CH Core (R4)
1.0.0 - Trial use

This page is part of the CH Core (R4) (v1.0.0: STU 1). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

StructureDefinition: CHCoreCoverage

The Coverage referenced in the CH Core profiles.

The official URL for this profile is:

http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-coverage

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Coverage

Summary

Mandatory: 0 element (2 nested mandatory elements)
Fixed Value: 1 element

Slices

This structure defines the following Slices:

  • The element Coverage.identifier is sliced based on the value of value:system

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH Core Coverage
... identifier 0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber 0..*Identifierinsurancecardnumber
..... system 1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value 1..1stringInsurance card number of the patient (20 digits)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*CoverageCH Core Coverage
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber ΣI0..*Identifierinsurancecardnumber
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system ΣI1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value ΣI1..1stringInsurance card number of the patient (20 digits)
Example General: 123456
..... period ΣI0..1PeriodTime period when id is/was valid for use
..... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type ΣI0..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred)
... policyHolder ΣI0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber ΣI0..1Reference(Patient | RelatedPerson)Subscriber to the policy
... subscriberId ΣI0..1stringID assigned to the subscriber
... beneficiary ΣI1..1Reference(Patient)Plan beneficiary
... dependent ΣI0..1stringDependent number
... relationship I0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible)
... period ΣI0..1PeriodCoverage start and end dates
... payor ΣI1..*Reference(Organization | Patient | RelatedPerson)Issuer of the policy
... class I0..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
.... value ΣI1..1stringValue associated with the type
.... name ΣI0..1stringHuman readable description of the type and value
... order ΣI0..1positiveIntRelative order of the coverage
... network ΣI0..1stringInsurer network
... costToBeneficiary I0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type ΣI0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible)
.... value[x] ΣI1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception I0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example)
..... period ΣI0..1PeriodThe effective period of the exception
... subrogation I0..1booleanReimbursement to insurer
... contract I0..*Reference(Contract)Contract details

doco Documentation for this format

This structure is derived from Coverage

Summary

Mandatory: 0 element (2 nested mandatory elements)
Fixed Value: 1 element

Slices

This structure defines the following Slices:

  • The element Coverage.identifier is sliced based on the value of value:system

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageCH Core Coverage
... identifier 0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber 0..*Identifierinsurancecardnumber
..... system 1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value 1..1stringInsurance card number of the patient (20 digits)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*CoverageCH Core Coverage
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*(Slice Definition)Business Identifier for the coverage
Slice: Unordered, Open by value:system
.... identifier:insurancecardnumber ΣI0..*Identifierinsurancecardnumber
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system ΣI1..1urioid of the insurance card number
Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
..... value ΣI1..1stringInsurance card number of the patient (20 digits)
Example General: 123456
..... period ΣI0..1PeriodTime period when id is/was valid for use
..... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type ΣI0..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred)
... policyHolder ΣI0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber ΣI0..1Reference(Patient | RelatedPerson)Subscriber to the policy
... subscriberId ΣI0..1stringID assigned to the subscriber
... beneficiary ΣI1..1Reference(Patient)Plan beneficiary
... dependent ΣI0..1stringDependent number
... relationship I0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible)
... period ΣI0..1PeriodCoverage start and end dates
... payor ΣI1..*Reference(Organization | Patient | RelatedPerson)Issuer of the policy
... class I0..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type ΣI1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible)
.... value ΣI1..1stringValue associated with the type
.... name ΣI0..1stringHuman readable description of the type and value
... order ΣI0..1positiveIntRelative order of the coverage
... network ΣI0..1stringInsurer network
... costToBeneficiary I0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type ΣI0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible)
.... value[x] ΣI1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception I0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type ΣI1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example)
..... period ΣI0..1PeriodThe effective period of the exception
... subrogation I0..1booleanReimbursement to insurer
... contract I0..*Reference(Contract)Contract details

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

Terminology Bindings

PathConformanceValueSet
Coverage.languagepreferredCommonLanguages
Max Binding: AllLanguages
Coverage.identifier:insurancecardnumber.userequiredIdentifierUse
Coverage.identifier:insurancecardnumber.typeextensibleIdentifier Type Codes
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.class.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Constraints

Constraints

IdPathDetailsRequirements
dom-2CoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3CoverageIf 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-4CoverageIf 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-5CoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6CoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1Coverage.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.identifier:insurancecardnumber.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.identifier:insurancecardnumber.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.identifier:insurancecardnumber.assignerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.policyHolderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subscriberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subscriberIdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.beneficiaryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.dependentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.payorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.classAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.class.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.class.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.class.nameAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.orderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.networkAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiaryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exceptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exception.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.exception.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.exception.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Coverage.costToBeneficiary.exception.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Coverage.costToBeneficiary.exception.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.costToBeneficiary.exception.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.subrogationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Coverage.contractAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())