Implementierungsleitfaden ISiK-Basismodul

There are no (further) constraints on this element

Element id

Coverage.id

Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Data type

Meta

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

implicitRules

Σ ?!

0..1

There are no (further) constraints on this element

Element id

Coverage.implicitRules

Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

Coverage.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Data type

Binding

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

text

0..1

Narrative

There are no (further) constraints on this element

Element id

Coverage.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Data type

Narrative

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: Act.text?

contained

0..*

Resource

There are no (further) constraints on this element

Element id

Coverage.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Data type

Resource

Mappings

rim: N/A

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

modifierExtension

?! C

0..*

There are no (further) constraints on this element

Element id

Coverage.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

identifier

0..*

There are no (further) constraints on this element

Element id

Coverage.identifier

Short description

Business Identifier for the coverage

Definition

A unique identifier assigned to this coverage.

Requirements

Allows coverages to be distinguished and referenced.

Comments

The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Event.identifier
w5: FiveWs.identifier
cdanetv4: C02
v2: IN1-2
rim: .id
cpha3pharm: C.32, C.33, C.39

status

S Σ ?!

1..1

codeBinding

Element id

Coverage.status

Short description

Status

Definition

The status of the resource instance.

Requirements

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

Comments

Zeigt den aktuellen Status der Ressource an.
WICHTIGER Hinweis für Implementierer:

Alle server-seitigen Implementierungen MÜSSEN in der Lage sein, die systemintern möglichen Statuswerte korrekt in FHIR abzubilden, mindestens jedoch den Wert active.
Alle client-seitigen Implementierungen MÜSSEN in der Lage sein, sämtliche Status-Codes zu interpretieren und dem Anwender in angemessener Form darstellen zu können, beispielsweise durch Ausblenden/Durchstreichen von Ressourcen mit dem status entered-in-error und Ausgrauen von Ressourcen, die einen Plan- oder Entwurfs-Status haben.

Data type

FinancialResourceStatusCodes (required)

Binding

A code specifying the state of the resource instance.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Event.status
w5: FiveWs.status
rim: Act.status

type

S Σ

1..1

CodeableConceptBinding

Element id

Coverage.type

Short description

Versicherungsart

Definition

Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt

Requirements

The order of application of coverages is dependent on the types of coverage.

Comments

Die Angabe der Versicherungsart GKV dient der Kennzeichnung dieser Coverage-Ressource als gesetzliches Versicherungsverhältnis.
Begründung Pflichtfeld: Die Angabe der Versicherungsart dient der Unterscheidung, wenn zu einem Patienten mehrere Coverage-Ressourcen hinterlegt sind, z.B. gesetzliche Versicherung + Selbszahlerverhältnis und als Suchkriterium, um gezielt nach der in einem konkreten Kontext relevanten Coverage suchen zu können.
Historie:
28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standard definierten preferred bindings, da die dortigen Codes nicht passen.

Data type

VersicherungsartDeBasisVS (required)

Binding

Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

w5: FiveWs.class
v2: IN1-15

0..1

There are no (further) constraints on this element

Element id

Coverage.type.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.type.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

coding

S Σ

1..*

Coding

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

Slicing

Unordered, Open, by $this(Pattern)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

VersicherungsArtDeBasis

S Σ

1..1

CodingPattern

Element id

Coverage.type.coding:VersicherungsArtDeBasis

Short description

Codierte Darstellung der Versicherungsart

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

Data type

Coding

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "system": "http://fhir.de/CodeSystem/versicherungsart-de-basis",
  "code": "GKV"
}

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

Coverage.type.coding:VersicherungsArtDeBasis.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.type.coding:VersicherungsArtDeBasis.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

system

S Σ

1..1

uriPattern

Element id

Coverage.type.coding:VersicherungsArtDeBasis.system

Short description

Codier-Schema

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

Hier ist stets der Wert http://fhir.de/CodeSystem/versicherungsart-de-basis anzugeben.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

http://fhir.de/CodeSystem/versicherungsart-de-basis

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element id

Coverage.type.coding:VersicherungsArtDeBasis.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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

S Σ

1..1

codePattern

Element id

Coverage.type.coding:VersicherungsArtDeBasis.code

Short description

Code

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Requirements

Need to refer to a particular code in the system.

