PrescribeIT™ Specification and Guide Version 2.0 Revision F

 

3.47 StructureDefinition: PrescribeIT Coverage (NOT SUPPORTED)

The official URL for this profile is: 

http://prescribeit.ca/fhir/StructureDefinition/profile-coverage

3.47.2 Formal Views of Profile Content

Download Excel representation

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

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This structure is derived from Coverage

NameCard.TypeConstraints and Usage
.  Coverage 0..*Definition:
Financial instrument which may be used to pay for or reimburse health care products and services.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


Comments:
Usage Note: This will usually be a GUID and is assigned by the sending application. Ideally it should be consistent for all messages referencing this same set of coverage information.

..  issuerReference 1..1Reference(Organization) {b}Definition:
The program or plan underwriter or payor.


Comments:
This is currently required in the spec. I've submitted a request to loosen it.

...  display 1..1stringMax Length: 500
Definition:
Plain text narrative that identifies the resource in addition to the resource reference.


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

..  type 0..1CodingBinding: ActCoverageTypeCode (example)
Definition:
The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health.

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (description) 		0..1Coding TextDefinition:
Allows the specification of a free-text description for a coded element that has a type of Coding rather than CodeableConcept.

....  url 1..1uri"http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text"
....  valueString 1..1stringMax Length: 5000
Definition:
Allows the specification of a free-text description for a coded element that has a type of Coding rather than CodeableConcept.

...  system 0..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


Comments:
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

...  code 0..1codeDefinition:
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

..  planholderIdentifier 1..1IdentifierDefinition:
The party who 'owns' the insurance contractual relationship to the policy or to whom the benefit of the policy is due.

...  value 1..1stringExample' General': 123456
Max Length: 500
Definition:
The portion of the identifier typically relevant to the user and which is unique within the context of the system.


Comments:
Conformance Rule: This element is required because of rules in the FHIR specification which may be relaxed in a future specification. If no useful value is known, this element may be populated 'Unknown'.

..  beneficiaryReference 1..1Reference(Shared Health Patient) {b}Definition:
A reference from one resource to another.

..  relationship 1..1CodingBinding: Beneficiary Relationship Codes (example)
Definition:
The relationship of the patient to the planholdersubscriber).

...  system 0..1uriFixed Value: http://hl7.org/fhir/v3/NullFlavor
Definition:
The identification of the code system that defines the meaning of the symbol in the code.


Comments:
Fixed value: http://hl7.org/fhir/v3/NullFlavor

...  code 0..1codeFixed Value: UNK
Definition:
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).


Comments:
Fixed value: UNK

..  identifier 0..1IdentifierDefinition:
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Subscriber Id, Certificate number or Personal Health Number or Case ID.

...  value 1..1string​Example' General': 123456
Example' ???': 123456
Definition:
The portion of the identifier typically relevant to the user and which is unique within the context of the system.


Comments:
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

..  group 0..1stringDefinition:
Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID.

This structure is derived from Coverage

Summary

Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 18 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage S0..*
... id S1..1id
... issuerReference S1..1Reference(Organization) {b}Identifier for the plan issuer/carrier id
.... display S1..1stringName of payor
Max Length: 500
... type S0..1Coding
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-coding-text S0..1stringFree text
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text
..... valueString S1..1stringMax Length: 5000
.... system S0..1uri
.... code S0..1code
... planholderIdentifier S1..1Identifier
.... value S1..1stringMax Length: 500
... beneficiaryReference S1..1Reference(Shared Health Patient) {b}
... relationship S1..1Coding
.... system S0..1uriFixed Value: http://hl7.org/fhir/v3/NullFlavor
.... code S0..1codeFixed Value: UNK
... identifier S0..1Identifier
.... value S1..1stringExample ???': 123456
... group S0..1string

