{ "resourceType": "StructureDefinition", "id": "profile-Coverage-family", "url": "https://bpcs.exchange/fhir/StructureDefinition/profile-Coverage-family", "name": "CoverageFamily", "title": "Coverage - Family", "status": "active", "experimental": false, "description": "Coverage that is enrolled in on a family rather than individual basis", "fhirVersion": "5.0.0", "mapping": [ { "identity": "BPCS", "name": "Internal BPCS API" } ], "kind": "resource", "abstract": false, "type": "Coverage", "baseDefinition": "https://bpcs.exchange/fhir/StructureDefinition/profile-Coverage-family-base", "derivation": "constraint", "snapshot": { "element": [ { "id": "Coverage", "path": "Coverage", "short": "Insurance or medical plan or a payment agreement", "definition": "Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.", "comment": "The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.", "min": 0, "max": "*", "base": { "path": "Coverage", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "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", "expression": "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()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "Entity, Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.support" }, { "identity": "rim", "map": "Coverage" } ] }, { "id": "Coverage.id", "path": "Coverage.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "This will be the application number for the coverage", "min": 1, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "Coverage.meta", "path": "Coverage.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.implicitRules", "path": "Coverage.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.language", "path": "Coverage.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "required", "description": "IETF language tag for a human language", "valueSet": "http://hl7.org/fhir/ValueSet/all-languages|5.0.0", "additional": [ { "purpose": "starter", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } ] }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.text", "path": "Coverage.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "dom-6" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "Coverage.contained", "path": "Coverage.contained", "slicing": { "discriminator": [ { "type": "profile", "path": "$this" } ], "rules": "open" }, "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 1, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "condition": [ "dom-2", "dom-4", "dom-3", "dom-5" ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.contained:provenance", "path": "Coverage.contained", "sliceName": "provenance", "short": "Creation/Update/etc. Metadata", "definition": "Nested Provenance information referring to this resource that describes the creation, and sometimes the most recent update and/or inactivation of the record, specifically who was responsible and when it occurred", "comment": "Some parties may be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.", "alias": [ "inline resources", "anonymous resources", "contained resources", "History", "Event", "Activity" ], "min": 1, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Provenance", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Provenance" ] } ], "condition": [ "dom-2", "dom-4", "dom-3", "dom-5" ], "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "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", "expression": "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()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Entity, Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "infrastructure.information" }, { "identity": "rim", "map": "ControlAct[isNormalAct() and subsumes(CACT, classCode) and moodCode=EVN]" }, { "identity": "w3c.prov", "map": "Activity" } ] }, { "id": "Coverage.extension", "path": "Coverage.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:delegate", "path": "Coverage.extension", "sliceName": "delegate", "short": "delegate", "definition": "Indicates a person that can act as a contact for a family member coverage other than a member of the covered family", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-Delegate" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:withReceipts", "path": "Coverage.extension", "sliceName": "withReceipts", "short": "withReceipts", "definition": "Indicates that a new Family Coverage has receipts submitted as part of the application. (Impacts whether the application can be deleted.)", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-WithReceiptsFlag" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "BPCS", "map": "ApplicationDTO.withReceipts" } ] }, { "id": "Coverage.extension:renewal", "path": "Coverage.extension", "sliceName": "renewal", "short": "Coverage not paying period", "definition": "If true, indicates the coverage is a renewal of a previous family coverage. Otherwise, this is a new new coverage", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-RenewalFlag" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "BPCS", "map": "ApplicationDTO.type" } ] }, { "id": "Coverage.extension:registrationDate", "path": "Coverage.extension", "sliceName": "registrationDate", "short": "When coverage was issued", "definition": "The date on which coverage was activated (which may be later or earlier than when the coverage becomes effective)", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-RegistrationDate" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:inYearAdjustment", "path": "Coverage.extension", "sliceName": "inYearAdjustment", "short": "In-year Adjustment", "definition": "If true, indicates that deductible is to be based on current-year income rather than previous year income (typically because of a significant income change)", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-InYearAdjustmentFlag" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:overpaidDeductible", "path": "Coverage.extension", "sliceName": "overpaidDeductible", "short": "overpaidDeductibleStatus", "definition": "The overpaid deductible status is used by certain processes to determine if an overpaid deductible is applicable to the family and if so, if that overpaid deductible calculation is completed.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-OverpaidDeductibleStatus" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:privateInsuranceContribution", "path": "Coverage.extension", "sliceName": "privateInsuranceContribution", "short": "pvtInsContribution", "definition": "This is the aggregate total of each family member’s private insurance contributions.