{ "resourceType": "StructureDefinition", "url": "http://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Krankenversicherungsverhaeltnis", "name": "KBV_PR_FOR_Krankenversicherungsverhaeltnis", "status": "draft", "fhirVersion": "4.0.0", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "cdanetv4", "uri": "http://www.cda-adc.ca/en/services/cdanet/", "name": "Canadian Dental Association eclaims standard" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "cpha3pharm", "uri": "http://www.pharmacists.ca/", "name": "Canadian Pharmacy Associaiton eclaims standard" } ], "kind": "resource", "abstract": false, "type": "Coverage", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage", "derivation": "constraint", "differential": { "element": [ { "id": "Coverage", "path": "Coverage", "constraint": [ { "key": "besondere-personengruppe-GKV", "severity": "error", "human": "Ist der Kostentraegertyp GKV ausgewählt, so muss auch ein Wert der besondere-personengruppe vorhanden sein", "expression": "type.coding.code='GKV' implies extension('http://fhir.de/StructureDefinition/gkv/besondere-personengruppe').exists()", "source": "Coverage" }, { "key": "besondere-personengruppe-SKT", "severity": "error", "human": "Ist der Kostentraegertyp SKT ausgewählt, so muss auch ein Wert der besondere-personengruppe vorhanden sein", "expression": "type.coding.code='SKT' implies extension('http://fhir.de/StructureDefinition/gkv/besondere-personengruppe').exists()", "source": "Coverage" }, { "key": "dmpkennzeichen-SKT", "severity": "error", "human": "Ist der Kostentraegertyp SKT ausgewählt, so muss auch ein DMP Kennzeichen vorhanden sein", "expression": "type.coding.code='SKT' implies extension('http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen').exists()", "source": "Coverage" }, { "key": "dmpkennzeichen-GKV", "severity": "error", "human": "Ist der Kostentraegertyp GKV ausgewählt, so muss auch ein DMP Kennzeichen vorhanden sein", "expression": "type.coding.code='GKV' implies extension('http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen').exists()", "source": "Coverage" }, { "key": "versichertenart-GKV", "severity": "error", "human": "Ist der Kostentraegertyp GKV ausgewählt, so muss auch eine Versichertenart vorhanden sein", "expression": "type.coding.code='GKV' implies extension('http://fhir.de/StructureDefinition/gkv/versichertenart').exists()", "source": "Coverage" }, { "key": "versichertenart-SKT", "severity": "error", "human": "Ist der Kostentraegertyp SKT ausgewählt, so muss auch eine Versichertenart vorhanden sein", "expression": "type.coding.code='SKT' implies extension('http://fhir.de/StructureDefinition/gkv/versichertenart').exists()", "source": "Coverage" } ] }, { "id": "Coverage.meta", "path": "Coverage.meta", "min": 1, "mustSupport": true }, { "id": "Coverage.meta.versionId", "path": "Coverage.meta.versionId", "max": "0" }, { "id": "Coverage.meta.lastUpdated", "path": "Coverage.meta.lastUpdated", "max": "0" }, { "id": "Coverage.meta.source", "path": "Coverage.meta.source", "max": "0" }, { "id": "Coverage.meta.profile", "path": "Coverage.meta.profile", "min": 1, "max": "1", "fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Krankenversicherungsverhaeltnis", "mustSupport": true }, { "id": "Coverage.meta.security", "path": "Coverage.meta.security", "max": "0" }, { "id": "Coverage.meta.tag", "path": "Coverage.meta.tag", "max": "0" }, { "id": "Coverage.implicitRules", "path": "Coverage.implicitRules", "max": "0" }, { "id": "Coverage.language", "path": "Coverage.language", "max": "0" }, { "id": "Coverage.text", "path": "Coverage.text", "max": "0" }, { "id": "Coverage.contained", "path": "Coverage.contained", "max": "0" }, { "id": "Coverage.extension", "path": "Coverage.