancelled | draft | entered-in-error |
type | S | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (required) |
beneficiary | S | 1..1 | Reference(CH Core Patient) | Plan beneficiary |
payor | S | 1..* | Reference(CH Core Organization | CH Core Patient | RelatedPerson) | Issuer of the policy |
Documentation for this format |
Path | Conformance | ValueSet |
Coverage.identifier.type | required | ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) |
Coverage.type | required | ChOrfCoverageType (a valid code from Coverage Type) |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH ORF Coverage | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
contained | S | 0..* | Resource | Contained, inline Resources |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | SΣ | 0..* | Identifier | Business Identifier for the coverage |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
type | SΣ | 1..1 | CodeableConcept | Description of identifier Binding: Coverage Identifier Type (required) |
coding | SΣ | 1..* | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
text | SΣ | 0..1 | string | Plain text representation of the concept |
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (required) |
beneficiary | SΣ | 1..1 | Reference(CH Core Patient) | Plan beneficiary |
payor | SΣ | 1..* | Reference(CH Core Organization | CH Core Patient | RelatedPerson) | Issuer of the policy |
Documentation for this format |
Path | Conformance | ValueSet |
Coverage.identifier.use | required | IdentifierUse |
Coverage.identifier.type | required | ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) |
Coverage.status | required | FinancialResourceStatusCodes |
Coverage.type | required | ChOrfCoverageType (a valid code from Coverage Type) |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | CH ORF Coverage | |||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | S | 0..* | Resource | Contained, inline Resources | ||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | SΣ | 0..* | Identifier | Business Identifier for the coverage | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | SΣ | 1..1 | CodeableConcept | Description of identifier Binding: Coverage Identifier Type (required) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | SΣ | 0..1 | string | Plain text representation of the concept | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (required) | ||||
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | SΣ | 1..1 | Reference(CH Core Patient) | Plan beneficiary | ||||
dependent | Σ | 0..1 | string | Dependent number | ||||
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
period | Σ | 0..1 | Period | Coverage start and end dates | ||||
payor | SΣ | 1..* | Reference(CH Core Organization | CH Core Patient | RelatedPerson) | Issuer of the policy | ||||
class | 0..* | BackboneElement | Additional coverage classifications | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
network | Σ | 0..1 | string | Insurer network | ||||
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
period | Σ | 0..1 | Period | The effective period of the exception | ||||
subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
contract | 0..* | Reference(Contract) | Contract details | |||||
Documentation for this format |
Path | Conformance | ValueSet | ||||
Coverage.language | preferred | CommonLanguages
| ||||
Coverage.identifier.use | required | IdentifierUse | ||||
Coverage.identifier.type | required | ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) | ||||
Coverage.status | required | FinancialResourceStatusCodes | ||||
Coverage.type | required | ChOrfCoverageType (a valid code from Coverage Type) | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
Coverage.class.type | extensible | CoverageClassCodes | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
Id | Grade | Path(s) | Details | Requirements |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Coverage
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH ORF Coverage | |
contained | S | 0..* | Resource | Contained, inline Resources |
identifier | S | 0..* | Identifier | Business Identifier for the coverage |
type | S | 1..1 | CodeableConcept | Description of identifier Binding: Coverage Identifier Type (required) |
coding | S | 1..* | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
text | S | 0..1 | string | Plain text representation of the concept |
value | S | 1..1 | string | The value that is unique |
status | S | 1..1 | code | active | cancelled | draft | entered-in-error |
type | S | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (required) |
beneficiary | S | 1..1 | Reference(CH Core Patient) | Plan beneficiary |
payor | S | 1..* | Reference(CH Core Organization | CH Core Patient | RelatedPerson) | Issuer of the policy |
Documentation for this format |
Path | Conformance | ValueSet |
Coverage.identifier.type | required | ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) |
Coverage.type | required | ChOrfCoverageType (a valid code from Coverage Type) |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | CH ORF Coverage | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
contained | S | 0..* | Resource | Contained, inline Resources |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | SΣ | 0..* | Identifier | Business Identifier for the coverage |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
type | SΣ | 1..1 | CodeableConcept | Description of identifier Binding: Coverage Identifier Type (required) |
coding | SΣ | 1..* | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
text | SΣ | 0..1 | string | Plain text representation of the concept |
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (required) |
beneficiary | SΣ | 1..1 | Reference(CH Core Patient) | Plan beneficiary |
payor | SΣ | 1..* | Reference(CH Core Organization | CH Core Patient | RelatedPerson) | Issuer of the policy |
Documentation for this format |
Path | Conformance | ValueSet |
Coverage.identifier.use | required | IdentifierUse |
Coverage.identifier.type | required | ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) |
Coverage.status | required | FinancialResourceStatusCodes |
Coverage.type | required | ChOrfCoverageType (a valid code from Coverage Type) |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | CH ORF Coverage | |||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | S | 0..* | Resource | Contained, inline Resources | ||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | SΣ | 0..* | Identifier | Business Identifier for the coverage | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | SΣ | 1..1 | CodeableConcept | Description of identifier Binding: Coverage Identifier Type (required) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | SΣ | 0..1 | string | Plain text representation of the concept | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
type | SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: Coverage Type (required) | ||||
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | SΣ | 1..1 | Reference(CH Core Patient) | Plan beneficiary | ||||
dependent | Σ | 0..1 | string | Dependent number | ||||
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
period | Σ | 0..1 | Period | Coverage start and end dates | ||||
payor | SΣ | 1..* | Reference(CH Core Organization | CH Core Patient | RelatedPerson) | Issuer of the policy | ||||
class | 0..* | BackboneElement | Additional coverage classifications | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
network | Σ | 0..1 | string | Insurer network | ||||
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
period | Σ | 0..1 | Period | The effective period of the exception | ||||
subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
contract | 0..* | Reference(Contract) | Contract details | |||||
Documentation for this format |
Path | Conformance | ValueSet | ||||
Coverage.language | preferred | CommonLanguages
| ||||
Coverage.identifier.use | required | IdentifierUse | ||||
Coverage.identifier.type | required | ChOrfCoverageIdentifierType (a valid code from Coverage Identifier Type) | ||||
Coverage.status | required | FinancialResourceStatusCodes | ||||
Coverage.type | required | ChOrfCoverageType (a valid code from Coverage Type) | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
Coverage.class.type | extensible | CoverageClassCodes | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
Id | Grade | Path(s) | Details | Requirements |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Coverage
Other representations of profile: CSV, Excel, Schematron