<status value="active" /> <experimental value="false" /> <description value="The set of coverage elements used when creating or updating an individual private coverage" /> <fhirVersion value="5.0.0" /> <mapping> <identity value="BPCS" /> <name value="Internal BPCS API" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Coverage" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Coverage" /> <derivation value="constraint" /> <differential> <element id="Coverage"> <path value="Coverage" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO, FamilyMemberHistoryDTO - separate repetitions for insurance...1 and insurance...2 fields, InsuranceDTO" /> </mapping> </element> <element id="Coverage.id"> <path value="Coverage.id" /> <short value="Unique identifier assigned to the coverage" /> <comment value="This id is used when querying history" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO.insuranceId '.' policyNum '.' id '.' coverageBegin (for insurance 1 or 2)" /> </mapping> </element> <element id="Coverage.extension"> <path value="Coverage.extension" /> <min value="1" /> </element> <element id="Coverage.extension:application"> <path value="Coverage.extension" /> <sliceName value="application" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-Application" /> </type> <mustSupport value="true" /> </element> <element id="Coverage.extension:premiumPaid"> <path value="Coverage.extension" /> <sliceName value="premiumPaid" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-PremiumPaid" /> </type> <mustSupport value="true" /> </element> <element id="Coverage.status"> <path value="Coverage.status" /> <short value="active" /> <patternCode value="active" /> <mustSupport value="true" /> </element> <element id="Coverage.kind"> <path value="Coverage.kind" /> <patternCode value="insurance" /> <mustSupport value="true" /> </element> <element id="Coverage.subscriber"> <path value="Coverage.subscriber" /> <min value="1" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-create" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="FamilyMemberHistoryDTO.policyHolderOdbNum1 or policyHolderOdbNum2, InsuranceDTO.policyHolderOdbNum" /> </mapping> </element> <element id="Coverage.subscriberId"> <path value="Coverage.subscriberId" /> <definition value="A unique identifier for a recipient within a policy offered by a private insurer." /> <mustSupport value="true" /> </element> <element id="Coverage.subscriberId.value"> <path value="Coverage.subscriberId.value" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO.id1 or id2, FamilyMemberHistoryDTO.identification1 or identification2, InsuranceDTO.identification" /> </mapping> </element> <element id="Coverage.beneficiary"> <path value="Coverage.beneficiary" /> <definition value="The patient for whom the insurance applies" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-search" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO.odbNum, InsuranceDTO.policyHolderOdbNum (when coverage is for policy holder)" /> </mapping> </element> <element id="Coverage.period"> <path value="Coverage.period" /> <mustSupport value="true" /> </element> <element id="Coverage.period.extension:notPayingPeriod"> <path value="Coverage.period.extension" /> <sliceName value="notPayingPeriod" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-NotPayingPeriod" /> </type> <mustSupport value="true" /> <isModifier value="false" /> </element> <element id="Coverage.period.start"> <path value="Coverage.period.start" /> <definition value="The earliest date on which benefits under this policy were available" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO.coverageBegin1 or coverageBegin2, FamilyMemberHistoryDTO.coverageStartDate1 or coverageStartDate2, FamilyMemberInsuranceDTO.coverageStartDate, InsuranceDTO.coverageStartDate" /> </mapping> </element> <element id="Coverage.period.end"> <path value="Coverage.period.end" /> <short value="coverageEnd/enrollmentEndDate/mbrshpEndDate/mbrshpEndDate" /> <definition value="The last date on which benefits under this policy were/will be available" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO.coverageEnd1 or coverageEnd2, FamilyMemberHistoryDTO.coverageEndDate1 or coverageEndDate2, FamilyMemberInsuranceDTO.coverageEndDate, InsuranceDTO.coverageEndDate" /> </mapping> </element> <element id="Coverage.insurer"> <path value="Coverage.insurer" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.insurer.reference"> <path value="Coverage.insurer.reference" /> <max value="0" /> </element> <element id="Coverage.insurer.identifier"> <path value="Coverage.insurer.identifier" /> <definition value="A unique identifier assigned to a private insurer." /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.insurer.identifier.system"> <path value="Coverage.insurer.identifier.system" /> <min value="1" /> <patternUri value="https://bpcs.exchange/fhir/NamingSystem/insurer-id" /> <mustSupport value="true" /> </element> <element id="Coverage.insurer.identifier.value"> <path value="Coverage.insurer.identifier.value" /> <short value="BPCS id for private insurer" /> <comment value="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 value="1" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-PrivateInsurer" /> </binding> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO.insuranceId1 or insuranceid2, FamilyMemberHistoryDTO.companyId1 or companyId2, InsuranceDTO.companyId" /> </mapping> </element> <element id="Coverage.class"> <path value="Coverage.class" /> <slicing> <discriminator> <type value="value" /> <path value="type" /> </discriminator> <rules value="closed" /> </slicing> <min value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.class:program"> <path value="Coverage.class" /> <sliceName value="program" /> <short value="Coverage plan info" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.class:program.type"> <path value="Coverage.class.type" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-class" /> <code value="plan" /> </coding> </patternCodeableConcept> <mustSupport value="true" /> </element> <element id="Coverage.class:program.value"> <path value="Coverage.class.value" /> <short value="Plan id" /> <mustSupport value="true" /> </element> <element id="Coverage.class:program.value.value"> <path value="Coverage.class.value.value" /> <short value="Plan id" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientInsuranceDTO/FamilyMemberHistoryDTO.policyNum1 or policyNum2, InsuranceDTO.policyNum, FamilyMemberInsuranceDTO.policyNum" /> </mapping> </element> </differential> </StructureDefinition>