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" } }, { "id": "Coverage.extension:BesonderePersonengruppe", "path": "Coverage.extension", "sliceName": "BesonderePersonengruppe", "max": "1", "type": [ { "code": "Extension", "profile": [ "http://fhir.de/StructureDefinition/gkv/besondere-personengruppe" ] } ], "mustSupport": true }, { "id": "Coverage.extension:BesonderePersonengruppe.value[x]", "path": "Coverage.extension.value[x]", "min": 1, "mustSupport": true }, { "id": "Coverage.extension:BesonderePersonengruppe.value[x].system", "path": "Coverage.extension.value[x].system", "mustSupport": true }, { "id": "Coverage.extension:BesonderePersonengruppe.value[x].version", "path": "Coverage.extension.value[x].version", "max": "0" }, { "id": "Coverage.extension:BesonderePersonengruppe.value[x].code", "path": "Coverage.extension.value[x].code", "mustSupport": true }, { "id": "Coverage.extension:BesonderePersonengruppe.value[x].display", "path": "Coverage.extension.value[x].display", "max": "0" }, { "id": "Coverage.extension:BesonderePersonengruppe.value[x].userSelected", "path": "Coverage.extension.value[x].userSelected", "max": "0" }, { "id": "Coverage.extension:DMPKennzeichen", "path": "Coverage.extension", "sliceName": "DMPKennzeichen", "type": [ { "code": "Extension", "profile": [ "http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen" ] } ], "mustSupport": true }, { "id": "Coverage.extension:DMPKennzeichen.value[x]", "path": "Coverage.extension.value[x]", "min": 1, "mustSupport": true }, { "id": "Coverage.extension:DMPKennzeichen.value[x].system", "path": "Coverage.extension.value[x].system", "mustSupport": true }, { "id": "Coverage.extension:DMPKennzeichen.value[x].version", "path": "Coverage.extension.value[x].version", "max": "0" }, { "id": "Coverage.extension:DMPKennzeichen.value[x].code", "path": "Coverage.extension.value[x].code", "mustSupport": true }, { "id": "Coverage.extension:DMPKennzeichen.value[x].display", "path": "Coverage.extension.value[x].display", "max": "0" }, { "id": "Coverage.extension:DMPKennzeichen.value[x].userSelected", "path": "Coverage.extension.value[x].userSelected", "max": "0" }, { "id": "Coverage.extension:Versichertenart", "path": "Coverage.extension", "sliceName": "Versichertenart", "type": [ { "code": "Extension", "profile": [ "http://fhir.de/StructureDefinition/gkv/versichertenart" ] } ], "mustSupport": true }, { "id": "Coverage.extension:Versichertenart.value[x]", "path": "Coverage.extension.value[x]", "min": 1 }, { "id": "Coverage.extension:WOP", "path": "Coverage.extension", "sliceName": "WOP", "type": [ { "code": "Extension", "profile": [ "http://fhir.de/StructureDefinition/gkv/wop" ] } ], "mustSupport": true }, { "id": "Coverage.extension:WOP.value[x].version", "path": "Coverage.extension.value[x].version", "max": "0" }, { "id": "Coverage.extension:WOP.value[x].display", "path": "Coverage.extension.value[x].display", "max": "0" }, { "id": "Coverage.extension:WOP.value[x].userSelected", "path": "Coverage.extension.value[x].userSelected", "max": "0" }, { "id": "Coverage.identifier", "path": "Coverage.identifier", "slicing": { "discriminator": [ { "type": "value", "path": "system" } ], "rules": "closed" }, "short": "Primaerer Identifier der Versicherung", "definition": "Ein gesetzliches Versicherungsverhaeltnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet.", "max": "1", "mustSupport": true }, { "id": "Coverage.identifier:VersichertenID", "path": "Coverage.identifier", "sliceName": "VersichertenID", "short": "Versicherten-ID", "definition": "Die Versicherten-ID ist der 10-stellige unveraenderliche Teil der 30-stelligen Krankenversichertennummer. Sie wird haeufig ebenfalls als Krankenversichertennummer bezeichnet. Der Term 'Versicherten-ID' wird hier in Uebereinstimmung mit der Gematik-Spezifikation fuer das VSDM verwendet.", "max": "1", "type": [ { "code": "Identifier", "profile": [ "http://fhir.de/StructureDefinition/identifier-kvid-10" ] } ], "mustSupport": true, "mapping": [ { "identity": "KHEntgG", "map": "Krankenversichertennummer (Versicherten –ID)" }, { "identity": "KBV", "map": "Krankenversichertenverhaeltnis: VersichertenID" } ] }, { "id": "Coverage.identifier:VersichertenID.use", "path": "Coverage.identifier.use", "max": "0" }, { "id": "Coverage.identifier:VersichertenID.type", "path": "Coverage.identifier.type", "max": "0" }, { "id": "Coverage.identifier:VersichertenID.period", "path": "Coverage.identifier.period", "max": "0" }, { "id": "Coverage.identifier:VersichertenID.assigner", "path": "Coverage.identifier.assigner", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer", "path": "Coverage.identifier", "sliceName": "KVK-Versichertennummer", "max": "1", "mustSupport": true }, { "id": "Coverage.identifier:KVK-Versichertennummer.use", "path": "Coverage.identifier.use", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer.type", "path": "Coverage.identifier.type", "max": "0", "mustSupport": true }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.coding", "path": "Coverage.