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage S0..*Insurance or medical plan
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... issuerReference SΣ1..1Reference(Organization) {b}Identifier for the plan issuer/carrier id
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display SΣ1..1stringName of payor
Max Length: 500
... bin 0..1stringBIN Number
... period Σ0..1PeriodCoverage start and end dates
... type SΣ0..1CodingType of coverage
Binding: ActCoverageTypeCode (example)
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-coding-text S0..1stringFree text
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text"
..... valueString S1..1stringFree text
Max Length: 5000
.... system SΣ0..1uriIdentity of the terminology system
.... version Σ0..1stringVersion of the system - if relevant
.... code SΣ0..1codeSymbol in syntax defined by the system
.... display Σ0..1stringRepresentation defined by the system
.... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... planholderIdentifier ?!S1..1IdentifierPlan holder
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required)
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ0..1uriThe namespace for the identifier
Example General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value SΣ1..1stringThe value that is unique
Example General': 123456
Max Length: 500
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... beneficiaryReference ?!S1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... relationship S1..1CodingPatient relationship to planholder
Binding: Beneficiary Relationship Codes (example)
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... system SΣ0..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/v3/NullFlavor
.... version Σ0..1stringVersion of the system - if relevant
.... code SΣ0..1codeSymbol in syntax defined by the system
Fixed Value: UNK
.... display Σ0..1stringRepresentation defined by the system
.... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... identifier SΣ0..1IdentifierThe primary coverage ID
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required)
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ0..1uriThe namespace for the identifier
Example General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value SΣ1..1stringThe value that is unique
Example General': 123456
Example ???': 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... group SΣ0..1stringAn identifier for the group
... plan Σ0..1stringAn identifier for the plan
... subPlan Σ0..1stringAn identifier for the subsection of the plan
... dependent Σ0..1positiveIntDependent number
... sequence Σ0..1positiveIntThe plan instance or sequence counter
... exception 0..*CodingEligibility exceptions
Binding: Exception Codes (example)
... school 0..1stringName of School
... network Σ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Grid View

This structure is derived from Coverage

NameCard.TypeConstraints and Usage
.  Coverage 0..*Definition:
Financial instrument which may be used to pay for or reimburse health care products and services.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


Comments:
Usage Note: This will usually be a GUID and is assigned by the sending application. Ideally it should be consistent for all messages referencing this same set of coverage information.

..  issuerReference 1..1Reference(Organization) {b}Definition:
The program or plan underwriter or payor.


Comments:
This is currently required in the spec. I've submitted a request to loosen it.

...  display 1..1stringMax Length: 500
Definition:
Plain text narrative that identifies the resource in addition to the resource reference.


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

..  type 0..1CodingBinding: ActCoverageTypeCode (example)
Definition:
The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health.

...  extension 0..*ExtensionSlice: Unordered, Open by value:url
Definition:
An Extension

...  extension
       (description) 		0..1Coding TextDefinition:
Allows the specification of a free-text description for a coded element that has a type of Coding rather than CodeableConcept.

....  url 1..1uri"http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text"
....  valueString 1..1stringMax Length: 5000
Definition:
Allows the specification of a free-text description for a coded element that has a type of Coding rather than CodeableConcept.

...  system 0..1uriDefinition:
The identification of the code system that defines the meaning of the symbol in the code.


Comments:
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

...  code 0..1codeDefinition:
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

..  planholderIdentifier 1..1IdentifierDefinition:
The party who 'owns' the insurance contractual relationship to the policy or to whom the benefit of the policy is due.

...  value 1..1stringExample' General': 123456
Max Length: 500
Definition:
The portion of the identifier typically relevant to the user and which is unique within the context of the system.


Comments:
Conformance Rule: This element is required because of rules in the FHIR specification which may be relaxed in a future specification. If no useful value is known, this element may be populated 'Unknown'.

..  beneficiaryReference 1..1Reference(Shared Health Patient) {b}Definition:
A reference from one resource to another.

..  relationship 1..1CodingBinding: Beneficiary Relationship Codes (example)
Definition:
The relationship of the patient to the planholdersubscriber).

...  system 0..1uriFixed Value: http://hl7.org/fhir/v3/NullFlavor
Definition:
The identification of the code system that defines the meaning of the symbol in the code.


Comments:
Fixed value: http://hl7.org/fhir/v3/NullFlavor

...  code 0..1codeFixed Value: UNK
Definition:
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).


Comments:
Fixed value: UNK

..  identifier 0..1IdentifierDefinition:
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Subscriber Id, Certificate number or Personal Health Number or Case ID.

...  value 1..1string​Example' General': 123456
Example' ???': 123456
Definition:
The portion of the identifier typically relevant to the user and which is unique within the context of the system.


