EHI Export Implementation Guide
0.1.0 - ci-build
EHI Export Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://ehi-export.pointclickcare.com//StructureDefinition/coverage | Version: 0.1.0 | |||
| Draft as of 2025-12-10 | Computable Name: EHICoverage | |||
Insurance Coverage
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-MedicareAdvantagePlan.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-CompanyName.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-ProviderNumber.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerType.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerDescription.html | |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() |
Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |
![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type |
![]() ![]() ![]() |
0..* | BackboneElement | (USCDI) Group | |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..* | Coding | Code defined by a terminology system |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | (USCDI) Group Number |
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | (USCDI) Group Name |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.class:group.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
0..0 | A set of rules under which this content was created | ||
![]() ![]() |
0..0 | Language of the resource content | ||
![]() ![]() |
0..0 | Contained, inline Resources | ||
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-MedicareAdvantagePlan.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-CompanyName.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-ProviderNumber.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerType.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerDescription.html | |
![]() ![]() |
1..1 | Reference(Patient) | Plan beneficiary | |
![]() ![]() |
0..0 | Dependent number | ||
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |
![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) | |
![]() ![]() ![]() |
0..* | BackboneElement | (USCDI) Group | |
![]() ![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
![]() ![]() ![]() ![]() |
1..1 | string | (USCDI) Group Number | |
![]() ![]() ![]() ![]() |
0..1 | string | (USCDI) Group Name | |
![]() ![]() |
0..0 | Relative order of the coverage | ||
![]() ![]() |
0..0 | Insurer network | ||
![]() ![]() |
0..0 | Patient payments for services/products | ||
![]() ![]() |
0..0 | Reimbursement to insurer | ||
![]() ![]() |
0..0 | Contract details | ||
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact |
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-MedicareAdvantagePlan.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-CompanyName.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-ProviderNumber.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerType.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerDescription.html | |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
![]() ![]() |
Σ | 0..1 | string | ID assigned to the subscriber |
![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |
![]() ![]() |
Σ | 0..1 | Period | Coverage start and end dates |
![]() ![]() |
Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |
![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type |
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value |
![]() ![]() ![]() |
0..* | BackboneElement | (USCDI) Group | |
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..* | Coding | Code defined by a terminology system |
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user |
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | (USCDI) Group Number |
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | (USCDI) Group Name |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.class:group.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
This structure is derived from Coverage
Summary
Mandatory: 0 element(2 nested mandatory elements)
Fixed: 2 elements
Prohibited: 9 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-MedicareAdvantagePlan.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-CompanyName.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-ProviderNumber.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerType.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerDescription.html | |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() |
Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |
![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type |
![]() ![]() ![]() |
0..* | BackboneElement | (USCDI) Group | |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..* | Coding | Code defined by a terminology system |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | (USCDI) Group Number |
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | (USCDI) Group Name |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.class:group.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
Differential View
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
0..0 | A set of rules under which this content was created | ||
![]() ![]() |
0..0 | Language of the resource content | ||
![]() ![]() |
0..0 | Contained, inline Resources | ||
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-MedicareAdvantagePlan.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-CompanyName.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-ProviderNumber.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerType.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerDescription.html | |
![]() ![]() |
1..1 | Reference(Patient) | Plan beneficiary | |
![]() ![]() |
0..0 | Dependent number | ||
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |
![]() ![]() ![]() |
Content/Rules for all slices | |||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) | |
![]() ![]() ![]() |
0..* | BackboneElement | (USCDI) Group | |
![]() ![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() ![]() |
1..* | Coding | Code defined by a terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system Fixed Value: group | |
![]() ![]() ![]() ![]() |
1..1 | string | (USCDI) Group Number | |
![]() ![]() ![]() ![]() |
0..1 | string | (USCDI) Group Name | |
![]() ![]() |
0..0 | Relative order of the coverage | ||
![]() ![]() |
0..0 | Insurer network | ||
![]() ![]() |
0..0 | Patient payments for services/products | ||
![]() ![]() |
0..0 | Reimbursement to insurer | ||
![]() ![]() |
0..0 | Contract details | ||
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact |
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |
![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-MedicareAdvantagePlan.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-CompanyName.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-ProviderNumber.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerType.html | |
![]() ![]() ![]() |
0..1 | string | Extension URL: https://ehi-export.pointclickcare.com/site/StructureDefinition-PayerDescription.html | |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy |
![]() ![]() |
Σ | 0..1 | string | ID assigned to the subscriber |
![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |
![]() ![]() |
Σ | 0..1 | Period | Coverage start and end dates |
![]() ![]() |
Σ | 1..* | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type | |
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Content/Rules for all slices | |||
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
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Σ | 1..1 | string | Value associated with the type |
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Σ | 0..1 | string | Human readable description of the type and value |
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0..* | BackboneElement | (USCDI) Group | |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations | |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible) |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
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Σ | 1..* | Coding | Code defined by a terminology system |
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0..1 | string | Unique id for inter-element referencing | |
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
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Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
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Σ | 0..1 | string | Version of the system - if relevant |
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Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group |
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Σ | 0..1 | string | Representation defined by the system |
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Σ | 0..1 | boolean | If this coding was chosen directly by the user |
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Σ | 0..1 | string | Plain text representation of the concept |
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Σ | 1..1 | string | (USCDI) Group Number |
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Σ | 0..1 | string | (USCDI) Group Name |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.class:group.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
This structure is derived from Coverage
Summary
Mandatory: 0 element(2 nested mandatory elements)
Fixed: 2 elements
Prohibited: 9 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron