RLCoverageEsenzioni

RLCoverageEsenzioni

Descrizione

Profilo declinato a partire dalla risorsa standard FHIR Coverage che contiene i dettagli inerenti alle esenzioni di cui il paziente beneficia, la cui codifica è ricavata dalla tabella delle codifiche SISS delle esenzioni.

Di seguito è presentato il contenuto del profilo in diversi formati. La corrispondente definizione è consultabile al seguente link: RLCoverageEsenzioni.

Snapshot View

Coverage	I		Coverage	There are no (further) constraints on this element Element Id Coverage Short description Insurance or medical plan or a payment agreement Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. 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
identifier	Σ	0..*	Identifier	Element Id Coverage.identifier Short description Codice dell'esenzione Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments Per il dettaglio esaustivo della codifica consultare la Tabella della tipologia di esenzioni contenuta nella sezione dei value-set del profilo presente nell'Implementation Guide. 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	codeBindingFixed Value	Element Id Coverage.status Short description Stato dell'esenzione Definition Valore fisso su "active" 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 This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. 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())` Fixed Value active Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:Act.status
type	Σ	0..1	CodeableConceptBinding	Element Id Coverage.type Short description Tipologia e descrizione esenzione 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())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:IN1-15
coding	Σ	0..*	Coding	There are no (further) constraints on this element Element Id Coverage.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Coverage.type.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. 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 v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. 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:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	0..1	codeBinding	Element Id Coverage.type.coding.code Short description Codice che indica la tipologia dell’esenzione Definition Stringa alfabetica di 2 caratteri Requirements Need to refer to a particular code in the system. Comments La fonte del dato è il campo CD_TIPO_ESENZIONE della tabella della codifica ministeriale delle "Esenzioni" Data Type code Binding ValueSet relativo alla tipologia di esenzioni SGDT Tipologia Esenzioni (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.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	Element Id Coverage.type.coding.display Short description Descrizione dell’esenzione Definition Stringa alfanumerica di al più 100 caratteri Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments La fonte del dato è il campo DS_ESENZIONE della tabella della codifica ministeriale delle "Esenzioni" 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:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Coverage.type.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. 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 v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. 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:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
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(RLPatientCittadino)	Element Id Coverage.beneficiary Short description Paziente beneficiario dell'esenzione Definition Reference alla profilo RLPatientCittadino contenente i dettagli anagrafici del paziente Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments Il dato è detenuto dal SGDT Data Type Reference(RLPatientCittadino) 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	Element Id Coverage.period Short description Decorrenza e scadenza esenzione 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
start	Σ I	0..1	dateTime	Element Id Coverage.period.start Short description Decorrenza esenzione Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Comments Il dato è detenuto dal SGDT 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
end	Σ I	0..1	dateTime	Element Id Coverage.period.end Short description Scadenza esenzione Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Comments Il dato è detenuto dal SGDT 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
payor	Σ I	1..*	Reference(RLOrganizationL1)	Element Id Coverage.payor Short description Riferimento all'ATS di appartenenza del paziente che ha emesso l'esenzione Definition Reference al profilo RLOrganizationL1 contenente i dettagli dell'ATS Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments Il dato è detenuto dal SGDT Data Type Reference(RLOrganizationL1) 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
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
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
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
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

