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 2024-11-21 Responsible: Example Publisher Computable Name: MOPEDCoverage

MOPED Profil der Coverage Ressource für Versicherungen.

Usage:

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 Coverage
... Slices for identifier 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID 0..1 Identifier Business identifier(s) for this coverage
..... system 1..1 uri The namespace for the identifier value
Required Pattern: http://tbd-svc/vdasid
..... assigner 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... paymentBy
.... party 1..1 Reference(HL7® AT Core Organization Profile) Parties performing self-payment
... subscriber 0..1 Reference(HL7® AT Core Patient Profile | Hauptversicherter) Subscriber to the policy
... insurer 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... coding
....... system 1..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.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
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
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... identifier:VDASID Σ 0..1 Identifier Business identifier(s) for this coverage
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: http://tbd-svc/vdasid
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... 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)
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile | Hauptversicherter) Subscriber to the policy
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... insurer Σ 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system
.... 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: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: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
..... value Σ 1..1 Identifier Value associated with the type

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|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.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

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
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID Σ 0..1 Identifier Business identifier(s) for this coverage
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: http://tbd-svc/vdasid
..... value ΣC 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... 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(HL7® AT Core Organization Profile) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelfPayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile | Hauptversicherter) 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(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system
.... 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: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: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (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 1..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.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
from the FHIR Standard
Coverage.identifier:VDASID.typeextensibleIdentifierTypeCodes
http://hl7.org/fhir/ValueSet/identifier-type
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.typepreferredCoverageTypeAndSelfPayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
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:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
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

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 1 element

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

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

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage Coverage
... Slices for identifier 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID 0..1 Identifier Business identifier(s) for this coverage
..... system 1..1 uri The namespace for the identifier value
Required Pattern: http://tbd-svc/vdasid
..... assigner 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... paymentBy
.... party 1..1 Reference(HL7® AT Core Organization Profile) Parties performing self-payment
... subscriber 0..1 Reference(HL7® AT Core Patient Profile | Hauptversicherter) Subscriber to the policy
... insurer 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... coding
....... system 1..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.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

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
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... identifier:VDASID Σ 0..1 Identifier Business identifier(s) for this coverage
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: http://tbd-svc/vdasid
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... 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)
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile | Hauptversicherter) Subscriber to the policy
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... insurer Σ 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system
.... 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: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: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
..... value Σ 1..1 Identifier Value associated with the type

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|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.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

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
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID Σ 0..1 Identifier Business identifier(s) for this coverage
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: http://tbd-svc/vdasid
..... value ΣC 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... 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(HL7® AT Core Organization Profile) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelfPayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(HL7® AT Core Patient Profile | Hauptversicherter) 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(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding.system
.... 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: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: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (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 1..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.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
from the FHIR Standard
Coverage.identifier:VDASID.typeextensibleIdentifierTypeCodes
http://hl7.org/fhir/ValueSet/identifier-type
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.typepreferredCoverageTypeAndSelfPayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
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:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
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

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 1 element

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

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

 

Other representations of profile: CSV, Excel, Schematron