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HdBe-Payer

Profile	Description	Status	URL
HdBe-Payer.InsuranceCompany	Payers are organizations or individuals that pay for the healthcare supplied to the patient. This profile represents insurance organizations with direct financial responsibility to the patient.	draft	https://fhir.healthdata.be/StructureDefinition/HdBe-Payer.InsuranceCompany
HdBe-Payer.PayerPerson	Payers are organizations or individuals that pay for the healthcare supplied to the patient. This profile represents a payer as a natural person or a juridical person, such as an organization, municipality, etc.	draft	https://fhir.healthdata.be/StructureDefinition/HdBe-Payer.PayerPerson
HdBe-Payer-Organization	The Payer profiles can refer to respectively an Organization as PayerPerson or an InsuranceCompany. This profile can thus represent either the PayerName or InsuranceCompany concept and both the AddressInformation and ContactInformation concepts of the CBB Payer.	draft	https://fhir.healthdata.be/StructureDefinition/HdBe-Payer-Organization

Overview

Overview
The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.InsuranceCompany is mapped to this Coverage profile and uses the profile HdBe-Payer-Organization to capture the OrganizationName, IdentificationNumber, AddressInformation and ContactInformation. The HdBe-Payer-Organization profile is referenced using the `.payor` element.

The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as .payor and .type.

The CBB container Payer.InsuranceCompany is mapped to this Coverage profile and uses the profile HdBe-Payer-Organization to capture the OrganizationName, IdentificationNumber, AddressInformation and ContactInformation. The HdBe-Payer-Organization profile is referenced using the .payor element.

HdBe-Payer.InsuranceCompany

Coverage	I		Coverage	Element id Coverage Short description Payer / Insurance Alternate names Betaler, Verzekering Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.InsuranceCompany is mapped to this Coverage profile and uses the profile HdBe-Payer-Organization to capture the OrganizationName, IdentificationNumber, AddressInformation and ContactInformation. The HdBe-Payer-Organization profile is referenced using the `.payor` element. Data type Coverage Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Coverage zib-payer-v3.1.1-2020EN: NL-CM:1.1.1 zib-payer-v3.1.1-2020EN: NL-CM:1.1.8 HdBe-Payer: Payer HdBe-Payer: Insurance
id	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Coverage.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Coverage.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Coverage.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Coverage.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Coverage.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments 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. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier cdanetv4: C02 v2: IN1-2 rim: .id cpha3pharm: C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	Element id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. Comments Sending systems that don't record an explicit status can use the following guidance to infer a value from the CBB: StartDateTime is present and in the future: draft EndDateTime is present: and in the future: active and in the past: cancelled When no status can be derived from StartDateTime and EndDateTime it is expected that only active Coverage resources are exchanged. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: Act.status zib-payer-v3.1.1-2020EN: NL-CM:1.1.13 zib-payer-v3.1.1-2020EN: NL-CM:1.1.14 HdBe-Payer: Payer.InsuranceCompany.Insurance.StartDateTime HdBe-Payer: Payer.InsuranceCompany.Insurance.EndDateTime
type	Σ	0..1	CodeableConceptBinding	Element id Coverage.type Short description InsuranceType Alternate names Verzekeringssoort Definition Type of insurance policy. Codes as returned in the Check for Right to Insurance. Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data type CodeableConcept Binding The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. InsuranceType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: IN1-15 zib-payer-v3.1.1-2020EN: NL-CM:1.1.15 HdBe-Payer: Payer.InsuranceCompany.Insurance.InsuranceType
policyHolder	Σ I	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments For example: may be an individual, corporation or the subscriber's employer. Data type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Coverage.subscriber Short description Subscriber to the policy Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriberId	Σ	0..1	string	Element id Coverage.subscriberId Short description InsurantNumber Alternate names VerzekerdeNummer Definition Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8 Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject zib-payer-v3.1.1-2020EN: NL-CM:1.1.6 HdBe-Payer: Payer.InsuranceCompany.InsurantNumber
beneficiary	Σ I	1..1	Reference(Patient \| HdBe-Patient)	Element id Coverage.beneficiary Short description Plan beneficiary Definition The party who benefits from the insurance coverage; the patient when products and/or services are provided. Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Patient \| HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C17 v2: - No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4: C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.period Short description 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. Requirements Some insurers require the submission of the coverage term. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: IN1-12 / IN1-13 rim: Act.effectiveTime
id		0..1	string	There are no (further) constraints on this element Element id Coverage.period.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.period.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
start	Σ I	0..1	dateTime	Element id Coverage.period.start Short description StartDateTime Alternate names BeginDatumTijd Definition Date from which the insurance policy coverage applies. Comments If the low element is missing, the meaning is that the low boundary is not known. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: DR.1 rim: ./low zib-payer-v3.1.1-2020EN: NL-CM:1.1.13 HdBe-Payer: Payer.InsuranceCompany.Insurance.StartDateTime
end	Σ I	0..1	dateTime	Element id Coverage.period.end Short description EndDateTime Alternate names EindDatumTijd Definition Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9. Comments The high 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. Meaning when missing If the end of the period is missing, it means that the period is ongoing Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: DR.2 rim: ./high zib-payer-v3.1.1-2020EN: NL-CM:1.1.14 HdBe-Payer: Payer.InsuranceCompany.Insurance.EndDateTime
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization)	Element id Coverage.payor Short description InsuranceCompany Alternate names Verzekeraar Definition The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. Data type Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author cdanetv4: A05 v2: IN1-3 cpha3pharm: C.30 zib-payer-v3.1.1-2020EN: NL-CM:1.1.3 HdBe-Payer: Payer.InsuranceCompany
class		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.class.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.class.type Short description 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 may be used to identify a class of coverage or employer group, Policy, Plan. Requirements The insurer issued label for a specific health card value. Comments 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. Data type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Coverage.order Short description 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. Requirements Used in managing the coordination of benefits. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: - No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.network Short description 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. Requirements Used in referral for treatment and in claims processing. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception Short description 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments 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. Data type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element id Coverage.subrogation Short description 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. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Contract) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4: D01 through D09 v2: IN1-16, 18, 19 cpha3pharm: C.35