Differential View

Coverage	I		Coverage	There are no (further) constraints on this element Element Id Coverage Short description Insurance or medical plan or a payment agreement Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. 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
identifier	Σ	0..*	Identifier	Element Id Coverage.identifier Short description Codice dell'esenzione Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments Per il dettaglio esaustivo della codifica consultare la Tabella della tipologia di esenzioni contenuta nella sezione dei value-set del profilo presente nell'Implementation Guide. 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	codeBindingFixed Value	Element Id Coverage.status Short description Stato dell'esenzione Definition Valore fisso su "active" 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 This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. 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())` Fixed Value active Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:Act.status
type	Σ	0..1	CodeableConceptBinding	Element Id Coverage.type Short description Tipologia e descrizione esenzione 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())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:IN1-15
coding	Σ	0..*	Coding	There are no (further) constraints on this element Element Id Coverage.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Coverage.type.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. 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 v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. 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:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	0..1	codeBinding	Element Id Coverage.type.coding.code Short description Codice che indica la tipologia dell’esenzione Definition Stringa alfabetica di 2 caratteri Requirements Need to refer to a particular code in the system. Comments La fonte del dato è il campo CD_TIPO_ESENZIONE della tabella della codifica ministeriale delle "Esenzioni" Data Type code Binding ValueSet relativo alla tipologia di esenzioni SGDT Tipologia Esenzioni (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.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	Element Id Coverage.type.coding.display Short description Descrizione dell’esenzione Definition Stringa alfanumerica di al più 100 caratteri Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments La fonte del dato è il campo DS_ESENZIONE della tabella della codifica ministeriale delle "Esenzioni" 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:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Coverage.type.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. 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 v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. 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:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
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(RLPatientCittadino)	Element Id Coverage.beneficiary Short description Paziente beneficiario dell'esenzione Definition Reference alla profilo RLPatientCittadino contenente i dettagli anagrafici del paziente Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments Il dato è detenuto dal SGDT Data Type Reference(RLPatientCittadino) 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	Element Id Coverage.period Short description Decorrenza e scadenza esenzione 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
start	Σ I	0..1	dateTime	Element Id Coverage.period.start Short description Decorrenza esenzione Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Comments Il dato è detenuto dal SGDT 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
end	Σ I	0..1	dateTime	Element Id Coverage.period.end Short description Scadenza esenzione Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Comments Il dato è detenuto dal SGDT 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
payor	Σ I	1..*	Reference(RLOrganizationL1)	Element Id Coverage.payor Short description Riferimento all'ATS di appartenenza del paziente che ha emesso l'esenzione Definition Reference al profilo RLOrganizationL1 contenente i dettagli dell'ATS Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments Il dato è detenuto dal SGDT Data Type Reference(RLOrganizationL1) 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
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
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
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
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

Hybrid View

Coverage	I		Coverage	There are no (further) constraints on this element Element Id Coverage Short description Insurance or medical plan or a payment agreement Definition Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. Comments The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. 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
identifier	Σ	0..*	Identifier	Element Id Coverage.identifier Short description Codice dell'esenzione Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. Comments Per il dettaglio esaustivo della codifica consultare la Tabella della tipologia di esenzioni contenuta nella sezione dei value-set del profilo presente nell'Implementation Guide. 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	codeBindingFixed Value	Element Id Coverage.status Short description Stato dell'esenzione Definition Valore fisso su "active" 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 This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. 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())` Fixed Value active Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:Act.status
type	Σ	0..1	CodeableConceptBinding	Element Id Coverage.type Short description Tipologia e descrizione esenzione 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())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:IN1-15
coding	Σ	0..*	Coding	There are no (further) constraints on this element Element Id Coverage.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id Coverage.type.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. 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 v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. 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:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	0..1	codeBinding	Element Id Coverage.type.coding.code Short description Codice che indica la tipologia dell’esenzione Definition Stringa alfabetica di 2 caratteri Requirements Need to refer to a particular code in the system. Comments La fonte del dato è il campo CD_TIPO_ESENZIONE della tabella della codifica ministeriale delle "Esenzioni" Data Type code Binding ValueSet relativo alla tipologia di esenzioni SGDT Tipologia Esenzioni (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.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	Element Id Coverage.type.coding.display Short description Descrizione dell’esenzione Definition Stringa alfanumerica di al più 100 caratteri Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments La fonte del dato è il campo DS_ESENZIONE della tabella della codifica ministeriale delle "Esenzioni" 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:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Coverage.type.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. 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 v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. 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:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
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(RLPatientCittadino)	Element Id Coverage.beneficiary Short description Paziente beneficiario dell'esenzione Definition Reference alla profilo RLPatientCittadino contenente i dettagli anagrafici del paziente Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments Il dato è detenuto dal SGDT Data Type Reference(RLPatientCittadino) 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	Element Id Coverage.period Short description Decorrenza e scadenza esenzione 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
start	Σ I	0..1	dateTime	Element Id Coverage.period.start Short description Decorrenza esenzione Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Comments Il dato è detenuto dal SGDT 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
end	Σ I	0..1	dateTime	Element Id Coverage.period.end Short description Scadenza esenzione Definition Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR Comments Il dato è detenuto dal SGDT 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
payor	Σ I	1..*	Reference(RLOrganizationL1)	Element Id Coverage.payor Short description Riferimento all'ATS di appartenenza del paziente che ha emesso l'esenzione Definition Reference al profilo RLOrganizationL1 contenente i dettagli dell'ATS Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments Il dato è detenuto dal SGDT Data Type Reference(RLOrganizationL1) 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
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
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
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
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