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.coding.system", "path": "Coverage.identifier.type.coding.system", "min": 1, "fixedUri": "http://www.kbv.de/fhir/CodeSystem/KBV_CS_KBV_Krankenversicherung_ID_Typ", "mustSupport": true }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.coding.version", "path": "Coverage.identifier.type.coding.version", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.coding.code", "path": "Coverage.identifier.type.coding.code", "min": 1, "mustSupport": true }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.coding.display", "path": "Coverage.identifier.type.coding.display", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.coding.userSelected", "path": "Coverage.identifier.type.coding.userSelected", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer.type.text", "path": "Coverage.identifier.type.text", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer.system", "path": "Coverage.identifier.system", "min": 1, "fixedUri": "http://fhir.de/NamingSystem/gkv/kvk-versichertennummer" }, { "id": "Coverage.identifier:KVK-Versichertennummer.value", "path": "Coverage.identifier.value", "min": 1 }, { "id": "Coverage.identifier:KVK-Versichertennummer.period", "path": "Coverage.identifier.period", "max": "0" }, { "id": "Coverage.identifier:KVK-Versichertennummer.assigner", "path": "Coverage.identifier.assigner", "max": "0" }, { "id": "Coverage.type", "path": "Coverage.type", "short": "Kostenträgertyp", "definition": "Art des Kostenträgers", "min": 1, "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://fhir.kbv.de/ValueSet/KBV_VS_FOR_Payor_type" } }, { "id": "Coverage.type.coding", "path": "Coverage.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Coverage.type.coding.system", "path": "Coverage.type.coding.system", "min": 1, "mustSupport": true }, { "id": "Coverage.type.coding.version", "path": "Coverage.type.coding.version", "max": "0" }, { "id": "Coverage.type.coding.code", "path": "Coverage.type.coding.code", "min": 1, "mustSupport": true }, { "id": "Coverage.type.coding.display", "path": "Coverage.type.coding.display", "max": "0" }, { "id": "Coverage.type.coding.userSelected", "path": "Coverage.type.coding.userSelected", "max": "0" }, { "id": "Coverage.type.text", "path": "Coverage.type.text", "max": "0" }, { "id": "Coverage.policyHolder", "path": "Coverage.policyHolder", "max": "0" }, { "id": "Coverage.subscriber", "path": "Coverage.subscriber", "max": "0" }, { "id": "Coverage.subscriberId", "path": "Coverage.subscriberId", "max": "0" }, { "id": "Coverage.beneficiary", "path": "Coverage.beneficiary", "short": "Begünstigte Person", "type": [ { "code": "Reference", "targetProfile": [ "http://www.kbv.de/fhir/Profil/KBV_PR_FOR_Patient" ] } ], "mustSupport": true }, { "id": "Coverage.beneficiary.reference", "path": "Coverage.beneficiary.reference", "min": 1 }, { "id": "Coverage.beneficiary.type", "path": "Coverage.beneficiary.type", "max": "0" }, { "id": "Coverage.beneficiary.identifier", "path": "Coverage.beneficiary.identifier", "max": "0" }, { "id": "Coverage.beneficiary.display", "path": "Coverage.beneficiary.display", "max": "0" }, { "id": "Coverage.dependent", "path": "Coverage.dependent", "max": "0" }, { "id": "Coverage.relationship", "path": "Coverage.relationship", "max": "0" }, { "id": "Coverage.period", "path": "Coverage.period", "constraint": [ { "key": "KBVdate", "severity": "error", "human": "Beschränkung auf die Angaben JJJJ-MM-TT", "expression": "end.toString().length() = 10", "source": "Coverage" } ], "mustSupport": true }, { "id": "Coverage.period.start", "path": "Coverage.period.start", "max": "0" }, { "id": "Coverage.period.end", "path": "Coverage.period.end", "short": "Versicherungsschutz Ende", "definition": "Angabe zum Versicherungsschutz Ende", "mustSupport": true }, { "id": "Coverage.payor", "path": "Coverage.payor", "slicing": { "description": "1. zustaendigeKrankenkasse\r\n2. kostentraeger", "ordered": true, "rules": "closed" }, "max": "2", "mustSupport": true }, { "id": "Coverage.payor:zustaendigeKrankenkasse", "path": "Coverage.payor", "sliceName": "zustaendigeKrankenkasse", "short": "IK der zuständigen Krankenkasse lt. eGK", "definition": "Dieses Feld enthält das IK laut der Versichertenkarte. \r\nSiehe hierzu die Übertragungsregel nach der \"Technische Anlage zur Anlage 4a BMV-Ä\" Kapitel 2.2 \"USE-CASES\"", "min": 1, "max": "1", "mustSupport": true }, { "id": "Coverage.payor:zustaendigeKrankenkasse.reference", "path": "Coverage.payor.reference", "max": "0" }, { "id": "Coverage.payor:zustaendigeKrankenkasse.type", "path": "Coverage.payor.type", "max": "0" }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier", "path": "Coverage.payor.identifier", "short": "IK-Nummer des Versicherers", "min": 1, "mustSupport": true, "mapping": [ { "identity": "KVDT", "map": "4111" }, { "identity": "KHEntgG", "map": "Institutionskennzeichen der Krankenkasse" } ] }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier.use", "path": "Coverage.payor.identifier.use", "max": "0" }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier.type", "path": "Coverage.payor.identifier.type", "max": "0" }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier.system", "path": "Coverage.payor.identifier.system", "min": 1, "fixedUri": "http://fhir.de/NamingSystem/arge-ik/iknr", "mustSupport": true }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier.value", "path": "Coverage.payor.identifier.value", "min": 1, "mustSupport": true }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier.period", "path": "Coverage.payor.identifier.period", "max": "0" }, { "id": "Coverage.payor:zustaendigeKrankenkasse.identifier.assigner", "path": "Coverage.payor.identifier.assigner", "max": "0" }, { "id": "Coverage.payor:zustaendigeKrankenkasse.display", "path": "Coverage.payor.display", "short": "Kostenträgername der zuständigen Krankenkasse lt. eGK", "definition": "Dieses Feld bildet den Namen des Kostenträgers der zuständigen Krankenkasse lt. eGK ab.", "mustSupport": true, "mapping": [ { "identity": "KVDT", "map": "4134" } ] }, { "id": "Coverage.payor:kostentraeger", "path": "Coverage.payor", "sliceName": "kostentraeger", "short": "zuständiger Kostenträger", "definition": "Kostenträger zu dessen Lasten eine Verordnung, Krankschreibung usw. geschieht.", "max": "1", "mustSupport": true }, { "id": "Coverage.payor:kostentraeger.reference", "path": "Coverage.payor.reference", "max": "0" }, { "id": "Coverage.payor:kostentraeger.type", "path": "Coverage.payor.type", "max": "0" }, { "id": "Coverage.payor:kostentraeger.identifier", "path": "Coverage.payor.identifier", "short": "IK-Nummer des Kostenträgers", "mustSupport": true }, { "id": "Coverage.payor:kostentraeger.identifier.use", "path": "Coverage.payor.identifier.use", "max": "0" }, { "id": "Coverage.payor:kostentraeger.identifier.type", "path": "Coverage.payor.identifier.type", "max": "0" }, { "id": "Coverage.payor:kostentraeger.identifier.system", "path": "Coverage.payor.identifier.system", "min": 1, "fixedUri": "http://fhir.de/NamingSystem/arge-ik/iknr", "mustSupport": true }, { "id": "Coverage.payor:kostentraeger.identifier.value", "path": "Coverage.payor.identifier.value", "min": 1, "mustSupport": true }, { "id": "Coverage.payor:kostentraeger.identifier.period", "path": "Coverage.payor.identifier.period", "max": "0" }, { "id": "Coverage.payor:kostentraeger.identifier.assigner", "path": "Coverage.payor.identifier.assigner", "max": "0" }, { "id": "Coverage.payor:kostentraeger.display", "path": "Coverage.payor.display", "short": "Name des Kostentraegers", "definition": "Name des Kostenträgers", "min": 1, "mustSupport": true }, { "id": "Coverage.class", "path": "Coverage.class", "max": "0" }, { "id": "Coverage.order", "path": "Coverage.order", "max": "0" }, { "id": "Coverage.network", "path": "Coverage.network", "max": "0" }, { "id": "Coverage.costToBeneficiary", "path": "Coverage.costToBeneficiary", "max": "0" }, { "id": "Coverage.subrogation", "path": "Coverage.subrogation", "max": "0" }, { "id": "Coverage.contract", "path": "Coverage.contract", "max": "0" } ] } }