Coverage	I		Coverage	Element id Coverage Short description Payer / Insurance Alternate names Betaler, Verzekering Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.InsuranceCompany is mapped to this Coverage profile and uses the profile HdBe-Payer-Organization to capture the OrganizationName, IdentificationNumber, AddressInformation and ContactInformation. The HdBe-Payer-Organization profile is referenced using the `.payor` element. Data type Coverage Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Coverage zib-payer-v3.1.1-2020EN: NL-CM:1.1.1 zib-payer-v3.1.1-2020EN: NL-CM:1.1.8 HdBe-Payer: Payer HdBe-Payer: Insurance
id	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Coverage.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Coverage.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Coverage.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Coverage.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Coverage.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments 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. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier cdanetv4: C02 v2: IN1-2 rim: .id cpha3pharm: C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	Element id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. Comments Sending systems that don't record an explicit status can use the following guidance to infer a value from the CBB: StartDateTime is present and in the future: draft EndDateTime is present: and in the future: active and in the past: cancelled When no status can be derived from StartDateTime and EndDateTime it is expected that only active Coverage resources are exchanged. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: Act.status zib-payer-v3.1.1-2020EN: NL-CM:1.1.13 zib-payer-v3.1.1-2020EN: NL-CM:1.1.14 HdBe-Payer: Payer.InsuranceCompany.Insurance.StartDateTime HdBe-Payer: Payer.InsuranceCompany.Insurance.EndDateTime
type	Σ	0..1	CodeableConceptBinding	Element id Coverage.type Short description InsuranceType Alternate names Verzekeringssoort Definition Type of insurance policy. Codes as returned in the Check for Right to Insurance. Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data type CodeableConcept Binding The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. InsuranceType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: IN1-15 zib-payer-v3.1.1-2020EN: NL-CM:1.1.15 HdBe-Payer: Payer.InsuranceCompany.Insurance.InsuranceType
policyHolder	Σ I	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments For example: may be an individual, corporation or the subscriber's employer. Data type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Coverage.subscriber Short description Subscriber to the policy Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriberId	Σ	0..1	string	Element id Coverage.subscriberId Short description InsurantNumber Alternate names VerzekerdeNummer Definition Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8 Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject zib-payer-v3.1.1-2020EN: NL-CM:1.1.6 HdBe-Payer: Payer.InsuranceCompany.InsurantNumber
beneficiary	Σ I	1..1	Reference(Patient \| HdBe-Patient)	Element id Coverage.beneficiary Short description Plan beneficiary Definition The party who benefits from the insurance coverage; the patient when products and/or services are provided. Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Patient \| HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C17 v2: - No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4: C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.period Short description 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. Requirements Some insurers require the submission of the coverage term. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: IN1-12 / IN1-13 rim: Act.effectiveTime
id		0..1	string	There are no (further) constraints on this element Element id Coverage.period.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.period.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
start	Σ I	0..1	dateTime	Element id Coverage.period.start Short description StartDateTime Alternate names BeginDatumTijd Definition Date from which the insurance policy coverage applies. Comments If the low element is missing, the meaning is that the low boundary is not known. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: DR.1 rim: ./low zib-payer-v3.1.1-2020EN: NL-CM:1.1.13 HdBe-Payer: Payer.InsuranceCompany.Insurance.StartDateTime
end	Σ I	0..1	dateTime	Element id Coverage.period.end Short description EndDateTime Alternate names EindDatumTijd Definition Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9. Comments The high 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. Meaning when missing If the end of the period is missing, it means that the period is ongoing Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: DR.2 rim: ./high zib-payer-v3.1.1-2020EN: NL-CM:1.1.14 HdBe-Payer: Payer.InsuranceCompany.Insurance.EndDateTime
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization)	Element id Coverage.payor Short description InsuranceCompany Alternate names Verzekeraar Definition The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. Data type Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author cdanetv4: A05 v2: IN1-3 cpha3pharm: C.30 zib-payer-v3.1.1-2020EN: NL-CM:1.1.3 HdBe-Payer: Payer.InsuranceCompany
class		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.class.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.class.type Short description 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 may be used to identify a class of coverage or employer group, Policy, Plan. Requirements The insurer issued label for a specific health card value. Comments 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. Data type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Coverage.order Short description 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. Requirements Used in managing the coordination of benefits. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: - No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.network Short description 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. Requirements Used in referral for treatment and in claims processing. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception Short description 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments 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. Data type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element id Coverage.subrogation Short description 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. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Contract) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4: D01 through D09 v2: IN1-16, 18, 19 cpha3pharm: C.35

Coverage	I		Coverage	Element id Coverage Short description Payer / Insurance Alternate names Betaler, Verzekering Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.InsuranceCompany is mapped to this Coverage profile and uses the profile HdBe-Payer-Organization to capture the OrganizationName, IdentificationNumber, AddressInformation and ContactInformation. The HdBe-Payer-Organization profile is referenced using the `.payor` element. Data type Coverage Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Coverage zib-payer-v3.1.1-2020EN: NL-CM:1.1.1 zib-payer-v3.1.1-2020EN: NL-CM:1.1.8 HdBe-Payer: Payer HdBe-Payer: Insurance
id	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Coverage.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Coverage.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Coverage.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Coverage.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Coverage.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments 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. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier cdanetv4: C02 v2: IN1-2 rim: .id cpha3pharm: C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	Element id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. Comments Sending systems that don't record an explicit status can use the following guidance to infer a value from the CBB: StartDateTime is present and in the future: draft EndDateTime is present: and in the future: active and in the past: cancelled When no status can be derived from StartDateTime and EndDateTime it is expected that only active Coverage resources are exchanged. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: Act.status zib-payer-v3.1.1-2020EN: NL-CM:1.1.13 zib-payer-v3.1.1-2020EN: NL-CM:1.1.14 HdBe-Payer: Payer.InsuranceCompany.Insurance.StartDateTime HdBe-Payer: Payer.InsuranceCompany.Insurance.EndDateTime
type	Σ	0..1	CodeableConceptBinding	Element id Coverage.type Short description InsuranceType Alternate names Verzekeringssoort Definition Type of insurance policy. Codes as returned in the Check for Right to Insurance. Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data type CodeableConcept Binding The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. InsuranceType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: IN1-15 zib-payer-v3.1.1-2020EN: NL-CM:1.1.15 HdBe-Payer: Payer.InsuranceCompany.Insurance.InsuranceType
policyHolder	Σ I	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments For example: may be an individual, corporation or the subscriber's employer. Data type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Coverage.subscriber Short description Subscriber to the policy Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriberId	Σ	0..1	string	Element id Coverage.subscriberId Short description InsurantNumber Alternate names VerzekerdeNummer Definition Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8 Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject zib-payer-v3.1.1-2020EN: NL-CM:1.1.6 HdBe-Payer: Payer.InsuranceCompany.InsurantNumber
beneficiary	Σ I	1..1	Reference(Patient \| HdBe-Patient)	Element id Coverage.beneficiary Short description Plan beneficiary Definition The party who benefits from the insurance coverage; the patient when products and/or services are provided. Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Patient \| HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C17 v2: - No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4: C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.period Short description 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. Requirements Some insurers require the submission of the coverage term. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: IN1-12 / IN1-13 rim: Act.effectiveTime
id		0..1	string	There are no (further) constraints on this element Element id Coverage.period.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.period.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
start	Σ I	0..1	dateTime	Element id Coverage.period.start Short description StartDateTime Alternate names BeginDatumTijd Definition Date from which the insurance policy coverage applies. Comments If the low element is missing, the meaning is that the low boundary is not known. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: DR.1 rim: ./low zib-payer-v3.1.1-2020EN: NL-CM:1.1.13 HdBe-Payer: Payer.InsuranceCompany.Insurance.StartDateTime
end	Σ I	0..1	dateTime	Element id Coverage.period.end Short description EndDateTime Alternate names EindDatumTijd Definition Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9. Comments The high 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. Meaning when missing If the end of the period is missing, it means that the period is ongoing Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: DR.2 rim: ./high zib-payer-v3.1.1-2020EN: NL-CM:1.1.14 HdBe-Payer: Payer.InsuranceCompany.Insurance.EndDateTime
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization)	Element id Coverage.payor Short description InsuranceCompany Alternate names Verzekeraar Definition The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. Data type Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author cdanetv4: A05 v2: IN1-3 cpha3pharm: C.30 zib-payer-v3.1.1-2020EN: NL-CM:1.1.3 HdBe-Payer: Payer.InsuranceCompany
class		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.class.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.class.type Short description 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 may be used to identify a class of coverage or employer group, Policy, Plan. Requirements The insurer issued label for a specific health card value. Comments 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. Data type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Coverage.order Short description 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. Requirements Used in managing the coordination of benefits. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: - No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.network Short description 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. Requirements Used in referral for treatment and in claims processing. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception Short description 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments 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. Data type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element id Coverage.subrogation Short description 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. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Contract) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4: D01 through D09 v2: IN1-16, 18, 19 cpha3pharm: C.35

Mapping FHIR profile to CBB

Path	map	CBB	comment
Coverage	Payer	HdBe-Payer
Coverage	Insurance	HdBe-Payer
Coverage.status	Payer.InsuranceCompany.Insurance.StartDateTime	HdBe-Payer	StartDateTime (implicit, main mapping is on Coverage.period.start)
Coverage.status	Payer.InsuranceCompany.Insurance.EndDateTime	HdBe-Payer	EndDateTime (implicit, main mapping is on Coverage.period.end)
Coverage.type	Payer.InsuranceCompany.Insurance.InsuranceType	HdBe-Payer
Coverage.subscriberId	Payer.InsuranceCompany.InsurantNumber	HdBe-Payer
Coverage.period.start	Payer.InsuranceCompany.Insurance.StartDateTime	HdBe-Payer
Coverage.period.end	Payer.InsuranceCompany.Insurance.EndDateTime	HdBe-Payer
Coverage.payor	Payer.InsuranceCompany	HdBe-Payer

HdBe-Payer.InsuranceCompany-01

zib-Payer.InsuranceCompany difference

Concept	Category	Description
description	textual	Made the profile more specific to the profile instead of the copied zib description for a better rendering in the IG.

HdBe-Payer.PayerPerson

Coverage	I		Coverage	Element id Coverage Short description Payer Alternate names Betaler Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.PayerPerson is mapped to this Coverage profile and uses the profiles HdBe-Patient, HdBe-ContactPerson and HdBe-Payer-Organization to capture the PayerName, AddressInformation and ContactInformation. These profiles are referenced using the `.payor` element. Data type Coverage Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Coverage zib-payer-v3.1.1-2020EN: NL-CM:1.1.1 HdBe-Payer: Payer
id	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Coverage.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Coverage.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Coverage.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Coverage.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Coverage.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
bankInformation	I	0..*	Extension(Complex)	Element id Coverage.extension:bankInformation Short description BankInformation Alternate names extensions, user content, Bankgegevens Definition Optional Extension Element - found in all resources. Comments 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. Data type Extension(Complex) Extension URL https://fhir.healthdata.be/StructureDefinition/ext-Payer.BankInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.4 HdBe-Payer: Payer.PayerPerson.BankInformation
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
bankName	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value bankName Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:bankName.value[x] Short description BankName Alternate names BankNaam Definition Name of the financial organization. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.9 HdBe-Payer: Payer.PayerPerson.BankInformation.BankName
valueString			string	There are no (further) constraints on this element Data type string
bankCode	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value bankCode Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:bankCode.value[x] Short description BankCode Alternate names Bankcode Definition Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.10 HdBe-Payer: Payer.PayerPerson.BankInformation.BankCode
valueString			string	There are no (further) constraints on this element Data type string
accountNumber	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value accountNumber Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:accountNumber.value[x] Short description AccountNumber Alternate names Rekeningnummer Definition The payer’s bank account number at the listed organization. For European countries, this is the IBAN. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.11 HdBe-Payer: Payer.PayerPerson.BankInformation.AccountNumber
valueString			string	There are no (further) constraints on this element Data type string
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value https://fhir.healthdata.be/StructureDefinition/ext-Payer.BankInformation Mappings rim: N/A
value[x]		0..0		There are no (further) constraints on this element Element id Coverage.extension:bankInformation.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments 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. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier cdanetv4: C02 v2: IN1-2 rim: .id cpha3pharm: C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	Element id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. Comments When systems don't record an explicit status and no status can be derived from the `.period.start` and `.period.end` elements it is expected that only active Coverage resources are exchanged. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: Act.status
type	Σ	1..1	CodeableConceptBindingPattern	Element id Coverage.type Short description 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. Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data type CodeableConcept Binding The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. CoverageTypeAndSelf-PayCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-selfpay", "code": "pay" } ] } Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: IN1-15
policyHolder	Σ I	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments For example: may be an individual, corporation or the subscriber's employer. Data type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Coverage.subscriber Short description Subscriber to the policy Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriberId	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.subscriberId Short description ID assigned to the subscriber Definition The insurer assigned ID for the Subscriber. Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
beneficiary	Σ I	1..1	Reference(Patient \| HdBe-Patient)	Element id Coverage.beneficiary Short description Plan beneficiary Definition The party who benefits from the insurance coverage; the patient when products and/or services are provided. Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Patient \| HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C17 v2: - No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4: C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.period Short description 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. Requirements Some insurers require the submission of the coverage term. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: IN1-12 / IN1-13 rim: Act.effectiveTime
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization \| HdBe-Patient \| HdBe-ContactPerson)	Element id Coverage.payor Short description PayerPerson Alternate names BetalerPersoon Definition In the PayerPerson concept a person is a natural person or a juridical person, such as an organization, municipality, etc. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments If the resource referenced is conformant to one of the target CBB profiles, these profiles provide a mapping to the relevant CBB Payer concepts. If it is not conformant to one of these CBB profiles, it SHALL have at least the following FHIR elements filled to be compliant with the subsequent CBB Payer concepts: `name.text` - PayerPerson::PayerName `address` - AddressInformation `telecom` - ContactInformation Data type Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization \| HdBe-Patient \| HdBe-ContactPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author cdanetv4: A05 v2: IN1-3 cpha3pharm: C.30 zib-payer-v3.1.1-2020EN: NL-CM:1.1.2 HdBe-Payer: Payer.PayerPerson
class		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.class.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.class.type Short description 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 may be used to identify a class of coverage or employer group, Policy, Plan. Requirements The insurer issued label for a specific health card value. Comments 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. Data type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Coverage.order Short description 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. Requirements Used in managing the coordination of benefits. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: - No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.network Short description 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. Requirements Used in referral for treatment and in claims processing. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception Short description 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments 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. Data type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element id Coverage.subrogation Short description 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. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Contract) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4: D01 through D09 v2: IN1-16, 18, 19 cpha3pharm: C.35

Coverage	I		Coverage	Element id Coverage Short description Payer Alternate names Betaler Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.PayerPerson is mapped to this Coverage profile and uses the profiles HdBe-Patient, HdBe-ContactPerson and HdBe-Payer-Organization to capture the PayerName, AddressInformation and ContactInformation. These profiles are referenced using the `.payor` element. Data type Coverage Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Coverage zib-payer-v3.1.1-2020EN: NL-CM:1.1.1 HdBe-Payer: Payer
id	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Coverage.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Coverage.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Coverage.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Coverage.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Coverage.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
bankInformation	I	0..*	Extension(Complex)	Element id Coverage.extension:bankInformation Short description BankInformation Alternate names extensions, user content, Bankgegevens Definition Optional Extension Element - found in all resources. Comments 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. Data type Extension(Complex) Extension URL https://fhir.healthdata.be/StructureDefinition/ext-Payer.BankInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.4 HdBe-Payer: Payer.PayerPerson.BankInformation
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
bankName	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value bankName Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:bankName.value[x] Short description BankName Alternate names BankNaam Definition Name of the financial organization. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.9 HdBe-Payer: Payer.PayerPerson.BankInformation.BankName
valueString			string	There are no (further) constraints on this element Data type string
bankCode	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value bankCode Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:bankCode.value[x] Short description BankCode Alternate names Bankcode Definition Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.10 HdBe-Payer: Payer.PayerPerson.BankInformation.BankCode
valueString			string	There are no (further) constraints on this element Data type string
accountNumber	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value accountNumber Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:accountNumber.value[x] Short description AccountNumber Alternate names Rekeningnummer Definition The payer’s bank account number at the listed organization. For European countries, this is the IBAN. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.11 HdBe-Payer: Payer.PayerPerson.BankInformation.AccountNumber
valueString			string	There are no (further) constraints on this element Data type string
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value https://fhir.healthdata.be/StructureDefinition/ext-Payer.BankInformation Mappings rim: N/A
value[x]		0..0		There are no (further) constraints on this element Element id Coverage.extension:bankInformation.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments 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. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier cdanetv4: C02 v2: IN1-2 rim: .id cpha3pharm: C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	Element id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. Comments When systems don't record an explicit status and no status can be derived from the `.period.start` and `.period.end` elements it is expected that only active Coverage resources are exchanged. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: Act.status
type	Σ	1..1	CodeableConceptBindingPattern	Element id Coverage.type Short description 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. Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data type CodeableConcept Binding The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. CoverageTypeAndSelf-PayCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-selfpay", "code": "pay" } ] } Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: IN1-15
policyHolder	Σ I	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments For example: may be an individual, corporation or the subscriber's employer. Data type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Coverage.subscriber Short description Subscriber to the policy Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriberId	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.subscriberId Short description ID assigned to the subscriber Definition The insurer assigned ID for the Subscriber. Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
beneficiary	Σ I	1..1	Reference(Patient \| HdBe-Patient)	Element id Coverage.beneficiary Short description Plan beneficiary Definition The party who benefits from the insurance coverage; the patient when products and/or services are provided. Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Patient \| HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C17 v2: - No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4: C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.period Short description 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. Requirements Some insurers require the submission of the coverage term. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: IN1-12 / IN1-13 rim: Act.effectiveTime
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization \| HdBe-Patient \| HdBe-ContactPerson)	Element id Coverage.payor Short description PayerPerson Alternate names BetalerPersoon Definition In the PayerPerson concept a person is a natural person or a juridical person, such as an organization, municipality, etc. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments If the resource referenced is conformant to one of the target CBB profiles, these profiles provide a mapping to the relevant CBB Payer concepts. If it is not conformant to one of these CBB profiles, it SHALL have at least the following FHIR elements filled to be compliant with the subsequent CBB Payer concepts: `name.text` - PayerPerson::PayerName `address` - AddressInformation `telecom` - ContactInformation Data type Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization \| HdBe-Patient \| HdBe-ContactPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author cdanetv4: A05 v2: IN1-3 cpha3pharm: C.30 zib-payer-v3.1.1-2020EN: NL-CM:1.1.2 HdBe-Payer: Payer.PayerPerson
class		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.class.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.class.type Short description 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 may be used to identify a class of coverage or employer group, Policy, Plan. Requirements The insurer issued label for a specific health card value. Comments 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. Data type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Coverage.order Short description 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. Requirements Used in managing the coordination of benefits. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: - No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.network Short description 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. Requirements Used in referral for treatment and in claims processing. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception Short description 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments 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. Data type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element id Coverage.subrogation Short description 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. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Contract) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4: D01 through D09 v2: IN1-16, 18, 19 cpha3pharm: C.35

Coverage	I		Coverage	Element id Coverage Short description Payer Alternate names Betaler Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The CBB container Payer.PayerPerson is mapped to this Coverage profile and uses the profiles HdBe-Patient, HdBe-ContactPerson and HdBe-Payer-Organization to capture the PayerName, AddressInformation and ContactInformation. These profiles are referenced using the `.payor` element. Data type Coverage Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Coverage zib-payer-v3.1.1-2020EN: NL-CM:1.1.1 HdBe-Payer: Payer
id	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Coverage.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Coverage.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Coverage.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Coverage.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Coverage.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
bankInformation	I	0..*	Extension(Complex)	Element id Coverage.extension:bankInformation Short description BankInformation Alternate names extensions, user content, Bankgegevens Definition Optional Extension Element - found in all resources. Comments 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. Data type Extension(Complex) Extension URL https://fhir.healthdata.be/StructureDefinition/ext-Payer.BankInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.4 HdBe-Payer: Payer.PayerPerson.BankInformation
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
bankName	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankName.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value bankName Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:bankName.value[x] Short description BankName Alternate names BankNaam Definition Name of the financial organization. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.9 HdBe-Payer: Payer.PayerPerson.BankInformation.BankName
valueString			string	There are no (further) constraints on this element Data type string
bankCode	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:bankCode.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value bankCode Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:bankCode.value[x] Short description BankCode Alternate names Bankcode Definition Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.10 HdBe-Payer: Payer.PayerPerson.BankInformation.BankCode
valueString			string	There are no (further) constraints on this element Data type string
accountNumber	I	0..1	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.extension:accountNumber.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value accountNumber Mappings rim: N/A
value[x]		0..1		Element id Coverage.extension:bankInformation.extension:accountNumber.value[x] Short description AccountNumber Alternate names Rekeningnummer Definition The payer’s bank account number at the listed organization. For European countries, this is the IBAN. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A zib-payer-v3.1.1-2020EN: NL-CM:1.1.11 HdBe-Payer: Payer.PayerPerson.BankInformation.AccountNumber
valueString			string	There are no (further) constraints on this element Data type string
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Coverage.extension:bankInformation.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Fixed value https://fhir.healthdata.be/StructureDefinition/ext-Payer.BankInformation Mappings rim: N/A
value[x]		0..0		There are no (further) constraints on this element Element id Coverage.extension:bankInformation.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments 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. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier cdanetv4: C02 v2: IN1-2 rim: .id cpha3pharm: C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	Element id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. Comments When systems don't record an explicit status and no status can be derived from the `.period.start` and `.period.end` elements it is expected that only active Coverage resources are exchanged. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: Act.status
type	Σ	1..1	CodeableConceptBindingPattern	Element id Coverage.type Short description 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. Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data type CodeableConcept Binding The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. CoverageTypeAndSelf-PayCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-selfpay", "code": "pay" } ] } Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: IN1-15
policyHolder	Σ I	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments For example: may be an individual, corporation or the subscriber's employer. Data type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Coverage.subscriber Short description Subscriber to the policy Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
subscriberId	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.subscriberId Short description ID assigned to the subscriber Definition The insurer assigned ID for the Subscriber. Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
beneficiary	Σ I	1..1	Reference(Patient \| HdBe-Patient)	Element id Coverage.beneficiary Short description Plan beneficiary Definition The party who benefits from the insurance coverage; the patient when products and/or services are provided. Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Patient \| HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] cdanetv4: D01 through D09 v2: IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm: C.35 w5: FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C17 v2: - No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4: C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.period Short description 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. Requirements Some insurers require the submission of the coverage term. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: IN1-12 / IN1-13 rim: Act.effectiveTime
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization \| HdBe-Patient \| HdBe-ContactPerson)	Element id Coverage.payor Short description PayerPerson Alternate names BetalerPersoon Definition In the PayerPerson concept a person is a natural person or a juridical person, such as an organization, municipality, etc. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments If the resource referenced is conformant to one of the target CBB profiles, these profiles provide a mapping to the relevant CBB Payer concepts. If it is not conformant to one of these CBB profiles, it SHALL have at least the following FHIR elements filled to be compliant with the subsequent CBB Payer concepts: `name.text` - PayerPerson::PayerName `address` - AddressInformation `telecom` - ContactInformation Data type Reference(Organization \| Patient \| RelatedPerson \| HdBe-Payer Organization \| HdBe-Patient \| HdBe-ContactPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author cdanetv4: A05 v2: IN1-3 cpha3pharm: C.30 zib-payer-v3.1.1-2020EN: NL-CM:1.1.2 HdBe-Payer: Payer.PayerPerson
class		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.class.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.class.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.class.type Short description 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 may be used to identify a class of coverage or employer group, Policy, Plan. Requirements The insurer issued label for a specific health card value. Comments 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. Data type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Coverage.order Short description 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. Requirements Used in managing the coordination of benefits. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: - No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element id Coverage.network Short description 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. Requirements Used in referral for treatment and in claims processing. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a cdanetv4: C11 (Division,Section) v2: IN1-8 cpha3pharm: C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception Short description 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments 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. Data type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments 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"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element id Coverage.subrogation Short description 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. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Contract) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4: D01 through D09 v2: IN1-16, 18, 19 cpha3pharm: C.35