Table View

Coverage		..
Coverage.identifier		..
Coverage.status		..
Coverage.type		..
Coverage.type.coding		..
Coverage.type.coding.code		..
Coverage.type.coding.display		..
Coverage.beneficiary	Reference(RLPatientCittadino)	..
Coverage.period		..
Coverage.period.start		..
Coverage.period.end		..
Coverage.payor	Reference(RLOrganizationL1)	..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="RLCoverageEsenzioni" />
    <meta>
        <lastUpdated value="2023-01-25T10:07:48.4639615+00:00" />
    </meta>
    <url value="https://fhir.siss.regione.lombardia.it/StructureDefinition/RLCoverageEsenzioni" />
    <name value="RLCoverageEsenzioni" />
    <status value="draft" />
    <description value="Profilo volto a descrivere le esenzioni di cui il paziente beneficia" />
    <keyword>
        <system value="https://fhir.siss.regione.lombardia.it/CodeSystem/Tag" />
        <code value="PI" />
    </keyword>
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Coverage" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Coverage" />
    <derivation value="constraint" />
    <differential>
        <element id="Coverage.identifier">
            <path value="Coverage.identifier" />
            <short value="Codice dell&#39;esenzione" />
            <comment value="Per il dettaglio esaustivo della codifica consultare la Tabella della tipologia di esenzioni contenuta nella sezione dei value-set del profilo presente nell&#39;Implementation Guide." />
        </element>
        <element id="Coverage.status">
            <path value="Coverage.status" />
            <short value="Stato dell&#39;esenzione" />
            <definition value="Valore fisso su &quot;active&quot;" />
            <fixedCode value="active" />
        </element>
        <element id="Coverage.type">
            <path value="Coverage.type" />
            <short value="Tipologia e descrizione esenzione" />
        </element>
        <element id="Coverage.type.coding.code">
            <path value="Coverage.type.coding.code" />
            <short value="Codice che indica la tipologia dell’esenzione" />
            <definition value="Stringa alfabetica di 2 caratteri" />
            <comment value="La fonte del dato &#232; il campo CD_TIPO_ESENZIONE della tabella della codifica ministeriale delle &quot;Esenzioni&quot;" />
            <binding>
                <strength value="required" />
                <description value="ValueSet relativo alla tipologia di esenzioni" />
                <valueSet value="https://fhir.siss.regione.lombardia.it/ValueSet/SGDT-TipologiaEsenzioni" />
            </binding>
        </element>
        <element id="Coverage.type.coding.display">
            <path value="Coverage.type.coding.display" />
            <short value="Descrizione dell’esenzione" />
            <definition value="Stringa alfanumerica di al pi&#249; 100 caratteri" />
            <comment value="La fonte del dato &#232; il campo DS_ESENZIONE della tabella della codifica ministeriale delle &quot;Esenzioni&quot;" />
        </element>
        <element id="Coverage.beneficiary">
            <path value="Coverage.beneficiary" />
            <short value="Paziente beneficiario dell&#39;esenzione" />
            <definition value="Reference alla profilo RLPatientCittadino contenente i dettagli anagrafici del paziente" />
            <comment value="Il dato &#232; detenuto dal SGDT" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/RLPatientCittadino" />
            </type>
        </element>
        <element id="Coverage.period">
            <path value="Coverage.period" />
            <short value="Decorrenza e scadenza esenzione" />
        </element>
        <element id="Coverage.period.start">
            <path value="Coverage.period.start" />
            <short value="Decorrenza esenzione" />
            <definition value="Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR" />
            <comment value="Il dato &#232; detenuto dal SGDT" />
        </element>
        <element id="Coverage.period.end">
            <path value="Coverage.period.end" />
            <short value="Scadenza esenzione" />
            <definition value="Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR" />
            <comment value="Il dato &#232; detenuto dal SGDT" />
        </element>
        <element id="Coverage.payor">
            <path value="Coverage.payor" />
            <short value="Riferimento all&#39;ATS di appartenenza del paziente che ha emesso l&#39;esenzione" />
            <definition value="Reference al profilo RLOrganizationL1 contenente i dettagli dell&#39;ATS" />
            <comment value="Il dato &#232; detenuto dal SGDT" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.siss.regione.lombardia.it/StructureDefinition/RLOrganizationL1" />
            </type>
