<status value="draft" /> <publisher value="Nictiz" /> <contact> <name value="Nictiz" /> <telecom> <system value="url" /> <value value="https://www.nictiz.nl" /> <use value="work" /> </telecom> </contact> <description value="Payers are organizations or individuals that pay for the healthcare supplied to the patient. These organizations or individuals can be: facilities or people who financially guarantee or who are responsible for the patient (such as parents or guardians of minors), organizations with direct financial responsibility, combinations of these or the patient themselves." /> <purpose value="This Coverage resource represents the InsuranceCompany concept of the Dutch [zib ('Zorginformatiebouwsteen', i.e. Health and Care Information Model) Payer v3.1.1 (2020)](https://zibs.nl/wiki/Payer-v3.1.1(2020EN))." /> <copyright value="Copyright and related rights waived via CC0, https://creativecommons.org/publicdomain/zero/1.0/. This does not apply to information from third parties, for example a medical terminology system. The implementer alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize third party IP in connection with the specification or otherwise." /> <fhirVersion value="4.0.1" /> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <uri value="https://zibs.nl/wiki/Payer-v3.1.1(2020EN)" /> <name value="zib Payer-v3.1.1(2020EN)" /> </mapping> <kind value="resource" /> <abstract value="true" /> <type value="Coverage" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Coverage" /> <derivation value="constraint" /> <differential> <element id="Coverage"> <path value="Coverage" /> <short value="Payer / Insurance" /> <comment value="The zib Payer is split into two focal profiles on Coverage based on the PayerPerson and InsuranceCompany containers. These two containers cannot be profiled within one profile because they both require mapping different concepts on elements such as `.payor` and `.type`. The zib container Payer.InsuranceCompany is mapped to this Coverage profile and uses the profile zib-Payer-Organization (<http://nictiz.nl/fhir/StructureDefinition/zib-Payer-Organization>) to capture the OrganizationName, IdentificationNumber, AddressInformation and ContactInformation. The zib-Payer-Organization profile is referenced using the `.payor` element." /> <alias value="Betaler" /> <alias value="Verzekering" /> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.1" /> <comment value="Payer" /> </mapping> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.8" /> <comment value="Insurance" /> </mapping> </element> <element id="Coverage.status"> <path value="Coverage.status" /> <comment value="Sending systems that don't record an explicit status can use the following guidance to infer a value from the zib: * StartDateTime is present and in the future: _draft_ * EndDateTime is present: * and in the future: _active_ * and in the past: _cancelled_ * When no status can be derived from StartDateTime and EndDateTime it is expected that only _active_ Coverage resources are exchanged." /> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.13" /> <comment value="StartDateTime (implicit, main mapping is on Coverage.period.start)" /> </mapping> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.14" /> <comment value="EndDateTime (implicit, main mapping is on Coverage.period.end)" /> </mapping> </element> <element id="Coverage.type"> <path value="Coverage.type" /> <short value="InsuranceType" /> <definition value="Type of insurance policy. Codes as returned in the Check for Right to Insurance." /> <alias value="Verzekeringssoort" /> <binding> <strength value="required" /> <valueSet value="http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.1.1.1--20200901000000" /> </binding> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.15" /> <comment value="InsuranceType" /> </mapping> </element> <element id="Coverage.subscriberId"> <path value="Coverage.subscriberId" /> <short value="InsurantNumber" /> <definition value="Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8" /> <alias value="VerzekerdeNummer" /> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.6" /> <comment value="InsurantNumber" /> </mapping> </element> <element id="Coverage.period.start"> <path value="Coverage.period.start" /> <short value="StartDateTime" /> <definition value="Date from which the insurance policy coverage applies." /> <alias value="BeginDatumTijd" /> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.13" /> <comment value="StartDateTime" /> </mapping> </element> <element id="Coverage.period.end"> <path value="Coverage.period.end" /> <short value="EndDateTime" /> <definition value="Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9." /> <alias value="EindDatumTijd" /> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.14" /> <comment value="EndDateTime" /> </mapping> </element> <element id="Coverage.payor"> <path value="Coverage.payor" /> <short value="InsuranceCompany" /> <alias value="Verzekeraar" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/zib-Payer-Organization" /> </type> <mapping> <identity value="zib-payer-v3.1.1-2020EN" /> <map value="NL-CM:1.1.3" /> <comment value="InsuranceCompany" /> </mapping> </element> </differential> </StructureDefinition>

No narrative is provided for definitional resources. A human-readable rendering can be found in the implementation guide(s) where this resource is used.