Mapping FHIR profile to CBB

Path	map	CBB
Coverage	Payer	HdBe-Payer
Coverage.extension:bankInformation	Payer.PayerPerson.BankInformation	HdBe-Payer
Coverage.extension:bankInformation.extension:bankName.value[x]	Payer.PayerPerson.BankInformation.BankName	HdBe-Payer
Coverage.extension:bankInformation.extension:bankCode.value[x]	Payer.PayerPerson.BankInformation.BankCode	HdBe-Payer
Coverage.extension:bankInformation.extension:accountNumber.value[x]	Payer.PayerPerson.BankInformation.AccountNumber	HdBe-Payer
Coverage.payor	Payer.PayerPerson	HdBe-Payer

HdBe-Payer.PayerPerson-01

zib-Payer.PayerPerson difference

Concept	Category	Description
description	textual	Made the profile more specific to the profile instead of the copied zib description for a better rendering in the IG.

HdBe-Payer.Organization

Organization	I		Organization	Element id Organization Short description InsuranceCompany Alternate names Verzekeraar Definition A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These profiles can refer to respectively an Organization as PayerPerson or an InsuranceCompany. This profile can thus represent either the PayerName or InsuranceCompany concept and both the AddressInformation and ContactInformation concepts of the CBB. Data type Organization Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` org-1: The organization SHALL at least have a name or an identifier, and possibly more than one `(identifier.count() + name.count()) > 0` Mappings rim: Entity. Role, or Act v2: (also see master files messages) rim: Organization(classCode=ORG, determinerCode=INST) servd: Organization zib-payer-v3.1.1-2020EN: NL-CM:1.1.3 HdBe-Payer: Payer.InsuranceCompany
id	Σ	0..1	string	There are no (further) constraints on this element Element id Organization.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Organization.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Organization.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Organization.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Organization.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Organization.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Organization.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Organization.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ I	0..*	Identifier	Element id Organization.identifier Short description Identifies this organization across multiple systems Definition Identifier for the organization that is used to identify the organization across multiple disparate systems. Requirements Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization. Data type Identifier Sliced: Unordered, Open, by $this(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier w5: FiveWs.identifier v2: XON.10 / XON.3 rim: .scopes[Role](classCode=IDENT) servd: ./Identifiers
be-InsuranceIdentificationNumber	Σ I	0..1	IdentifierPattern	Element id Organization.identifier:be-InsuranceIdentificationNumber Short description IdentificationNumber Alternate names IdentificatieNummer Definition Unique healthcare insurance company identification. Requirements Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-insurancenumber" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier w5: FiveWs.identifier v2: XON.10 / XON.3 rim: .scopes[Role](classCode=IDENT) servd: ./Identifiers zib-payer-v3.1.1-2020EN: NL-CM:1.1.7 HdBe-Payer: Payer.InsuranceCompany.IdentificationNumber
active	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element id Organization.active Short description Whether the organization's record is still in active use Definition Whether the organization's record is still in active use. Requirements Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. Comments This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used. This element is labeled as a modifier because it may be used to mark that the resource was created in error. Meaning when missing This resource is generally assumed to be active if no value is provided for the active element Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.status v2: No equivalent in HL7 v2 rim: .status servd: ./Status (however this concept in ServD more covers why the organization is active or not, could be delisted, deregistered, not operational yet) this could alternatively be derived from ./StartDate and ./EndDate and given a context date.
type	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Organization.type Short description Kind of organization Definition The kind(s) of organization that this is. Requirements Need to be able to track the kind of organization that this is - different organization types have different uses. Comments Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center. We expect that some jurisdictions will profile this optionality to be a single cardinality. Data type CodeableConcept Binding Used to categorize the organization. OrganizationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: No equivalent in v2 rim: .code servd: n/a
name	Σ I	0..1	string	Element id Organization.name Short description OrganizationName / PayerName Alternate names OrganisatieNaam, BetalerNaam Definition Full, official name of the healthcare insurance company or paying organization. Requirements Need to use the name as the label of the organization. Comments If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XON.1 rim: .name servd: .PreferredName/Name zib-payer-v3.1.1-2020EN: NL-CM:1.1.16 zib-payer-v3.1.1-2020EN: NL-CM:1.1.5 HdBe-Payer: Payer.InsuranceCompany.OrganizationName HdBe-Payer: Payer.PayerPerson.PayerName
alias		0..*	string	There are no (further) constraints on this element Element id Organization.alias Short description A list of alternate names that the organization is known as, or was known as in the past Definition A list of alternate names that the organization is known as, or was known as in the past. Requirements Over time locations and organizations go through many changes and can be known by different names. For searching knowing previous names that the organization was known by can be very useful. Comments There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .name
telecom	I	0..*	HdBe-ContactInformation	Element id Organization.telecom Short description ContactInformation Alternate names Contactpunten, Contactgegevens Definition The payer’s telephone number and/or e-mail address. Requirements Human contact for the organization. Comments Implementation of the CBB ContactInformation. Please note that this profile differs significantly from the zib ContactInformation because the zib model is deemed overly complex, too Dutch-specific, and contains unsuited terminology. The mapping from zib to FHIR is not trivial and results in too complex mapping. Therefore, the CBB is redesigned based on what is implemented internationally and in Belgium by looking at the FHIR data type and eHealth core profiles. The new model replaces the containers for phone numbers and email addresses with elements on the root that can capture both. Therefore, no need for two profiles, slicing in the host profiles and no ConceptMaps. Data type HdBe-ContactInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cpt-2: A system is required if a value is provided. `value.empty() or system.exists()` org-3: The telecom of an organization can never be of use 'home' `where(use = 'home').empty()` Mappings rim: n/a v2: XTN rim: TEL servd: ContactPoint v2: ORC-22? rim: .telecom servd: ./ContactPoints zib-contactinformation-v1.2-2020EN: NL-CM:20.6.2 zib-contactinformation-v1.2-2020EN: NL-CM:20.6.3 HdBe-ContactInformation: ContactInformation zib-payer-v3.1.1-2020EN: NL-CM:1.1.12 HdBe-Payer: Payer.ContactInformation
address	I	0..*	HdBe-AddressInformation	Element id Organization.address Short description AddressInformation Alternate names Adresgegevens Definition The payer’s address information. Requirements May need to keep track of the organization's addresses for contacting, billing or reporting requirements. Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type HdBe-AddressInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` org-2: An address of an organization can never be of use 'home' `where(use = 'home').empty()` Mappings rim: n/a v2: XAD rim: AD servd: Address v2: ORC-23? rim: .address servd: ./PrimaryAddress and ./OtherAddresses zib-addressinformation-v1.1-2020EN: NL-CM:20.5.1 HdBe-AddressInformation: AddressInformation zib-payer-v3.1.1-2020EN: NL-CM:1.1.17 HdBe-Payer: Payer.AddressInformation
partOf	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Organization.partOf Short description The organization of which this organization forms a part Definition The organization of which this organization forms a part. Requirements Need to be able to track the hierarchy of organizations within an organization. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: No equivalent in HL7 v2 rim: .playedBy[classCode=Part].scoper servd: n/a
contact		0..*	BackboneElement	There are no (further) constraints on this element Element id Organization.contact Short description Contact for the organization for a certain purpose Definition Contact for the organization for a certain purpose. Requirements Need to keep track of assigned contact points within bigger organization. Comments Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .contactParty
id		0..1	string	There are no (further) constraints on this element Element id Organization.contact.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Organization.contact.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Organization.contact.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
purpose		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Organization.contact.purpose Short description The type of contact Definition Indicates a purpose for which the contact can be reached. Requirements Need to distinguish between multiple contact persons. Comments 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. Data type CodeableConcept Binding The purpose for which you would contact a contact party. ContactEntityType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: ./type
name		0..1	HumanName	There are no (further) constraints on this element Element id Organization.contact.name Short description A name associated with the contact Definition A name associated with the contact. Requirements Need to be able to track the person by name. Comments Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely. Data type HumanName Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XPN rim: EN (actually, PN) servd: ProviderName v2: PID-5, PID-9 rim: ./name
telecom	I	0..*	ContactPoint	There are no (further) constraints on this element Element id Organization.contact.telecom Short description Contact details (telephone, email, etc.) for a contact Definition A contact detail (e.g. a telephone number or an email address) by which the party may be contacted. Requirements People have (primary) ways to contact them in some way such as phone, email. Data type ContactPoint Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cpt-2: A system is required if a value is provided. `value.empty() or system.exists()` Mappings rim: n/a v2: XTN rim: TEL servd: ContactPoint v2: PID-13, PID-14 rim: ./telecom
address		0..1	Address	There are no (further) constraints on this element Element id Organization.contact.address Short description Visiting or postal addresses for the contact Definition Visiting or postal addresses for the contact. Requirements May need to keep track of a contact party's address for contacting, billing or reporting requirements. Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type Address Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XAD rim: AD servd: Address v2: PID-11 rim: ./addr
endpoint	I	0..*	Reference(Endpoint)	There are no (further) constraints on this element Element id Organization.endpoint Short description Technical endpoints providing access to services operated for the organization Definition Technical endpoints providing access to services operated for the organization. Requirements Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Endpoint) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)