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "RLCoverageEsenzioni",
    "meta": {
        "lastUpdated": "2023-01-25T10:07:48.4639615+00:00"
    },
    "url": "https://fhir.siss.regione.lombardia.it/StructureDefinition/RLCoverageEsenzioni",
    "name": "RLCoverageEsenzioni",
    "status": "draft",
    "description": "Profilo volto a descrivere le esenzioni di cui il paziente beneficia",
    "keyword":  [
        {
            "system": "https://fhir.siss.regione.lombardia.it/CodeSystem/Tag",
            "code": "PI"
        }
    ],
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Coverage",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Coverage.identifier",
                "path": "Coverage.identifier",
                "short": "Codice dell'esenzione",
                "comment": "Per il dettaglio esaustivo della codifica consultare la Tabella della tipologia di esenzioni contenuta nella sezione dei value-set del profilo presente nell'Implementation Guide."
            },
            {
                "id": "Coverage.status",
                "path": "Coverage.status",
                "short": "Stato dell'esenzione",
                "definition": "Valore fisso su \"active\"",
                "fixedCode": "active"
            },
            {
                "id": "Coverage.type",
                "path": "Coverage.type",
                "short": "Tipologia e descrizione esenzione"
            },
            {
                "id": "Coverage.type.coding.code",
                "path": "Coverage.type.coding.code",
                "short": "Codice che indica la tipologia dell’esenzione",
                "definition": "Stringa alfabetica di 2 caratteri",
                "comment": "La fonte del dato è il campo CD_TIPO_ESENZIONE della tabella della codifica ministeriale delle \"Esenzioni\"",
                "binding": {
                    "strength": "required",
                    "description": "ValueSet relativo alla tipologia di esenzioni",
                    "valueSet": "https://fhir.siss.regione.lombardia.it/ValueSet/SGDT-TipologiaEsenzioni"
                }
            },
            {
                "id": "Coverage.type.coding.display",
                "path": "Coverage.type.coding.display",
                "short": "Descrizione dell’esenzione",
                "definition": "Stringa alfanumerica di al più 100 caratteri",
                "comment": "La fonte del dato è il campo DS_ESENZIONE della tabella della codifica ministeriale delle \"Esenzioni\""
            },
            {
                "id": "Coverage.beneficiary",
                "path": "Coverage.beneficiary",
                "short": "Paziente beneficiario dell'esenzione",
                "definition": "Reference alla profilo RLPatientCittadino contenente i dettagli anagrafici del paziente",
                "comment": "Il dato è detenuto dal SGDT",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/RLPatientCittadino"
                        ]
                    }
                ]
            },
            {
                "id": "Coverage.period",
                "path": "Coverage.period",
                "short": "Decorrenza e scadenza esenzione"
            },
            {
                "id": "Coverage.period.start",
                "path": "Coverage.period.start",
                "short": "Decorrenza esenzione",
                "definition": "Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR",
                "comment": "Il dato è detenuto dal SGDT"
            },
            {
                "id": "Coverage.period.end",
                "path": "Coverage.period.end",
                "short": "Scadenza esenzione",
                "definition": "Formato: YYYY-MM-DDThh:mm:ss+zz:zz secondo lo standard FHIR",
                "comment": "Il dato è detenuto dal SGDT"
            },
            {
                "id": "Coverage.payor",
                "path": "Coverage.payor",
                "short": "Riferimento all'ATS di appartenenza del paziente che ha emesso l'esenzione",
                "definition": "Reference al profilo RLOrganizationL1 contenente i dettagli dell'ATS",
                "comment": "Il dato è detenuto dal SGDT",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.siss.regione.lombardia.it/StructureDefinition/RLOrganizationL1"
                        ]
                    }
                ]
            }
        ]
    }
}

Esempi

Al momento non ci sono esempi disponibili.

Tipologie di ricerca

Attualmente non sono stati definiti criteri di ricerca.

Search parameter

Attualmente non sono definiti Search Parameters oltre quelli previsti dallo standard per la risorsa Coverage.

Value set

Nella seguente tabella sono elencati i value set relativi al profilo RLCoverageEsenzioni:

Nome	Descrizione	Riferimento al dettaglio della codifica
type	Codice e descrizione dell'esenzione