Comments:
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

..  group 0..1stringDefinition:
Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID.

This structure is derived from Coverage

Summary

Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 18 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage S0..*
... id S1..1id
... issuerReference S1..1Reference(Organization) {b}Identifier for the plan issuer/carrier id
.... display S1..1stringName of payor
Max Length: 500
... type S0..1Coding
.... extension S0..*ExtensionSlice: Unordered, Open by value:url
.... ext-coding-text S0..1stringFree text
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text
..... valueString S1..1stringMax Length: 5000
.... system S0..1uri
.... code S0..1code
... planholderIdentifier S1..1Identifier
.... value S1..1stringMax Length: 500
... beneficiaryReference S1..1Reference(Shared Health Patient) {b}
... relationship S1..1Coding
.... system S0..1uriFixed Value: http://hl7.org/fhir/v3/NullFlavor
.... code S0..1codeFixed Value: UNK
... identifier S0..1Identifier
.... value S1..1stringExample ???': 123456
... group S0..1string

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage S0..*Insurance or medical plan
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... issuerReference SΣ1..1Reference(Organization) {b}Identifier for the plan issuer/carrier id
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... reference ΣI0..1stringRelative, internal or absolute URL reference
.... display SΣ1..1stringName of payor
Max Length: 500
... bin 0..1stringBIN Number
... period Σ0..1PeriodCoverage start and end dates
... type SΣ0..1CodingType of coverage
Binding: ActCoverageTypeCode (example)
.... id 0..1idxml:id (or equivalent in JSON)
.... extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ext-coding-text S0..1stringFree text
URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text
..... id 0..1idxml:id (or equivalent in JSON)
..... url S1..1uri"http://sharedhealth.exchange/fhir/StructureDefinition/ext-coding-text"
..... valueString S1..1stringFree text
Max Length: 5000
.... system SΣ0..1uriIdentity of the terminology system
.... version Σ0..1stringVersion of the system - if relevant
.... code SΣ0..1codeSymbol in syntax defined by the system
.... display Σ0..1stringRepresentation defined by the system
.... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... planholderIdentifier ?!S1..1IdentifierPlan holder
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required)
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ0..1uriThe namespace for the identifier
Example General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value SΣ1..1stringThe value that is unique
Example General': 123456
Max Length: 500
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... beneficiaryReference ?!S1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... relationship S1..1CodingPatient relationship to planholder
Binding: Beneficiary Relationship Codes (example)
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... system SΣ0..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/v3/NullFlavor
.... version Σ0..1stringVersion of the system - if relevant
.... code SΣ0..1codeSymbol in syntax defined by the system
Fixed Value: UNK
.... display Σ0..1stringRepresentation defined by the system
.... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... identifier SΣ0..1IdentifierThe primary coverage ID
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required)
.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ0..1uriThe namespace for the identifier
Example General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value SΣ1..1stringThe value that is unique
Example General': 123456
Example ???': 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... group SΣ0..1stringAn identifier for the group
... plan Σ0..1stringAn identifier for the plan
... subPlan Σ0..1stringAn identifier for the subsection of the plan
... dependent Σ0..1positiveIntDependent number
... sequence Σ0..1positiveIntThe plan instance or sequence counter
... exception 0..*CodingEligibility exceptions
Binding: Exception Codes (example)
... school 0..1stringName of School
... network Σ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

 

Other representations of profile: Schematron

3.47.3 Terminology Bindings

Terminology Bindings

PathNameConformanceValueSet
Coverage.language?extrequiredhttp://tools.ietf.org/html/bcp47
Coverage.typeActCoverageTypeCodeexampleActCoverageTypeCode
Coverage.planholderIdentifier.useIdentifierUserequiredIdentifierUse
Coverage.planholderIdentifier.typeIdentifier Type CodesextensibleIdentifier Type Codes
Coverage.relationshipBeneficiary Relationship CodesexampleBeneficiary Relationship Codes
Coverage.identifier.useIdentifierUserequiredIdentifierUse
Coverage.identifier.typeIdentifier Type CodesextensibleIdentifier Type Codes
Coverage.exceptionException CodesexampleException Codes

3.47.4 Constraints

Constraints

IdPathDetailsRequirements