Organization	I		Organization	Element id Organization Short description InsuranceCompany Alternate names Verzekeraar Definition A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These profiles can refer to respectively an Organization as PayerPerson or an InsuranceCompany. This profile can thus represent either the PayerName or InsuranceCompany concept and both the AddressInformation and ContactInformation concepts of the CBB. Data type Organization Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` org-1: The organization SHALL at least have a name or an identifier, and possibly more than one `(identifier.count() + name.count()) > 0` Mappings rim: Entity. Role, or Act v2: (also see master files messages) rim: Organization(classCode=ORG, determinerCode=INST) servd: Organization zib-payer-v3.1.1-2020EN: NL-CM:1.1.3 HdBe-Payer: Payer.InsuranceCompany
id	Σ	0..1	string	There are no (further) constraints on this element Element id Organization.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Organization.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Organization.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Organization.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Organization.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Organization.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Organization.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Organization.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ I	0..*	Identifier	Element id Organization.identifier Short description Identifies this organization across multiple systems Definition Identifier for the organization that is used to identify the organization across multiple disparate systems. Requirements Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization. Data type Identifier Sliced: Unordered, Open, by $this(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier w5: FiveWs.identifier v2: XON.10 / XON.3 rim: .scopes[Role](classCode=IDENT) servd: ./Identifiers
be-InsuranceIdentificationNumber	Σ I	0..1	IdentifierPattern	Element id Organization.identifier:be-InsuranceIdentificationNumber Short description IdentificationNumber Alternate names IdentificatieNummer Definition Unique healthcare insurance company identification. Requirements Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-insurancenumber" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier w5: FiveWs.identifier v2: XON.10 / XON.3 rim: .scopes[Role](classCode=IDENT) servd: ./Identifiers zib-payer-v3.1.1-2020EN: NL-CM:1.1.7 HdBe-Payer: Payer.InsuranceCompany.IdentificationNumber
active	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element id Organization.active Short description Whether the organization's record is still in active use Definition Whether the organization's record is still in active use. Requirements Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. Comments This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used. This element is labeled as a modifier because it may be used to mark that the resource was created in error. Meaning when missing This resource is generally assumed to be active if no value is provided for the active element Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.status v2: No equivalent in HL7 v2 rim: .status servd: ./Status (however this concept in ServD more covers why the organization is active or not, could be delisted, deregistered, not operational yet) this could alternatively be derived from ./StartDate and ./EndDate and given a context date.
type	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Organization.type Short description Kind of organization Definition The kind(s) of organization that this is. Requirements Need to be able to track the kind of organization that this is - different organization types have different uses. Comments Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center. We expect that some jurisdictions will profile this optionality to be a single cardinality. Data type CodeableConcept Binding Used to categorize the organization. OrganizationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: No equivalent in v2 rim: .code servd: n/a
name	Σ I	0..1	string	Element id Organization.name Short description OrganizationName / PayerName Alternate names OrganisatieNaam, BetalerNaam Definition Full, official name of the healthcare insurance company or paying organization. Requirements Need to use the name as the label of the organization. Comments If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XON.1 rim: .name servd: .PreferredName/Name zib-payer-v3.1.1-2020EN: NL-CM:1.1.16 zib-payer-v3.1.1-2020EN: NL-CM:1.1.5 HdBe-Payer: Payer.InsuranceCompany.OrganizationName HdBe-Payer: Payer.PayerPerson.PayerName
alias		0..*	string	There are no (further) constraints on this element Element id Organization.alias Short description A list of alternate names that the organization is known as, or was known as in the past Definition A list of alternate names that the organization is known as, or was known as in the past. Requirements Over time locations and organizations go through many changes and can be known by different names. For searching knowing previous names that the organization was known by can be very useful. Comments There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .name
telecom	I	0..*	HdBe-ContactInformation	Element id Organization.telecom Short description ContactInformation Alternate names Contactpunten, Contactgegevens Definition The payer’s telephone number and/or e-mail address. Requirements Human contact for the organization. Comments Implementation of the CBB ContactInformation. Please note that this profile differs significantly from the zib ContactInformation because the zib model is deemed overly complex, too Dutch-specific, and contains unsuited terminology. The mapping from zib to FHIR is not trivial and results in too complex mapping. Therefore, the CBB is redesigned based on what is implemented internationally and in Belgium by looking at the FHIR data type and eHealth core profiles. The new model replaces the containers for phone numbers and email addresses with elements on the root that can capture both. Therefore, no need for two profiles, slicing in the host profiles and no ConceptMaps. Data type HdBe-ContactInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cpt-2: A system is required if a value is provided. `value.empty() or system.exists()` org-3: The telecom of an organization can never be of use 'home' `where(use = 'home').empty()` Mappings rim: n/a v2: XTN rim: TEL servd: ContactPoint v2: ORC-22? rim: .telecom servd: ./ContactPoints zib-contactinformation-v1.2-2020EN: NL-CM:20.6.2 zib-contactinformation-v1.2-2020EN: NL-CM:20.6.3 HdBe-ContactInformation: ContactInformation zib-payer-v3.1.1-2020EN: NL-CM:1.1.12 HdBe-Payer: Payer.ContactInformation
address	I	0..*	HdBe-AddressInformation	Element id Organization.address Short description AddressInformation Alternate names Adresgegevens Definition The payer’s address information. Requirements May need to keep track of the organization's addresses for contacting, billing or reporting requirements. Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type HdBe-AddressInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` org-2: An address of an organization can never be of use 'home' `where(use = 'home').empty()` Mappings rim: n/a v2: XAD rim: AD servd: Address v2: ORC-23? rim: .address servd: ./PrimaryAddress and ./OtherAddresses zib-addressinformation-v1.1-2020EN: NL-CM:20.5.1 HdBe-AddressInformation: AddressInformation zib-payer-v3.1.1-2020EN: NL-CM:1.1.17 HdBe-Payer: Payer.AddressInformation
partOf	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Organization.partOf Short description The organization of which this organization forms a part Definition The organization of which this organization forms a part. Requirements Need to be able to track the hierarchy of organizations within an organization. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: No equivalent in HL7 v2 rim: .playedBy[classCode=Part].scoper servd: n/a
contact		0..*	BackboneElement	There are no (further) constraints on this element Element id Organization.contact Short description Contact for the organization for a certain purpose Definition Contact for the organization for a certain purpose. Requirements Need to keep track of assigned contact points within bigger organization. Comments Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .contactParty
id		0..1	string	There are no (further) constraints on this element Element id Organization.contact.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Organization.contact.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Organization.contact.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
purpose		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Organization.contact.purpose Short description The type of contact Definition Indicates a purpose for which the contact can be reached. Requirements Need to distinguish between multiple contact persons. Comments 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. Data type CodeableConcept Binding The purpose for which you would contact a contact party. ContactEntityType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: ./type
name		0..1	HumanName	There are no (further) constraints on this element Element id Organization.contact.name Short description A name associated with the contact Definition A name associated with the contact. Requirements Need to be able to track the person by name. Comments Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely. Data type HumanName Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XPN rim: EN (actually, PN) servd: ProviderName v2: PID-5, PID-9 rim: ./name
telecom	I	0..*	ContactPoint	There are no (further) constraints on this element Element id Organization.contact.telecom Short description Contact details (telephone, email, etc.) for a contact Definition A contact detail (e.g. a telephone number or an email address) by which the party may be contacted. Requirements People have (primary) ways to contact them in some way such as phone, email. Data type ContactPoint Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cpt-2: A system is required if a value is provided. `value.empty() or system.exists()` Mappings rim: n/a v2: XTN rim: TEL servd: ContactPoint v2: PID-13, PID-14 rim: ./telecom
address		0..1	Address	There are no (further) constraints on this element Element id Organization.contact.address Short description Visiting or postal addresses for the contact Definition Visiting or postal addresses for the contact. Requirements May need to keep track of a contact party's address for contacting, billing or reporting requirements. Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type Address Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XAD rim: AD servd: Address v2: PID-11 rim: ./addr
endpoint	I	0..*	Reference(Endpoint)	There are no (further) constraints on this element Element id Organization.endpoint Short description Technical endpoints providing access to services operated for the organization Definition Technical endpoints providing access to services operated for the organization. Requirements Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Endpoint) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)

