Standard Health Record FHIR Implementation Guide

SHR Coverage Profile

 

The official URL for this profile is:

http://standardhealthrecord.org/fhir/StructureDefinition/shr-financial-Coverage

Health insurance coverage available (even if not used for payment for a given encounter).

This profile builds on Coverage.

This profile was published on Tue Feb 27 00:00:00 EST 2018 as a draft by The MITRE Corporation: Standard Health Record Collaborative.

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

Summary

Mandatory: 0 element (1 nested mandatory element)

SHR Mapping Source

This structure represents the following SHR mapping definition:

shr.financial.Coverage maps to Coverage:
  Type maps to type
  InsuranceMemberId maps to subscriberId
  EffectiveTimePeriod maps to period

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*SHR Coverage Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierThe primary coverage ID
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type Σ1..1CodeableConceptType of coverage such as medical or accident
Binding: SHR InsuranceProviderTypeVS ValueSet (required)
... policyHolder Σ0..1Reference(Patient), Reference(RelatedPerson), Reference(Organization)Owner of the policy
... subscriber Σ0..1Reference(Patient), Reference(RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the Subscriber
... beneficiary Σ0..1Reference(Patient)Plan Beneficiary
... relationship 0..1CodeableConceptBeneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (example)
... period Σ0..1PeriodCoverage start and end dates
... payor Σ0..*Reference(Organization), Reference(Patient), Reference(RelatedPerson)Identifier for the plan or agreement issuer
... grouping I0..1BackboneElementAdditional coverage classifications
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... group Σ0..1stringAn identifier for the group
.... groupDisplay Σ0..1stringDisplay text for an identifier for the group
.... subGroup Σ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay Σ0..1stringDisplay text for the subsection of the group
.... plan Σ0..1stringAn identifier for the plan
.... planDisplay Σ0..1stringDisplay text for the plan
.... subPlan Σ0..1stringAn identifier for the subsection of the plan
.... subPlanDisplay Σ0..1stringDisplay text for the subsection of the plan
.... class Σ0..1stringAn identifier for the class
.... classDisplay Σ0..1stringDisplay text for the class
.... subClass Σ0..1stringAn identifier for the subsection of the class
.... subClassDisplay Σ0..1stringDisplay text for the subsection of the subclass
... dependent Σ0..1stringDependent number
... sequence Σ0..1stringThe plan instance or sequence counter
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Summary

Mandatory: 0 element (1 nested mandatory element)

SHR Mapping Source

This structure represents the following SHR mapping definition:

shr.financial.Coverage maps to Coverage:
  Type maps to type
  InsuranceMemberId maps to subscriberId
  EffectiveTimePeriod maps to period

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*SHR Coverage Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierThe primary coverage ID
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type Σ1..1CodeableConceptType of coverage such as medical or accident
Binding: SHR InsuranceProviderTypeVS ValueSet (required)
... policyHolder Σ0..1Reference(Patient), Reference(RelatedPerson), Reference(Organization)Owner of the policy
... subscriber Σ0..1Reference(Patient), Reference(RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the Subscriber
... beneficiary Σ0..1Reference(Patient)Plan Beneficiary
... relationship 0..1CodeableConceptBeneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (example)
... period Σ0..1PeriodCoverage start and end dates
... payor Σ0..*Reference(Organization), Reference(Patient), Reference(RelatedPerson)Identifier for the plan or agreement issuer
... grouping I0..1BackboneElementAdditional coverage classifications
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... group Σ0..1stringAn identifier for the group
.... groupDisplay Σ0..1stringDisplay text for an identifier for the group
.... subGroup Σ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay Σ0..1stringDisplay text for the subsection of the group
.... plan Σ0..1stringAn identifier for the plan
.... planDisplay Σ0..1stringDisplay text for the plan
.... subPlan Σ0..1stringAn identifier for the subsection of the plan
.... subPlanDisplay Σ0..1stringDisplay text for the subsection of the plan
.... class Σ0..1stringAn identifier for the class
.... classDisplay Σ0..1stringDisplay text for the class
.... subClass Σ0..1stringAn identifier for the subsection of the class
.... subClassDisplay Σ0..1stringDisplay text for the subsection of the subclass
... dependent Σ0..1stringDependent number
... sequence Σ0..1stringThe plan instance or sequence counter
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON, TTL), Schema: XML Schematron

 

Terminology Bindings

PathNameConformanceValueSet
Coverage.languageCommon LanguagesextensibleCommon Languages
Coverage.statusFinancial Resource Status CodesrequiredFinancial Resource Status Codes
Coverage.typeSHR InsuranceProviderTypeVS ValueSetrequiredSHR InsuranceProviderTypeVS ValueSet
Coverage.relationshipPolicyholder Relationship CodesexamplePolicyholder Relationship Codes

 

Constraints

IdPathDetailsRequirements
dom-2CoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-1CoverageIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.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-3CoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
: contained.where(('#'+id in %resource.descendants().reference).not()).empty()
ele-1Coverage.groupingAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())