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-PrivateInsuranceContribution" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:basePrivateInsuranceCredit", "path": "Coverage.extension", "sliceName": "basePrivateInsuranceCredit", "short": "Base private insurance credit", "definition": "The full, non-prorated private insurance credit (i.e. the amount credited towards the family deductible based on funds paid for private insurance)", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-BasePrivateInsuranceCredit" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:baseDeductible", "path": "Coverage.extension", "sliceName": "baseDeductible", "short": "Base deductible amount", "definition": "The full, non-prorated deductible amount prior to adjustments", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-BaseDeductible" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:problemCode", "path": "Coverage.extension", "sliceName": "problemCode", "short": "problemCodes", "definition": "Indicates issues with recipient information, a private individual coverage or public family coverage as part of a family coverage application", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ProblemCode" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "BPCS", "map": "FamilyDTO.problemCodes" } ] }, { "id": "Coverage.extension:problemCode.id", "path": "Coverage.extension.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.extension:problemCode.extension", "path": "Coverage.extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:problemCode.url", "path": "Coverage.extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "fixedUri": "https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ProblemCode", "mustSupport": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.extension:problemCode.value[x]", "path": "Coverage.extension.value[x]", "short": "A reference to a code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Coding", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Coding-simple" ] } ], "condition": [ "ext-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "cod-1", "severity": "warning", "human": "A Coding SHOULD NOT have a display unless a code is also present. Computation on Coding.display alone is generally unsafe. Consider using CodeableConcept.text", "expression": "code.exists().not() implies display.exists().not()", "source": "http://hl7.org/fhir/StructureDefinition/Coding" } ], "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Problem-family" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "BPCS", "map": "InsuranceDTO.problemCodes, FamilyMemberDTO.problemCodes" } ] }, { "id": "Coverage.modifierExtension", "path": "Coverage.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.identifier", "path": "Coverage.identifier", "short": "Business identifier(s) for this coverage", "definition": "The identifier of the coverage as issued by the insurer.", "comment": "The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant. Note that not all insurers issue unique member IDs therefore searches may result in multiple responses.", "requirements": "Allows coverages to be distinguished and referenced.", "min": 0, "max": "*", "base": { "path": "Coverage.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "cdanetv4", "map": "C02" }, { "identity": "rim", "map": ".id" }, { "identity": "cpha3pharm", "map": "C.32, C.33, C.39" } ] }, { "id": "Coverage.status", "path": "Coverage.status", "short": "draft | active", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.", "requirements": "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.", "min": 1, "max": "1", "base": { "path": "Coverage.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-FinancialStatus" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": "Act.status" } ] }, { "id": "Coverage.kind", "path": "Coverage.kind", "short": "insurance | self-pay | other", "definition": "The nature of the coverage be it insurance, or cash payment such as self-pay.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "This is used to implement conformance on other elements.", "min": 1, "max": "1", "base": { "path": "Coverage.kind", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "patternCode": "insurance", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageKind" } ], "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.paymentBy", "path": "Coverage.paymentBy", "short": "Self-pay parties and responsibility", "definition": "Link to the paying party and optionally what specifically they will be responsible to pay.", "min": 0, "max": "*", "base": { "path": "Coverage.paymentBy", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.paymentBy.id", "path": "Coverage.paymentBy.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.paymentBy.extension", "path": "Coverage.paymentBy.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.paymentBy.modifierExtension", "path": "Coverage.paymentBy.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.paymentBy.party", "path": "Coverage.paymentBy.party", "short": "Parties performing self-payment", "definition": "The list of parties providing non-insurance payment for the treatment costs.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 1, "max": "1", "base": { "path": "Coverage.paymentBy.party", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Coverage.paymentBy.responsibility", "path": "Coverage.paymentBy.responsibility", "short": "Party's responsibility", "definition": "Description of the financial responsibility.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "min": 0, "max": "1", "base": { "path": "Coverage.paymentBy.responsibility", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.type", "path": "Coverage.type", "short": "Coverage category such as medical or accident", "definition": "The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "The order of application of coverages is dependent on the types of coverage.", "min": 0, "max": "1", "base": { "path": "Coverage.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageType" } ], "strength": "preferred", "description": "The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "v2", "map": "IN1-15" } ] }, { "id": "Coverage.policyHolder", "path": "Coverage.policyHolder", "short": "Owner of the policy", "definition": "The party who 'owns' the insurance policy.", "comment": "For example: may be an individual, corporation or the subscriber's employer.", "requirements": "This provides employer information in the case of Worker's Compensation and other policies.", "min": 0, "max": "1", "base": { "path": "Coverage.policyHolder", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "cdanetv4", "map": "D01 through D09" }, { "identity": "v2", "map": "IN1-16, 18, 19-name of insured, address, date of birth" }, { "identity": "cpha3pharm", "map": "C.35" } ] }, { "id": "Coverage.subscriber", "path": "Coverage.subscriber", "short": "A reference from one resource to another", "definition": "A reference from one resource to another.