Versicherungsverhältnis - Pseudonymisiert (Coverage)
Dieses Profil beschreibt ein pseudonymisiertes Versicherungsverhältnis eines Patienten innerhalb des nNGM-Projektes.
Name: "Profile_nNGM_Coverage_VersicherungsverhaeltnisPseudonymisiert" (Profile - nNGM - Coverage - Versicherungsverhältnis Pseudonymisiert)
Canonical: http://uk-koeln.de/fhir/StructureDefinition/Coverage/nNGM/pseudonymisiert
Differential
Coverage | I | Coverage | There are no (further) constraints on this element Element idCoverage Versicherungsdaten DefinitionAngaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte. The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idCoverage.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCoverage.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCoverage.implicitRules A set of rules under which this content was created DefinitionA 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. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCoverage.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idCoverage.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idCoverage.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCoverage.identifier Business Identifier for the coverage DefinitionA unique identifier assigned to this coverage. Allows coverages to be distinguished and referenced. 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.
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status | Σ ?! | 1..1 | codeBindingFixed Value | Element idCoverage.status Für die Übermittelung im Rahmen der Anforderung einer Diagnostik sind nur aktive Versicherungsverhältnisse zu übermitteln DefinitionThe status of the resource instance. 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'. This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. A code specifying the state of the resource instance.
active
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type | S Σ | 1..1 | CodeableConceptBinding | Element idCoverage.type Ob es sich um eine GKV oder PKV Krankenversicherung handelt DefinitionArt der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The order of application of coverages is dependent on the types of coverage. 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen. Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
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policyHolder | Σ I | 0..0 | Reference(Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Element idCoverage.policyHolder Owner of the policy DefinitionThe party who 'owns' the insurance policy. This provides employer information in the case of Worker's Compensation and other policies. 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 Reference(Patient | RelatedPerson | Organization) Constraints
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subscriber | Σ I | 0..1 | Reference(Patient | RelatedPerson) | There are no (further) constraints on this element Element idCoverage.subscriber Hauptversicherte Person / Mitglied DefinitionHauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung This is the party who is entitled to the benfits under the policy. May be self or a parent in the case of dependants. Reference(Patient | RelatedPerson) Constraints
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subscriberId | Σ | 0..0 | string | There are no (further) constraints on this element Element idCoverage.subscriberId ID assigned to the subscriber DefinitionThe insurer assigned ID for the Subscriber. The insurer requires this identifier on correspondance and claims (digital and otherwise). Note that FHIR strings SHALL NOT exceed 1MB in size
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beneficiary | S Σ I | 1..1 | Reference(Patient) | Element idCoverage.beneficiary Begünstigter Patient DefinitionPerson, auf die sich die Kostenübernahme bezieht (der Patient) This is the party who receives treatment for which the costs are reimbursed under the coverage. 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.
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dependent | Σ | 0..0 | string | There are no (further) constraints on this element Element idCoverage.dependent Dependent number DefinitionA unique identifier for a dependent under the coverage. For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Periodically the member number is constructed from the subscriberId and the dependant number.
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relationship | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idCoverage.relationship Beneficiary relationship to the subscriber DefinitionThe relationship of beneficiary (patient) to the subscriber. To determine relationship between the patient and the subscriber to determine coordination of benefits. Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
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period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idCoverage.period Coverage start and end dates DefinitionTime 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. Some insurers require the submission of the coverage term. 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.
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payor | Σ I | 1..1 | Reference(Organization | Patient | RelatedPerson) | There are no (further) constraints on this element Element idCoverage.payor Versicherer DefinitionVersicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. Need to identify the issuer to target for claim processing and for coordination of benefit processing. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. Reference(Organization | Patient | RelatedPerson) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCoverage.payor.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.payor.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idCoverage.payor.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idCoverage.payor.type Type the reference refers to (e.g. "Patient") DefinitionThe 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). 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. Aa resource (or, for logical models, the URI of the logical model).
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idCoverage.payor.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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).
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display | S Σ | 1..1 | stringBinding | Element idCoverage.payor.display Nur zugelassene Krankenkassen dürfen übermittelt werden. Die Liste kann auf Anfrage bei der nNGM Geschäfststelle erweitert werden DefinitionVersicherer, der die Police ausgegeben hat oder Person/Organisation, die die Kosten übernimmt. 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. ValueSet_nNGM_Krankenkassen (required) Constraints
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class | 0..* | BackboneElement | There are no (further) constraints on this element Element idCoverage.class Additional coverage classifications DefinitionA suite of underwriter specific classifiers. The codes provided on the health card which identify or confirm the specific policy for the insurer. For example may be used to identify a class of coverage or employer group, Policy, Plan.