Organization	I		Organization	Element id Organization Short description InsuranceCompany Alternate names Verzekeraar Definition A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc. Comments The CBB Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These profiles can refer to respectively an Organization as PayerPerson or an InsuranceCompany. This profile can thus represent either the PayerName or InsuranceCompany concept and both the AddressInformation and ContactInformation concepts of the CBB. Data type Organization Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: 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 `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` org-1: The organization SHALL at least have a name or an identifier, and possibly more than one `(identifier.count() + name.count()) > 0` Mappings rim: Entity. Role, or Act v2: (also see master files messages) rim: Organization(classCode=ORG, determinerCode=INST) servd: Organization zib-payer-v3.1.1-2020EN: NL-CM:1.1.3 HdBe-Payer: Payer.InsuranceCompany
id	Σ	0..1	string	There are no (further) constraints on this element Element id Organization.id Short description 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. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Organization.meta Short description 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Organization.implicitRules Short description 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. Comments 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 it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Organization.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Organization.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. Comments Contained resources do not have 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Organization.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Organization.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Organization.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ I	0..*	Identifier	Element id Organization.identifier Short description Identifies this organization across multiple systems Definition Identifier for the organization that is used to identify the organization across multiple disparate systems. Requirements Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization. Data type Identifier Sliced: Unordered, Open, by $this(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier w5: FiveWs.identifier v2: XON.10 / XON.3 rim: .scopes[Role](classCode=IDENT) servd: ./Identifiers
be-InsuranceIdentificationNumber	Σ I	0..1	IdentifierPattern	Element id Organization.identifier:be-InsuranceIdentificationNumber Short description IdentificationNumber Alternate names IdentificatieNummer Definition Unique healthcare insurance company identification. Requirements Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-insurancenumber" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: 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] servd: Identifier w5: FiveWs.identifier v2: XON.10 / XON.3 rim: .scopes[Role](classCode=IDENT) servd: ./Identifiers zib-payer-v3.1.1-2020EN: NL-CM:1.1.7 HdBe-Payer: Payer.InsuranceCompany.IdentificationNumber
active	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element id Organization.active Short description Whether the organization's record is still in active use Definition Whether the organization's record is still in active use. Requirements Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI. Comments This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used. This element is labeled as a modifier because it may be used to mark that the resource was created in error. Meaning when missing This resource is generally assumed to be active if no value is provided for the active element Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.status v2: No equivalent in HL7 v2 rim: .status servd: ./Status (however this concept in ServD more covers why the organization is active or not, could be delisted, deregistered, not operational yet) this could alternatively be derived from ./StartDate and ./EndDate and given a context date.
type	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Organization.type Short description Kind of organization Definition The kind(s) of organization that this is. Requirements Need to be able to track the kind of organization that this is - different organization types have different uses. Comments Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center. We expect that some jurisdictions will profile this optionality to be a single cardinality. Data type CodeableConcept Binding Used to categorize the organization. OrganizationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class v2: No equivalent in v2 rim: .code servd: n/a
name	Σ I	0..1	string	Element id Organization.name Short description OrganizationName / PayerName Alternate names OrganisatieNaam, BetalerNaam Definition Full, official name of the healthcare insurance company or paying organization. Requirements Need to use the name as the label of the organization. Comments If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XON.1 rim: .name servd: .PreferredName/Name zib-payer-v3.1.1-2020EN: NL-CM:1.1.16 zib-payer-v3.1.1-2020EN: NL-CM:1.1.5 HdBe-Payer: Payer.InsuranceCompany.OrganizationName HdBe-Payer: Payer.PayerPerson.PayerName
alias		0..*	string	There are no (further) constraints on this element Element id Organization.alias Short description A list of alternate names that the organization is known as, or was known as in the past Definition A list of alternate names that the organization is known as, or was known as in the past. Requirements Over time locations and organizations go through many changes and can be known by different names. For searching knowing previous names that the organization was known by can be very useful. Comments There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .name
telecom	I	0..*	HdBe-ContactInformation	Element id Organization.telecom Short description ContactInformation Alternate names Contactpunten, Contactgegevens Definition The payer’s telephone number and/or e-mail address. Requirements Human contact for the organization. Comments Implementation of the CBB ContactInformation. Please note that this profile differs significantly from the zib ContactInformation because the zib model is deemed overly complex, too Dutch-specific, and contains unsuited terminology. The mapping from zib to FHIR is not trivial and results in too complex mapping. Therefore, the CBB is redesigned based on what is implemented internationally and in Belgium by looking at the FHIR data type and eHealth core profiles. The new model replaces the containers for phone numbers and email addresses with elements on the root that can capture both. Therefore, no need for two profiles, slicing in the host profiles and no ConceptMaps. Data type HdBe-ContactInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cpt-2: A system is required if a value is provided. `value.empty() or system.exists()` org-3: The telecom of an organization can never be of use 'home' `where(use = 'home').empty()` Mappings rim: n/a v2: XTN rim: TEL servd: ContactPoint v2: ORC-22? rim: .telecom servd: ./ContactPoints zib-contactinformation-v1.2-2020EN: NL-CM:20.6.2 zib-contactinformation-v1.2-2020EN: NL-CM:20.6.3 HdBe-ContactInformation: ContactInformation zib-payer-v3.1.1-2020EN: NL-CM:1.1.12 HdBe-Payer: Payer.ContactInformation
address	I	0..*	HdBe-AddressInformation	Element id Organization.address Short description AddressInformation Alternate names Adresgegevens Definition The payer’s address information. Requirements May need to keep track of the organization's addresses for contacting, billing or reporting requirements. Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type HdBe-AddressInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` org-2: An address of an organization can never be of use 'home' `where(use = 'home').empty()` Mappings rim: n/a v2: XAD rim: AD servd: Address v2: ORC-23? rim: .address servd: ./PrimaryAddress and ./OtherAddresses zib-addressinformation-v1.1-2020EN: NL-CM:20.5.1 HdBe-AddressInformation: AddressInformation zib-payer-v3.1.1-2020EN: NL-CM:1.1.17 HdBe-Payer: Payer.AddressInformation
partOf	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Organization.partOf Short description The organization of which this organization forms a part Definition The organization of which this organization forms a part. Requirements Need to be able to track the hierarchy of organizations within an organization. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: No equivalent in HL7 v2 rim: .playedBy[classCode=Part].scoper servd: n/a
contact		0..*	BackboneElement	There are no (further) constraints on this element Element id Organization.contact Short description Contact for the organization for a certain purpose Definition Contact for the organization for a certain purpose. Requirements Need to keep track of assigned contact points within bigger organization. Comments Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .contactParty
id		0..1	string	There are no (further) constraints on this element Element id Organization.contact.id Short description 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. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Organization.contact.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Organization.contact.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
purpose		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Organization.contact.purpose Short description The type of contact Definition Indicates a purpose for which the contact can be reached. Requirements Need to distinguish between multiple contact persons. Comments 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. Data type CodeableConcept Binding The purpose for which you would contact a contact party. ContactEntityType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: ./type
name		0..1	HumanName	There are no (further) constraints on this element Element id Organization.contact.name Short description A name associated with the contact Definition A name associated with the contact. Requirements Need to be able to track the person by name. Comments Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely. Data type HumanName Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XPN rim: EN (actually, PN) servd: ProviderName v2: PID-5, PID-9 rim: ./name
telecom	I	0..*	ContactPoint	There are no (further) constraints on this element Element id Organization.contact.telecom Short description Contact details (telephone, email, etc.) for a contact Definition A contact detail (e.g. a telephone number or an email address) by which the party may be contacted. Requirements People have (primary) ways to contact them in some way such as phone, email. Data type ContactPoint Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cpt-2: A system is required if a value is provided. `value.empty() or system.exists()` Mappings rim: n/a v2: XTN rim: TEL servd: ContactPoint v2: PID-13, PID-14 rim: ./telecom
address		0..1	Address	There are no (further) constraints on this element Element id Organization.contact.address Short description Visiting or postal addresses for the contact Definition Visiting or postal addresses for the contact. Requirements May need to keep track of a contact party's address for contacting, billing or reporting requirements. Comments Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type Address Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: XAD rim: AD servd: Address v2: PID-11 rim: ./addr
endpoint	I	0..*	Reference(Endpoint)	There are no (further) constraints on this element Element id Organization.endpoint Short description Technical endpoints providing access to services operated for the organization Definition Technical endpoints providing access to services operated for the organization. Requirements Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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. Data type Reference(Endpoint) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)