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "This is the party who is entitled to the benfits under the policy.", "min": 0, "max": "1", "base": { "path": "Coverage.subscriber", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" ], "targetProfile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-search" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "cdanetv4", "map": "D01 through D09" }, { "identity": "v2", "map": "IN1-16, 18, 19-name of insured, address, date of birth" }, { "identity": "cpha3pharm", "map": "C.35" } ] }, { "id": "Coverage.subscriberId", "path": "Coverage.subscriberId", "short": "ID assigned to the subscriber", "definition": "The insurer assigned ID for the Subscriber.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "The insurer requires this identifier on correspondance and claims (digital and otherwise).", "min": 0, "max": "*", "base": { "path": "Coverage.subscriberId", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "cdanetv4", "map": "D01 through D09" }, { "identity": "v2", "map": "IN1-16, 18, 19-name of insured, address, date of birth" }, { "identity": "cpha3pharm", "map": "C.35" } ] }, { "id": "Coverage.beneficiary", "path": "Coverage.beneficiary", "short": "A reference from one resource to another", "definition": "The policyholder ID is the ODB eligibility number of the person who took out the insurance policy. Any given recipient can be the policyholder of more than one insurance policy. This attribute should always be populated.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "This is the party who receives treatment for which the costs are reimbursed under the coverage.", "min": 1, "max": "1", "base": { "path": "Coverage.beneficiary", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-no-patient" ], "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "cdanetv4", "map": "D01 through D09" }, { "identity": "v2", "map": "IN1-16, 18, 19-name of insured, address, date of birth" }, { "identity": "cpha3pharm", "map": "C.35" } ] }, { "id": "Coverage.dependent", "path": "Coverage.dependent", "short": "Dependent number", "definition": "A designator for a dependent under the coverage.", "comment": "Sometimes the member number is constructed from the subscriberId and the dependant number.", "requirements": "For some coverages a single identifier is issued to the Subscriber and then an additional dependent number is issued to each beneficiary.", "min": 0, "max": "1", "base": { "path": "Coverage.dependent", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "C17" }, { "identity": "v2", "map": "- No exact HL7 V2 equivalent concept seems to exist;" } ] }, { "id": "Coverage.relationship", "path": "Coverage.relationship", "short": "Beneficiary relationship to the subscriber", "definition": "The relationship of beneficiary (patient) to the subscriber.", "comment": "Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.", "requirements": "The relationship between the patient and the subscriber to determine coordination of benefits.", "min": 0, "max": "1", "base": { "path": "Coverage.relationship", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Relationship" } ], "strength": "extensible", "description": "The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).", "valueSet": "http://hl7.org/fhir/ValueSet/subscriber-relationship" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "cdanetv4", "map": "C03" } ] }, { "id": "Coverage.period", "path": "Coverage.period", "short": "Coverage start and end dates", "definition": "Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "requirements": "Some insurers require the submission of the coverage term.", "min": 0, "max": "1", "base": { "path": "Coverage.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" }, { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.done[x]" }, { "identity": "v2", "map": "IN1-12 / IN1-13" }, { "identity": "rim", "map": "Act.effectiveTime" } ] }, { "id": "Coverage.period.id", "path": "Coverage.period.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.period.extension", "path": "Coverage.period.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.period.start", "path": "Coverage.period.start", "short": "Starting time with inclusive boundary", "definition": "The start of the period. The boundary is inclusive.", "comment": "If the low element is missing, the meaning is that the low boundary is not known.", "min": 0, "max": "1", "base": { "path": "Period.start", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "per-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR.1" }, { "identity": "rim", "map": "./low" }, { "identity": "BPCS", "map": "ApplicationDTO.proRatedStartDate (if not Aug 1), FamilyDTO.enrollmentEffectiveDate, FamilyHistoryDTO.enrollmentEffDate" } ] }, { "id": "Coverage.period.end", "path": "Coverage.period.end", "short": "End time with inclusive boundary, if not ongoing", "definition": "The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.", "comment": "The end value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.", "min": 0, "max": "1", "base": { "path": "Period.end", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "meaningWhenMissing": "If the end of the period is missing, it means that the period is ongoing", "condition": [ "per-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR.2" }, { "identity": "rim", "map": "./high" }, { "identity": "BPCS", "map": "FamilyDTO.enrollmentEndDate, FamilyHistoryDTO.enrollmentEndDate" } ] }, { "id": "Coverage.insurer", "path": "Coverage.insurer", "short": "Issuer of the policy", "definition": "The program or plan underwriter, payor, insurance company.", "comment": "May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).", "requirements": "Need to identify the issuer to target for claim processing and for coordination of benefit processing.", "min": 0, "max": "1", "base": { "path": "Coverage.insurer", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "patternReference": { "reference": "Organization/bpcs" }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Coverage.class", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Class" } ], "path": "Coverage.class", "slicing": { "discriminator": [ { "type": "value", "path": "type" } ], "rules": "closed" }, "short": "Additional coverage classifications", "definition": "A suite of underwriter specific classifiers.", "comment": "For example, class may be used to identify a class of coverage or employer group, policy, or plan.", "requirements": "The codes provided on the health card which identify or confirm the specific policy for the insurer.", "min": 2, "max": "*", "base": { "path": "Coverage.class", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class.id", "path": "Coverage.class.