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id | 0..1 | string | There are no (further) constraints on this element Element idCoverage.class.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.class.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.class.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idCoverage.class.type Type of class such as 'group' or 'plan' DefinitionThe 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. The insurer issued label for a specific health card value. 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. The policy classifications, eg. Group, Plan, Class, etc.
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value | Σ | 1..1 | string | There are no (further) constraints on this element Element idCoverage.class.value Value associated with the type DefinitionThe alphanumeric string value associated with the insurer issued label. The insurer issued label and value are necessary to identify the specific policy. For example, the Group or Plan number.
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name | Σ | 0..1 | string | There are no (further) constraints on this element Element idCoverage.class.name Human readable description of the type and value DefinitionA short description for the class. Used to provide a meaningful description in correspondence to the patient. Note that FHIR strings SHALL NOT exceed 1MB in size
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order | Σ | 0..0 | positiveInt | There are no (further) constraints on this element Element idCoverage.order Relative order of the coverage DefinitionThe 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. Used in managing the coordination of benefits. 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
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network | Σ | 0..0 | string | There are no (further) constraints on this element Element idCoverage.network Insurer network DefinitionDie Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Used in referral for treatment and in claims processing. 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
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costToBeneficiary | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCoverage.costToBeneficiary Patient payments for services/products Alternate namesCoPay, Deductible, Exceptions DefinitionA 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. Required by providers to manage financial transaction with the patient. For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
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subrogation | 0..0 | boolean | There are no (further) constraints on this element Element idCoverage.subrogation Reimbursement to insurer DefinitionWhen 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. See definition for when to be used. Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
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contract | I | 0..0 | Reference(Contract) | There are no (further) constraints on this element Element idCoverage.contract Contract details DefinitionThe policy(s) which constitute this insurance coverage. To reference the legally binding contract between the policy holder and the insurer. 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.
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Erläuterungen
FHIR-Element-Id | EDC-Label | Beschreibung |
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Coverage.type | Versicherungsart | Ob es sich um eine GKV oder PKV Krankenversicherung handelt |
Coverage.beneficiary | Patient | Begünstigter Patient |
Coverage.payor.display | Versicherer | Nur zugelassene Krankenkassen dürfen übermittelt werden. Die Liste kann auf Anfrage bei der nNGM Geschäfststelle erweitert werden |
Bindings
FHIR-Element-Id | ValueSets |
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Coverage.status | Fixed Value - active - (http://hl7.org/fhir/ValueSet/fm-status) |
Coverage.type | ValueSet_nNGM_Krankenkassentypen |
Coverage.payor.display | ValueSet_nNGM_Krankenkassen |
Snapshot
Coverage | I | Coverage | There are no (further) constraints on this element Element idCoverage Versicherungsdaten DefinitionAngaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte. The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idCoverage.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCoverage.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCoverage.implicitRules A set of rules under which this content was created DefinitionA 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. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCoverage.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idCoverage.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idCoverage.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCoverage.identifier Business Identifier for the coverage DefinitionA unique identifier assigned to this coverage. Allows coverages to be distinguished and referenced. 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.
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status | Σ ?! | 1..1 | codeBindingFixed Value | Element idCoverage.status Für die Übermittelung im Rahmen der Anforderung einer Diagnostik sind nur aktive Versicherungsverhältnisse zu übermitteln DefinitionThe status of the resource instance. 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'. This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. A code specifying the state of the resource instance.
active
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type | S Σ | 1..1 | CodeableConceptBinding | Element idCoverage.type Ob es sich um eine GKV oder PKV Krankenversicherung handelt DefinitionArt der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The order of application of coverages is dependent on the types of coverage. 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen. Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
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policyHolder | Σ I | 0..0 | Reference(Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Element idCoverage.policyHolder Owner of the policy DefinitionThe party who 'owns' the insurance policy. This provides employer information in the case of Worker's Compensation and other policies. 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 Reference(Patient | RelatedPerson | Organization) Constraints
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subscriber | Σ I | 0..1 | Reference(Patient | RelatedPerson) | There are no (further) constraints on this element Element idCoverage.subscriber Hauptversicherte Person / Mitglied DefinitionHauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung This is the party who is entitled to the benfits under the policy. May be self or a parent in the case of dependants. Reference(Patient | RelatedPerson) Constraints
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subscriberId | Σ | 0..0 | string | There are no (further) constraints on this element Element idCoverage.subscriberId ID assigned to the subscriber DefinitionThe insurer assigned ID for the Subscriber. The insurer requires this identifier on correspondance and claims (digital and otherwise). Note that FHIR strings SHALL NOT exceed 1MB in size
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beneficiary | S Σ I | 1..1 | Reference(Patient) | Element idCoverage.beneficiary Begünstigter Patient DefinitionPerson, auf die sich die Kostenübernahme bezieht (der Patient) This is the party who receives treatment for which the costs are reimbursed under the coverage. 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.