Comments

Hier ist stets der Code GKV anzugeben.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

GKV

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element id

Coverage.type.coding:VersicherungsArtDeBasis.display

Short description

Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element id

Coverage.type.coding:VersicherungsArtDeBasis.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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

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

0..1

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

policyHolder

0..0

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

Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org

Data type

Reference(Patient | RelatedPerson | Organization)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

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

S Σ

0..1

Reference(Patient | RelatedPerson)

Element id

Coverage.subscriber

Short description

Hauptversicherte Person

Definition

Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung

Requirements

This is the party who is entitled to the benfits under the policy.

Comments

Die hauptversicherte Person kann der Patient selbst sein, oder (z.B. im Falle einer Familienversicherung) auch ein Angehöriger (RelatedPerson) **Begründung MS: Die Information über die hauptversicherte Person ist insbesondere im Kontext der Korrespondenz von Bedeutung, da z.B. bei familienversicherten Kindern i.d.R. über die hauptversicherte Person korrespondiert wird.

Hinweis: Die Angabe der VersichertenID des Hauptversicherten in subscriber.identifier ist verpflichtend. Weitere Angaben zum Versicherten (Name, Adresse) können in einer RelatedPerson-Resource hinterlegt werden, auf die hier referenziert wird.

Data type

Reference(Patient | RelatedPerson)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

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

0..1

There are no (further) constraints on this element

Element id

Coverage.subscriber.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.subscriber.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

reference

S Σ C

0..1

Element id

Coverage.subscriber.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Comments

Die Verlinkung auf eine Patienten- oder RelatedPerson-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten/Angehörigen und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

Coverage.subscriber.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

identifier

S Σ

1..1

IdentifierKvid10

Element id

Coverage.subscriber.identifier

Short description

Lebenslange Krankenversichertennummer der Hauptversicherten

Definition

An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.

Comments

Die als 'KVZ10' kodierte Versichertennummer ist der 10-stellige, unveränderbare Teil der Versichertennummer, der lesbar auf die Elektronische Gesundheitskarte aufgedruckt ist. Er gilt für alle Krankenversichertennummern, unabhängig davon, ob es sich um GKV, PKV oder Sonderkostenträger handelt.
Weitere Hinweise: siehe Deutschen Basisprofile

Data type

IdentifierKvid10

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier
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

0..1

There are no (further) constraints on this element

Element id

Coverage.subscriber.identifier.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.subscriber.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

Coverage.subscriber.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data type

Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

type

Σ C

0..1

CodeableConceptBindingPattern

There are no (further) constraints on this element

Element id

Coverage.subscriber.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Data type

IdentifierTypeDeBasisVS (extensible)

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
kvid-2: Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden
($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()

Pattern

{
  "coding": [
    {
      "system": "http://fhir.de/CodeSystem/identifier-type-de-basis",
      "code": "KVZ10"
    }
  ]
}

Mappings

v2: CX.5
rim: Role.code or implied by context

system

S Σ

1..1

uriFixed Value

Element id

Coverage.subscriber.identifier.system

Short description

Namensraum der Versichertennummer

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Hier ist stets der Wert http://fhir.de/sid/gkv/kvid-10 anzugeben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed value

http://fhir.de/sid/gkv/kvid-10

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

S Σ C

1..1

Element id

Coverage.subscriber.identifier.value

Short description

Lebenslange Krankenversichertennummer

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Der 10-stellige, unveränderbare Teil der Versichertennummer.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
kvid-1: Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen
matches('^[A-Z][0-9]{9}$')

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

Coverage.subscriber.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

Coverage.subscriber.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

S Σ

0..1

Element id

Coverage.subscriber.display

Short description

Name des Hauptversicherten

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

Begründung MS: Da das die Versichertennummer nicht zur Darstellung für den Anwender geeignet ist, sollte ergänzend der Name des Versicherten angegeben werden.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

subscriberId

0..0

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).

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

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

S Σ

1..1

Reference(Patient)

Element id

Coverage.beneficiary

Short description

Versicherte Person

Definition

Person, auf die sich die Kostenübernahme bezieht (der Patient)

Requirements

This is the party who receives treatment for which the costs are reimbursed under the coverage.

Comments

Hier handelt es ich konkret um den Patienten, der unter diesem Versicherungsverhältnis behandelt wird.