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class.extension", "path": "Coverage.class.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class.modifierExtension", "path": "Coverage.class.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class.type", "path": "Coverage.class.type", "short": "Type of class such as 'group' or 'plan'", "definition": "The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "The insurer issued label for a specific health card value.", "min": 1, "max": "1", "base": { "path": "Coverage.class.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageClass" } ], "strength": "extensible", "description": "The policy classifications, e.g. Group, Plan, Class, etc.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-class" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.class.value", "path": "Coverage.class.value", "short": "Value associated with the type", "definition": "The alphanumeric identifier associated with the insurer issued label.", "comment": "For example, the Group or Plan number.", "requirements": "The insurer issued label and identifier are necessary to identify the specific policy, group, etc..", "min": 1, "max": "1", "base": { "path": "Coverage.class.value", "min": 1, "max": "1" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-2" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.class.name", "path": "Coverage.class.name", "short": "Human readable description of the type and value", "definition": "A short description for the class.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Used to provide a meaningful description in correspondence to the patient.", "min": 0, "max": "1", "base": { "path": "Coverage.class.name", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-8" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.class:program", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Class" } ], "path": "Coverage.class", "sliceName": "program", "short": "Coverage plan info", "definition": "A suite of underwriter specific classifiers.", "comment": "For example, class may be used to identify a class of coverage or employer group, policy, or plan.", "requirements": "The codes provided on the health card which identify or confirm the specific policy for the insurer.", "min": 1, "max": "1", "base": { "path": "Coverage.class", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class:program.id", "path": "Coverage.class.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class:program.extension", "path": "Coverage.class.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class:program.modifierExtension", "path": "Coverage.class.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class:program.type", "path": "Coverage.class.type", "short": "Type of class such as 'group' or 'plan'", "definition": "The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "The insurer issued label for a specific health card value.", "min": 1, "max": "1", "base": { "path": "Coverage.class.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageClass" } ], "strength": "extensible", "description": "The policy classifications, e.g. Group, Plan, Class, etc.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-class" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.class:program.value", "path": "Coverage.class.value", "short": "Value associated with the type", "definition": "The alphanumeric identifier associated with the insurer issued label.", "comment": "For example, the Group or Plan number.", "requirements": "The insurer issued label and identifier are necessary to identify the specific policy, group, etc..", "min": 1, "max": "1", "base": { "path": "Coverage.class.value", "min": 1, "max": "1" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-2" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.class:program.value.id", "path": "Coverage.class.value.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class:program.value.extension", "path": "Coverage.class.value.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class:program.value.use", "path": "Coverage.class.value.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition", "valueString": "Identifies the purpose for this identifier, if known ." }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|5.0.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Coverage.class:program.value.type", "path": "Coverage.class.value.type", "short": "Description of identifier", "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition", "valueString": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose." }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Coverage.class:program.value.system", "path": "Coverage.class.value.system", "short": "The namespace for the identifier value", "definition": "Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.", "comment": "Identifier.system is always case sensitive.", "requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "patternUri": "https://bpcs.exchange/fhir/CodeSystem/cs-ProgramPlan", "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Coverage.class:program.value.value", "path": "Coverage.class.value.value", "short": "BPCS Program id", "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment": "The binding is extensible to allow for the addition of new codes. Codes must be found in the current expansion of the value set.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "condition": [ "ident-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "binding": { "strength": "extensible", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Program" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" }, { "identity": "BPCS", "map": "ApplicationDTO.program" } ] }, { "id": "Coverage.class:program.value.period", "path": "Coverage.class.value.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" }, { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Coverage.class:program.value.assigner", "path": "Coverage.class.value.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Coverage.class:program.name", "path": "Coverage.class.name", "short": "Human readable description of the type and value", "definition": "A short description for the class.