Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build

Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: MOPEDCoverage

Official URL: http://example.org/StructureDefinition/MOPEDCoverage Version: 0.1.0
Draft as of 2024-09-11 Responsible: Example Publisher Computable Name: MOPEDCoverage

MOPED Profil der Coverage Ressource für Versicherungen. Basierend auf dem Profil "ecardAnspruch": https://www.chipkarte.at/de/vdas-on-fhir/site/StructureDefinition-ecard-anspruch-profile.html

Usage:

  • This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... RezeptgebbefreitExtension 0..1 boolean Rezeptgebührenbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
.... KostenanteilbefreitExtension 0..1 boolean Kostenanteilbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
... type 0..1 CodeableConcept Anspruchsart
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
... subscriber 0..1 Reference(HL7® AT Core Patient Profile) Subscriber to the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.code
.... class:Versichertenarten S 0..1 BackboneElement Versichertenarten
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class:Versichertenarten.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... RezeptgebbefreitExtension 0..1 boolean Rezeptgebührenbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
.... KostenanteilbefreitExtension 0..1 boolean Kostenanteilbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... type Σ 0..1 CodeableConcept Anspruchsart
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile) Subscriber to the policy
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.code
.... class:All Slices Content/Rules for all slices
..... 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, e.g. Group, Plan, Class, etc.

..... value Σ 1..1 Identifier Value associated with the type
.... class:Versichertenarten S 0..1 BackboneElement Versichertenarten
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
..... value Σ 1..1 Identifier Value associated with the type
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
..... value Σ 1..1 Identifier Value associated with the type

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
from the FHIR Standard
Coverage.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.class:Versichertenarten.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... 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: AllLanguages (required): IETF language tag for a human language

Additional BindingsPurpose
CommonLanguages Starter Set
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... RezeptgebbefreitExtension 0..1 boolean Rezeptgebührenbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
.... KostenanteilbefreitExtension 0..1 boolean Kostenanteilbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business identifier(s) for this coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... paymentBy 0..* BackboneElement Self-pay parties and responsibility
.... 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
.... party Σ 1..1 Reference(Patient | RelatedPerson | Organization) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Anspruchsart
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile) Subscriber to the policy
... subscriberId Σ 0..* Identifier ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) 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
... insurer Σ 0..1 Reference(Organization) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.code
.... class:All Slices Content/Rules for all slices
..... 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, e.g. Group, Plan, Class, etc.

..... value Σ 1..1 Identifier Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:Versichertenarten S 0..1 BackboneElement Versichertenarten
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
....... version Σ 0..1 string Version of the system - if relevant
....... code ΣC 0..1 code Symbol in syntax defined by the system
....... display ΣC 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... value Σ 1..1 Identifier Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
....... version Σ 0..1 string Version of the system - if relevant
....... code ΣC 0..1 code Symbol in syntax defined by the system
....... display ΣC 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... value Σ 1..1 Identifier 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.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example)
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example)
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example)
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example)
.... value[x] Σ 0..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
... insurancePlan 0..1 Reference(InsurancePlan) Insurance plan details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagerequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages|5.0.0
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
from the FHIR Standard
Coverage.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.class:Versichertenarten.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Coverage.costToBeneficiary.networkexampleNetworkTypeCodes
http://hl7.org/fhir/ValueSet/benefit-network
from the FHIR Standard
Coverage.costToBeneficiary.unitexampleUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
from the FHIR Standard
Coverage.costToBeneficiary.termexampleBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Must-Support: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.class

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... RezeptgebbefreitExtension 0..1 boolean Rezeptgebührenbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
.... KostenanteilbefreitExtension 0..1 boolean Kostenanteilbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
... type 0..1 CodeableConcept Anspruchsart
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
... subscriber 0..1 Reference(HL7® AT Core Patient Profile) Subscriber to the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.code
.... class:Versichertenarten S 0..1 BackboneElement Versichertenarten
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
...... coding
....... system 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class:Versichertenarten.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... RezeptgebbefreitExtension 0..1 boolean Rezeptgebührenbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
.... KostenanteilbefreitExtension 0..1 boolean Kostenanteilbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... type Σ 0..1 CodeableConcept Anspruchsart
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile) Subscriber to the policy
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.code
.... class:All Slices Content/Rules for all slices
..... 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, e.g. Group, Plan, Class, etc.

..... value Σ 1..1 Identifier Value associated with the type
.... class:Versichertenarten S 0..1 BackboneElement Versichertenarten
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
..... value Σ 1..1 Identifier Value associated with the type
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
..... value Σ 1..1 Identifier Value associated with the type

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
from the FHIR Standard
Coverage.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.class:Versichertenarten.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... 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: AllLanguages (required): IETF language tag for a human language

Additional BindingsPurpose
CommonLanguages Starter Set
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... RezeptgebbefreitExtension 0..1 boolean Rezeptgebührenbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
.... KostenanteilbefreitExtension 0..1 boolean Kostenanteilbefreit laut Versicherungsanspruch
URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business identifier(s) for this coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... paymentBy 0..* BackboneElement Self-pay parties and responsibility
.... 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
.... party Σ 1..1 Reference(Patient | RelatedPerson | Organization) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Anspruchsart
Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile) Subscriber to the policy
... subscriberId Σ 0..* Identifier ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) 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
... insurer Σ 0..1 Reference(Organization) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.code
.... class:All Slices Content/Rules for all slices
..... 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, e.g. Group, Plan, Class, etc.

..... value Σ 1..1 Identifier Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:Versichertenarten S 0..1 BackboneElement Versichertenarten
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
....... version Σ 0..1 string Version of the system - if relevant
....... code ΣC 0..1 code Symbol in syntax defined by the system
....... display ΣC 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... value Σ 1..1 Identifier Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... 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: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 0..* Coding Code defined by a terminology system
....... id 0..1 id Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
....... version Σ 0..1 string Version of the system - if relevant
....... code ΣC 0..1 code Symbol in syntax defined by the system
....... display ΣC 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... value Σ 1..1 Identifier 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.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example)
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example)
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example)
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example)
.... value[x] Σ 0..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
... insurancePlan 0..1 Reference(InsurancePlan) Insurance plan details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagerequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages|5.0.0
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
from the FHIR Standard
Coverage.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.class:Versichertenarten.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.typerequiredhttps://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Coverage.costToBeneficiary.networkexampleNetworkTypeCodes
http://hl7.org/fhir/ValueSet/benefit-network
from the FHIR Standard
Coverage.costToBeneficiary.unitexampleUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
from the FHIR Standard
Coverage.costToBeneficiary.termexampleBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Must-Support: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.class

 

Other representations of profile: CSV, Excel, Schematron