Data type

Reference(Patient)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

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

0..1

There are no (further) constraints on this element

Element id

Coverage.beneficiary.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.beneficiary.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

reference

S Σ C

1..1

Element id

Coverage.beneficiary.reference

Short description

Patienten-Link

Definition

Comments

Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

Coverage.beneficiary.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

Coverage.beneficiary.identifier

Short description

Logical reference, when literal reference is not known

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

display

0..1

There are no (further) constraints on this element

Element id

Coverage.beneficiary.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

dependent

0..1

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

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

SubscriberRelationshipCodes (extensible)

Binding

The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

cdanetv4: C03

period

0..1

There are no (further) constraints on this element

Element id

Coverage.period

Short description

Coverage start and end dates

Definition

Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.

Requirements

Some insurers require the submission of the coverage term.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Event.occurrence[x]
w5: FiveWs.done[x]
v2: IN1-12 / IN1-13
rim: Act.effectiveTime

payor

S Σ

1..1

Element id

Coverage.payor

Short description

Kostenträger

Definition

Versicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt.

Requirements

Need to identify the issuer to target for claim processing and for coordination of benefit processing.

Comments

Die Angabe der IK-Nummer in payor.identifier sowie des Namens der Versicherung in payor.display ist zwingend erforderlich.
Die Referenz auf eine Resource vom Typ Organization in payor.reference, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional.

Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

w5: FiveWs.author
cdanetv4: A05
v2: IN1-3
cpha3pharm: C.30

0..1

There are no (further) constraints on this element

Element id

Coverage.payor.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.payor.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

Coverage.payor.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

Coverage.payor.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

identifier

S Σ

1..1

IdentifierIknr

Element id

Coverage.payor.identifier

Short description

Institutskennzeichern der Versicherung

Definition

An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.

Comments

Begründung Pflichtfeld: Als eindeutiger Identifikator der Versicherung ist in vielen Fällen das Institutskennzeichen ausreichend.

Data type

IdentifierIknr

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier
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

0..1

There are no (further) constraints on this element

Element id

Coverage.payor.identifier.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.payor.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

Coverage.payor.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data type

Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBindingPattern

There are no (further) constraints on this element

Element id

Coverage.payor.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data type

IdentifierTypeDeBasisVS (extensible)

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Pattern

{
  "coding": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code": "XX"
    }
  ]
}

Mappings

v2: CX.5
rim: Role.code or implied by context

system

S Σ

1..1

uriFixed Value

Element id

Coverage.payor.identifier.system

Short description

Namensraum der IK-Nummer

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Hier ist stets der Wert http://fhir.de/sid/arge-ik/iknr anzugeben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed value

http://fhir.de/sid/arge-ik/iknr

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

S Σ C

1..1

Element id

Coverage.payor.identifier.value

Short description

IK-Nummer

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Das Institutskennzeichen der Versicherung

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ik-1: Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein
matches('^[0-9]{9}$')

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

Coverage.payor.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

Coverage.payor.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

S Σ

1..1

Element id

Coverage.payor.display

Short description

Name der Versicherung

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

Begründung Pflichtfeld: Da das Institutskennzeichen nicht zur Darstellung für den Anwender geeignet ist, muss ergänzend der Name der Versicherung angegeben werden.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

class

0..*

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

0..1

There are no (further) constraints on this element

Element id

Coverage.class.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.class.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Coverage.class.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

type

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.

Data type

CoverageClassCodes (extensible)

Binding

The policy classifications, eg. Group, Plan, Class, etc.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

value

1..1

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

cdanetv4: C11 (Division,Section)
v2: IN1-8
cpha3pharm: C.31

name

0..1

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.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

cdanetv4: C11 (Division,Section)
v2: IN1-8
cpha3pharm: C.31

order

0..0

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

Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org

Data type

positiveInt

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: - No exact HL7 v2 equivalent concept seems to exist;

network

0..0

There are no (further) constraints on this element

Element id

Coverage.network

Short description

Insurer network

Definition

Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden

Requirements

Used in referral for treatment and in claims processing.

Comments

Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

cdanetv4: D10

costToBeneficiary

0..*

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

0..1

There are no (further) constraints on this element

Element id

Coverage.costToBeneficiary.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.costToBeneficiary.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Coverage.costToBeneficiary.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

type

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

CoverageCopayTypeCodes (extensible)

Binding

The types of services to which patient copayments are specified.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

value[x]

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

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..*

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

0..1

There are no (further) constraints on this element

Element id

Coverage.costToBeneficiary.exception.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Coverage.costToBeneficiary.exception.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Coverage.costToBeneficiary.exception.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

type

1..1

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.

Data type

ExampleCoverageFinancialExceptionCodes (example)

Binding

The types of exceptions from the part or full value of financial obligations such as copays.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

period

0..1

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.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

subrogation

0..1

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