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Used to provide a meaningful description in correspondence to the patient.", "min": 0, "max": "1", "base": { "path": "Coverage.class.name", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-8" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.class:plan", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Class" } ], "path": "Coverage.class", "sliceName": "plan", "short": "BPCS plan info", "definition": "A suite of underwriter specific classifiers.", "comment": "For example, class may be used to identify a class of coverage or employer group, policy, or plan.", "requirements": "The codes provided on the health card which identify or confirm the specific policy for the insurer.", "min": 1, "max": "1", "base": { "path": "Coverage.class", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class:plan.id", "path": "Coverage.class.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class:plan.extension", "path": "Coverage.class.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class:plan.modifierExtension", "path": "Coverage.class.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class:plan.type", "path": "Coverage.class.type", "short": "Type of class such as 'group' or 'plan'", "definition": "The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "The insurer issued label for a specific health card value.", "min": 1, "max": "1", "base": { "path": "Coverage.class.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "subplan" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageClass" } ], "strength": "extensible", "description": "The policy classifications, e.g. Group, Plan, Class, etc.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-class" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.class:plan.value", "path": "Coverage.class.value", "short": "Value associated with the type", "definition": "The alphanumeric identifier associated with the insurer issued label.", "comment": "For example, the Group or Plan number.", "requirements": "The insurer issued label and identifier are necessary to identify the specific policy, group, etc..", "min": 1, "max": "1", "base": { "path": "Coverage.class.value", "min": 1, "max": "1" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-2" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.class:plan.value.id", "path": "Coverage.class.value.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.class:plan.value.extension", "path": "Coverage.class.value.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.class:plan.value.use", "path": "Coverage.class.value.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition", "valueString": "Identifies the purpose for this identifier, if known ." }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|5.0.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Coverage.class:plan.value.type", "path": "Coverage.class.value.type", "short": "Description of identifier", "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition", "valueString": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose." }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Coverage.class:plan.value.system", "path": "Coverage.class.value.system", "short": "The namespace for the identifier value", "definition": "Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.", "comment": "Identifier.system is always case sensitive.", "requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "patternUri": "https://bpcs.exchange/fhir/CodeSystem/cs-ProgramPlan", "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Coverage.class:plan.value.value", "path": "Coverage.class.value.value", "short": "BPCS plan id", "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment": "The binding is extensible to allow for the addition of new codes. Codes must be found in the current expansion of the value set.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "condition": [ "ident-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "binding": { "strength": "extensible", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Plan" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" }, { "identity": "BPCS", "map": "Inferred from ApplicationDTO.program" } ] }, { "id": "Coverage.class:plan.value.period", "path": "Coverage.class.value.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" }, { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Coverage.class:plan.value.assigner", "path": "Coverage.class.value.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Coverage.class:plan.name", "path": "Coverage.class.name", "short": "Human readable description of the type and value", "definition": "A short description for the class.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Used to provide a meaningful description in correspondence to the patient.", "min": 0, "max": "1", "base": { "path": "Coverage.class.name", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-8" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.order", "path": "Coverage.order", "short": "Relative order of the coverage", "definition": "The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. For example; a patient might have (0) auto insurance (1) their own health insurance and (2) spouse's health insurance. When claiming for treatments which were not the result of an auto accident then only coverages (1) and (2) above would be applicatble and would apply in the order specified in parenthesis.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Used in managing the coordination of benefits.", "min": 0, "max": "1", "base": { "path": "Coverage.order", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.network", "path": "Coverage.network", "short": "Insurer network", "definition": "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Used in referral for treatment and in claims processing.", "min": 0, "max": "1", "base": { "path": "Coverage.network", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "D10" } ] }, { "id": "Coverage.costToBeneficiary", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CostToBeneficiary" } ], "path": "Coverage.costToBeneficiary", "slicing": { "discriminator": [ { "type": "value", "path": "type" } ], "rules": "open" }, "short": "Patient payments for services/products", "definition": "A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.", "comment": "This is the application number", "requirements": "Required by providers to manage financial transaction with the patient.", "alias": [ "CoPay", "Deductible", "Exceptions" ], "min": 4, "max": "*", "base": { "path": "Coverage.costToBeneficiary", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary.id", "path": "Coverage.costToBeneficiary.