CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
1.0.0 - Release 1 United States of America flag

This page is part of the CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG (v1.0.0: Release) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: ACH Monthly Event Coverage

Official URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-monthly-coverage Version: 1.0.0
Standards status: Trial-use Maturity Level: 1 Computable Name: AcuteCareHospitalMonthlyReportingCoverage

This profile contains Required and Must Support data elements for reporting coverage information to the NHSN Acute Care Hospital (ACH) Monthly Digital Quality Measure. This profile is based on the HL7 FHIR® R4 Coverage Profile v4.0.1.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Name Flags Card. Type Description & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 1..1 id Logical id of this artifact
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Payer . (extensible)
... policyHolder SΣ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId SΣ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... dependent SΣ 0..1 string Dependent number
... relationship S 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL

doco Documentation for this format

Terminology Bindings

Path Conformance ValueSet URI
Coverage.status required FinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.type extensible Payer .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Coverage.relationship extensible SubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1
From the FHIR Standard

Constraints

Id Grade Path(s) Details Requirements
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management
: text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Name Flags Card. Type Description & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id 1..1 id Logical id of this artifact
... meta
.... Slices for extension Content/Rules for all slices
..... extension:link-received-date-extension 0..1 dateTime Received Date
URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
... type S 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Payer . (extensible)
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... subscriber S 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId S 0..1 string ID assigned to the subscriber
... beneficiary
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... dependent S 0..1 string Dependent number
... relationship S 0..1 CodeableConcept Beneficiary relationship to the subscriber
... period S 0..1 Period Coverage start and end dates
... payor
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL

doco Documentation for this format

Terminology Bindings (Differential)

Path Conformance ValueSet URI
Coverage.type extensible Payer .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Name Flags Card. Type Description & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 1..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... extension:link-received-date-extension 0..1 dateTime Received Date
URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Payer . (extensible)
... policyHolder SΣ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... subscriberId SΣ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... dependent SΣ 0..1 string Dependent number
... relationship S 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Conformance ValueSet URI
Coverage.meta.security extensible All Security Labels
http://hl7.org/fhir/ValueSet/security-labels|4.0.1
From the FHIR Standard
Coverage.meta.tag example CommonTags
http://hl7.org/fhir/ValueSet/common-tags|4.0.1
From the FHIR Standard
Coverage.language preferred CommonLanguages
http://hl7.org/fhir/ValueSet/languages|4.0.1
From the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.status required FinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.type extensible Payer .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Coverage.policyHolder.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.subscriber.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.beneficiary.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.relationship extensible SubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1
From the FHIR Standard
Coverage.payor.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.class.type extensible CoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class|4.0.1
From the FHIR Standard
Coverage.costToBeneficiary.type extensible CoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1
From the FHIR Standard
Coverage.costToBeneficiary.exception.type example ExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1
From the FHIR Standard

Constraints

Id Grade Path(s) Details Requirements
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management
: text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 11 elements

Extensions

This structure refers to these extensions:

Maturity: 1

Key Elements View

Name Flags Card. Type Description & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 1..1 id Logical id of this artifact
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Payer . (extensible)
... policyHolder SΣ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId SΣ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... dependent SΣ 0..1 string Dependent number
... relationship S 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL

doco Documentation for this format

Terminology Bindings

Path Conformance ValueSet URI
Coverage.status required FinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.type extensible Payer .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Coverage.relationship extensible SubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1
From the FHIR Standard

Constraints

Id Grade Path(s) Details Requirements
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management
: text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

Name Flags Card. Type Description & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id 1..1 id Logical id of this artifact
... meta
.... Slices for extension Content/Rules for all slices
..... extension:link-received-date-extension 0..1 dateTime Received Date
URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
... type S 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Payer . (extensible)
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... subscriber S 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... subscriberId S 0..1 string ID assigned to the subscriber
... beneficiary
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL
... dependent S 0..1 string Dependent number
... relationship S 0..1 CodeableConcept Beneficiary relationship to the subscriber
... period S 0..1 Period Coverage start and end dates
... payor
.... reference S 1..1 string Literal reference, Relative, internal or absolute URL

doco Documentation for this format

Terminology Bindings (Differential)

Path Conformance ValueSet URI
Coverage.type extensible Payer .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

Snapshot View

Name Flags Card. Type Description & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 1..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... extension:link-received-date-extension 0..1 dateTime Received Date
URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Payer . (extensible)
... policyHolder SΣ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... subscriberId SΣ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(Patient) Plan beneficiary
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... dependent SΣ 0..1 string Dependent number
... relationship S 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Conformance ValueSet URI
Coverage.meta.security extensible All Security Labels
http://hl7.org/fhir/ValueSet/security-labels|4.0.1
From the FHIR Standard
Coverage.meta.tag example CommonTags
http://hl7.org/fhir/ValueSet/common-tags|4.0.1
From the FHIR Standard
Coverage.language preferred CommonLanguages
http://hl7.org/fhir/ValueSet/languages|4.0.1
From the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.status required FinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.type extensible Payer .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Coverage.policyHolder.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.subscriber.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.beneficiary.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.relationship extensible SubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1
From the FHIR Standard
Coverage.payor.type extensible ResourceType
http://hl7.org/fhir/ValueSet/resource-types|4.0.1
From the FHIR Standard
Coverage.class.type extensible CoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class|4.0.1
From the FHIR Standard
Coverage.costToBeneficiary.type extensible CoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1
From the FHIR Standard
Coverage.costToBeneficiary.exception.type example ExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1
From the FHIR Standard

Constraints

Id Grade Path(s) Details Requirements
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management
: text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 11 elements

Extensions

This structure refers to these extensions:

Maturity: 1

 

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