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dependent | Σ | 0..0 | string | There are no (further) constraints on this element Element idCoverage.dependent Dependent number DefinitionA unique identifier for a dependent under the coverage. For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Periodically the member number is constructed from the subscriberId and the dependant number.
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relationship | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idCoverage.relationship Beneficiary relationship to the subscriber DefinitionThe relationship of beneficiary (patient) to the subscriber. To determine relationship between the patient and the subscriber to determine coordination of benefits. Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
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period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idCoverage.period Coverage start and end dates DefinitionTime 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. Some insurers require the submission of the coverage term. 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.
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payor | Σ I | 1..1 | Reference(Organization | Patient | RelatedPerson) | There are no (further) constraints on this element Element idCoverage.payor Versicherer DefinitionVersicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. Need to identify the issuer to target for claim processing and for coordination of benefit processing. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. Reference(Organization | Patient | RelatedPerson) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCoverage.payor.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.payor.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idCoverage.payor.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idCoverage.payor.type Type the reference refers to (e.g. "Patient") DefinitionThe 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). 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. Aa resource (or, for logical models, the URI of the logical model).
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idCoverage.payor.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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).
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display | S Σ | 1..1 | stringBinding | Element idCoverage.payor.display Nur zugelassene Krankenkassen dürfen übermittelt werden. Die Liste kann auf Anfrage bei der nNGM Geschäfststelle erweitert werden DefinitionVersicherer, der die Police ausgegeben hat oder Person/Organisation, die die Kosten übernimmt. 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. ValueSet_nNGM_Krankenkassen (required) Constraints
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class | 0..* | BackboneElement | There are no (further) constraints on this element Element idCoverage.class Additional coverage classifications DefinitionA suite of underwriter specific classifiers. The codes provided on the health card which identify or confirm the specific policy for the insurer. For example may be used to identify a class of coverage or employer group, Policy, Plan.
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id | 0..1 | string | There are no (further) constraints on this element Element idCoverage.class.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.class.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idCoverage.class.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idCoverage.class.type Type of class such as 'group' or 'plan' DefinitionThe 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. The insurer issued label for a specific health card value. 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. The policy classifications, eg. Group, Plan, Class, etc.
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value | Σ | 1..1 | string | There are no (further) constraints on this element Element idCoverage.class.value Value associated with the type DefinitionThe alphanumeric string value associated with the insurer issued label. The insurer issued label and value are necessary to identify the specific policy. For example, the Group or Plan number.
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name | Σ | 0..1 | string | There are no (further) constraints on this element Element idCoverage.class.name Human readable description of the type and value DefinitionA short description for the class. Used to provide a meaningful description in correspondence to the patient. Note that FHIR strings SHALL NOT exceed 1MB in size
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order | Σ | 0..0 | positiveInt | There are no (further) constraints on this element Element idCoverage.order Relative order of the coverage DefinitionThe 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. Used in managing the coordination of benefits. 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
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network | Σ | 0..0 | string | There are no (further) constraints on this element Element idCoverage.network Insurer network DefinitionDie Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Used in referral for treatment and in claims processing. 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
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costToBeneficiary | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCoverage.costToBeneficiary Patient payments for services/products Alternate namesCoPay, Deductible, Exceptions DefinitionA 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. Required by providers to manage financial transaction with the patient. For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
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subrogation | 0..0 | boolean | There are no (further) constraints on this element Element idCoverage.subrogation Reimbursement to insurer DefinitionWhen 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. See definition for when to be used. Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
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contract | I | 0..0 | Reference(Contract) | There are no (further) constraints on this element Element idCoverage.contract Contract details DefinitionThe policy(s) which constitute this insurance coverage. To reference the legally binding contract between the policy holder and the insurer. 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.
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