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary.extension", "path": "Coverage.costToBeneficiary.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary.modifierExtension", "path": "Coverage.costToBeneficiary.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary.type", "path": "Coverage.costToBeneficiary.type", "short": "Cost category", "definition": "The category of patient centric costs associated with treatment.", "comment": "For example visit, specialist visits, emergency, inpatient care, etc.", "requirements": "Needed to identify the category associated with the amount for the patient.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CopayTypes" } ], "strength": "extensible", "description": "The types of services to which patient copayments are specified.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-copay-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary.category", "path": "Coverage.costToBeneficiary.category", "short": "Benefit classification", "definition": "Code to identify the general type of benefits under which products and services are provided.", "comment": "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.", "requirements": "Needed to convey the category of service or product for which eligibility is sought.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.category", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitCategory" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary.network", "path": "Coverage.costToBeneficiary.network", "short": "In or out of network", "definition": "Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed as in or out of network providers are treated differently under the coverage.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.network", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitNetwork" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/benefit-network" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary.unit", "path": "Coverage.costToBeneficiary.unit", "short": "Individual or family", "definition": "Indicates if the benefits apply to an individual or to the family.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed for the understanding of the benefits.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.unit", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitUnit" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/benefit-unit" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary.term", "path": "Coverage.costToBeneficiary.term", "short": "Annual or lifetime", "definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed for the understanding of the benefits.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.term", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitTerm" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/benefit-term" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary.value[x]", "path": "Coverage.costToBeneficiary.value[x]", "short": "The amount or percentage due from the beneficiary", "definition": "The amount due from the patient for the cost category.", "comment": "Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.", "requirements": "Needed to identify the amount for the patient associated with the category.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] }, { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-8" }, { "identity": "cpha3pharm", "map": "C.31" } ] }, { "id": "Coverage.costToBeneficiary.exception", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Exemption" } ], "path": "Coverage.costToBeneficiary.exception", "short": "Exceptions for patient payments", "definition": "A suite of codes indicating exceptions or reductions to patient costs and their effective periods.", "requirements": "Required by providers to manage financial transaction with the patient.", "min": 0, "max": "*", "base": { "path": "Coverage.costToBeneficiary.exception", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary.exception.id", "path": "Coverage.costToBeneficiary.exception.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary.exception.extension", "path": "Coverage.costToBeneficiary.exception.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary.exception.modifierExtension", "path": "Coverage.costToBeneficiary.exception.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary.exception.type", "path": "Coverage.costToBeneficiary.exception.type", "short": "Exception category", "definition": "The code for the specific exception.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed to identify the exception associated with the amount for the patient.", "min": 1, "max": "1", "base": { "path": "Coverage.costToBeneficiary.exception.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageFinancialException" } ], "strength": "example", "description": "The types of exceptions from the part or full value of financial obligations such as copays.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-financial-exception" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary.exception.period", "path": "Coverage.costToBeneficiary.exception.period", "short": "The effective period of the exception", "definition": "The timeframe the exception is in force.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "requirements": "Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.exception.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "Coverage.costToBeneficiary:deductible", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CostToBeneficiary" } ], "path": "Coverage.costToBeneficiary", "sliceName": "deductible", "short": "Patient payments for services/products", "definition": "A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.", "comment": "For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.", "requirements": "Required by providers to manage financial transaction with the patient.", "alias": [ "CoPay", "Deductible", "Exceptions" ], "min": 4, "max": "*", "base": { "path": "Coverage.costToBeneficiary", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary:deductible.id", "path": "Coverage.costToBeneficiary.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary:deductible.extension", "path": "Coverage.costToBeneficiary.