Mapping FHIR profile to CBB

Path	map	CBB
Organization	Payer.InsuranceCompany	HdBe-Payer
Organization.identifier:be-InsuranceIdentificationNumber	Payer.InsuranceCompany.IdentificationNumber	HdBe-Payer
Organization.name	Payer.InsuranceCompany.OrganizationName	HdBe-Payer
Organization.name	Payer.PayerPerson.PayerName	HdBe-Payer
Organization.telecom	Payer.ContactInformation	HdBe-Payer
Organization.address	Payer.AddressInformation	HdBe-Payer

zib-Payer-Organization difference

Concept	Category	Description
description	textual	Made the profile more specific to the profile instead of the copied zib description for a better rendering in the IG.
`identifier`	slicing	Replaced uzovi identifier slice with a slice that describes the BE insurance identification. According to HL7 BE / eHealth this should be based on the BeInsuranceNumberNamingSystem
`name`	textual	Removed Dutch context.
`telecom`	reference	Added reference to HdBe-ContactInformation profile, which replaces the two separate HdBe-ContactInformation profiles.
`telecom`	slicing	Removed slicing as the two HdBe-ContactInformation profiles are replaced with one general HdBe-ContactInformation profile, which makes slicing unnecessary.

Terminology Bindings

Path	Name	Strength	URL	ConceptMap
Coverage.type	InsuranceType	required	https://fhir.healthdata.be/ValueSet/InsuranceType	No bound ConceptMap