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 1, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.extension:insuranceCredit", "path": "Coverage.costToBeneficiary.extension", "sliceName": "insuranceCredit", "short": "insCredit", "definition": "The amount of money paid as private insurance premium attributed to this quarter that adjusts the insurance premium for the quarter", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 1, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-InsuranceCredit" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.extension:reachedDate", "path": "Coverage.costToBeneficiary.extension", "sliceName": "reachedDate", "short": "dateReached", "definition": "Indicates when the deductible for the quarter was reached", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-DeductibleDateReached" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.extension:deductiblePct", "path": "Coverage.costToBeneficiary.extension", "sliceName": "deductiblePct", "short": "Deductible Percentage", "definition": "Indicates the percentage of the annual deductible that applies in a given quarter. Typically 25%, but may differ for years with partial coverage.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-DeductiblePct" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.modifierExtension", "path": "Coverage.costToBeneficiary.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.type", "path": "Coverage.costToBeneficiary.type", "short": "Cost category", "definition": "The category of patient centric costs associated with treatment.", "comment": "For example visit, specialist visits, emergency, inpatient care, etc.", "requirements": "Needed to identify the category associated with the amount for the patient.", "min": 1, "max": "1", "base": { "path": "Coverage.costToBeneficiary.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type", "code": "deductible" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CopayTypes" } ], "strength": "extensible", "description": "The types of services to which patient copayments are specified.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-copay-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary:deductible.category", "path": "Coverage.costToBeneficiary.category", "short": "Benefit classification", "definition": "Code to identify the general type of benefits under which products and services are provided.", "comment": "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.", "requirements": "Needed to convey the category of service or product for which eligibility is sought.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.category", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitCategory" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary:deductible.network", "path": "Coverage.costToBeneficiary.network", "short": "In or out of network", "definition": "Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed as in or out of network providers are treated differently under the coverage.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.network", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitNetwork" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/benefit-network" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary:deductible.unit", "path": "Coverage.costToBeneficiary.unit", "short": "Individual or family", "definition": "Indicates if the benefits apply to an individual or to the family.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed for the understanding of the benefits.", "min": 1, "max": "1", "base": { "path": "Coverage.costToBeneficiary.unit", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "family" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitUnit" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/benefit-unit" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary:deductible.term", "path": "Coverage.costToBeneficiary.term", "short": "Concept - reference to a terminology or just text", "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed for the understanding of the benefits.", "min": 1, "max": "1", "base": { "path": "Coverage.costToBeneficiary.term", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-CodeableConcept-simple" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitTerm" } ], "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Term" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary:deductible.value[x]", "path": "Coverage.costToBeneficiary.value[x]", "short": "The amount or percentage due from the beneficiary", "definition": "The amount due from the patient for the cost category.", "comment": "Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.", "requirements": "Needed to identify the amount for the patient associated with the category.", "min": 1, "max": "1", "base": { "path": "Coverage.costToBeneficiary.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Money", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" ] }, { "code": "Quantity", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Quantity-percentage" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "C11 (Division,Section)" }, { "identity": "v2", "map": "IN1-8" }, { "identity": "cpha3pharm", "map": "C.31" }, { "identity": "BPCS", "map": "FamilyExpensesDTO.deductLvl1, deductLvl2, deductLvl3, deductLvl4 (based on quarter), FamilyHistoryDTO.dedLvl1Period1Ytd, dedLvl1Period2Ytd, dedLvl1Period3Ytd, dedLvl1Period4Ytd" } ] }, { "id": "Coverage.costToBeneficiary:deductible.exception", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Exemption" } ], "path": "Coverage.costToBeneficiary.exception", "short": "Exceptions for patient payments", "definition": "A suite of codes indicating exceptions or reductions to patient costs and their effective periods.", "requirements": "Required by providers to manage financial transaction with the patient.", "min": 0, "max": "*", "base": { "path": "Coverage.costToBeneficiary.exception", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary:deductible.exception.id", "path": "Coverage.costToBeneficiary.exception.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.costToBeneficiary:deductible.exception.extension", "path": "Coverage.costToBeneficiary.exception.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.exception.modifierExtension", "path": "Coverage.costToBeneficiary.exception.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Coverage.costToBeneficiary:deductible.exception.type", "path": "Coverage.costToBeneficiary.exception.type", "short": "Exception category", "definition": "The code for the specific exception.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed to identify the exception associated with the amount for the patient.", "min": 1, "max": "1", "base": { "path": "Coverage.costToBeneficiary.exception.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CoverageFinancialException" } ], "strength": "example", "description": "The types of exceptions from the part or full value of financial obligations such as copays.", "valueSet": "http://hl7.org/fhir/ValueSet/coverage-financial-exception" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Coverage.costToBeneficiary:deductible.exception.period", "path": "Coverage.costToBeneficiary.exception.period", "short": "The effective period of the exception", "definition": "The timeframe the exception is in force.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "requirements": "Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.", "min": 0, "max": "1", "base": { "path": "Coverage.costToBeneficiary.exception.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "Coverage.subrogation", "path": "Coverage.subrogation", "short": "Reimbursement to insurer", "definition": "When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.", "comment": "Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.", "requirements": "See definition for when to be used.", "min": 0, "max": "1", "base": { "path": "Coverage.subrogation", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Coverage.contract", "path": "Coverage.contract", "short": "Contract details", "definition": "The policy(s) which constitute this insurance coverage.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "To reference the legally binding contract between the policy holder and the insurer.", "min": 0, "max": "*", "base": { "path": "Coverage.contract", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Contract" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "cdanetv4", "map": "D01 through D09" }, { "identity": "v2", "map": "IN1-16, 18, 19" }, { "identity": "cpha3pharm", "map": "C.35" } ] }, { "id": "Coverage.insurancePlan", "path": "Coverage.insurancePlan", "short": "Insurance plan details", "definition": "The insurance plan details, benefits and costs, which constitute this insurance coverage.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "To associate the plan benefits and costs with the coverage which is an instance of that plan.", "min": 0, "max": "1", "base": { "path": "Coverage.insurancePlan", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/InsurancePlan" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] } ] }, "differential": { "element": [ { "id": "Coverage.contained", "path": "Coverage.contained", "slicing": { "discriminator": [ { "type": "profile", "path": "$this" } ], "rules": "open" }, "min": 1 }, { "id": "Coverage.contained:provenance", "path": "Coverage.contained", "sliceName": "provenance", "short": "Creation/Update/etc. Metadata", "definition": "Nested Provenance information referring to this resource that describes the creation, and sometimes the most recent update and/or inactivation of the record, specifically who was responsible and when it occurred", "min": 1, "type": [ { "code": "Provenance", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Provenance" ] } ], "mustSupport": true }, { "id": "Coverage.extension:overpaidDeductible", "path": "Coverage.extension", "sliceName": "overpaidDeductible", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-OverpaidDeductibleStatus" ] } ], "mustSupport": true }, { "id": "Coverage.extension:privateInsuranceContribution", "path": "Coverage.extension", "sliceName": "privateInsuranceContribution", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-PrivateInsuranceContribution" ] } ], "mustSupport": true }, { "id": "Coverage.extension:basePrivateInsuranceCredit", "path": "Coverage.extension", "sliceName": "basePrivateInsuranceCredit", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-BasePrivateInsuranceCredit" ] } ], "mustSupport": true }, { "id": "Coverage.extension:baseDeductible", "path": "Coverage.extension", "sliceName": "baseDeductible", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-BaseDeductible" ] } ], "mustSupport": true }, { "id": "Coverage.extension:problemCode", "path": "Coverage.extension", "sliceName": "problemCode", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ProblemCode" ] } ], "mustSupport": true, "mapping": [ { "identity": "BPCS", "map": "FamilyDTO.problemCodes" } ] }, { "id": "Coverage.extension:problemCode.value[x]", "path": "Coverage.extension.value[x]", "binding": { "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Problem-family" } }, { "id": "Coverage.costToBeneficiary", "path": "Coverage.costToBeneficiary", "slicing": { "discriminator": [ { "type": "value", "path": "type" } ], "rules": "open" }, "comment": "This is the application number", "min": 4, "mustSupport": true }, { "id": "Coverage.costToBeneficiary:deductible", "path": "Coverage.costToBeneficiary", "sliceName": "deductible", "min": 4, "mustSupport": true }, { "id": "Coverage.costToBeneficiary:deductible.extension", "path": "Coverage.costToBeneficiary.extension", "min": 1, "mustSupport": true }, { "id": "Coverage.costToBeneficiary:deductible.extension:insuranceCredit", "path": "Coverage.costToBeneficiary.extension", "sliceName": "insuranceCredit", "min": 1, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-InsuranceCredit" ] } ], "mustSupport": true }, { "id": "Coverage.costToBeneficiary:deductible.extension:reachedDate", "path": "Coverage.costToBeneficiary.extension", "sliceName": "reachedDate", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-DeductibleDateReached" ] } ], "mustSupport": true }, { "id": "Coverage.costToBeneficiary:deductible.extension:deductiblePct", "path": "Coverage.costToBeneficiary.extension", "sliceName": "deductiblePct", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-DeductiblePct" ] } ], "mustSupport": true }, { "id": "Coverage.costToBeneficiary:deductible.type", "path": "Coverage.costToBeneficiary.type", "min": 1, "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type", "code": "deductible" } ] } }, { "id": "Coverage.costToBeneficiary:deductible.unit", "path": "Coverage.costToBeneficiary.unit", "min": 1, "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/benefit-unit", "code": "family" } ] } }, { "id": "Coverage.costToBeneficiary:deductible.term", "path": "Coverage.costToBeneficiary.term", "min": 1, "type": [ { "code": "CodeableConcept", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-CodeableConcept-simple" ] } ], "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Term" } }, { "id": "Coverage.costToBeneficiary:deductible.value[x]", "path": "Coverage.costToBeneficiary.value[x]", "min": 1, "type": [ { "code": "Money", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" ] }, { "code": "Quantity", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Quantity-percentage" ] } ], "mustSupport": true, "mapping": [ { "identity": "BPCS", "map": "FamilyExpensesDTO.deductLvl1, deductLvl2, deductLvl3, deductLvl4 (based on quarter), FamilyHistoryDTO.dedLvl1Period1Ytd, dedLvl1Period2Ytd, dedLvl1Period3Ytd, dedLvl1Period4Ytd" } ] } ] } }