HL7.FHIR.IT.BASE\Coverage - base

HL7 Italia FHIR Implementation Guide (base)
0.1.0 - PC Ballot

This page is part of the HL7 Italia FHIR Implementation Guide (base) (v0.1.0: Public Comment 1 Ballot 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

StructureDefinition: CoverageItBase

Profilo base generico per Coverage: include la rappresentazione dell’ASL di residenza e delle esensioni.

The official URL for this profile is:

http://hl7.it/fhir/StructureDefinition/Coverage-it-base

Formal Views of Profile Content

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

Text Summary
Differential Table
Snapshot Table
All

This structure is derived from Coverage

Summary

Must-Support: 5 elements

Extensions

This structure refers to these extensions:

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
value[x]		1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary
data-absent-reason	S	0..1	code	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
exception	S	0..*	BackboneElement	Exceptions for patient payments
extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
coverage-exceptionStatus	S	0..1	CodeableConcept	Extension URL: http://hl7.it/fhir/StructureDefinition/coverage-exceptionStatus
type	S	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	S	0..1	Period	The effective period of the exception
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage	I	0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	string	Logical id of this artifact
meta	ΣI	0..1	Meta	Metadata about the resource
implicitRules	?!ΣI	0..1	uri	A set of rules under which this content was created
language	I	0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages
text	I	0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!I	0..*	Extension	Extensions that cannot be ignored
identifier	ΣI	0..*	Identifier	Business Identifier for the coverage
status	?!ΣI	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required)
type	ΣI	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred)
policyHolder	ΣI	0..1	Reference(Patient \| RelatedPerson \| Organization)	Owner of the policy
subscriber	ΣI	0..1	Reference(Patient \| RelatedPerson)	Subscriber to the policy
subscriberId	ΣI	0..1	string	ID assigned to the subscriber
beneficiary	ΣI	1..1	Reference(Patient)	Plan beneficiary
dependent	ΣI	0..1	string	Dependent number
relationship	I	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
period	ΣI	0..1	Period	Coverage start and end dates
payor	ΣI	1..*	Reference(Organization \| Patient \| RelatedPerson)	Issuer of the policy
class	I	0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	ΣI	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible)
value	ΣI	1..1	string	Value associated with the type
name	ΣI	0..1	string	Human readable description of the type and value
order	ΣI	0..1	positiveInt	Relative order of the coverage
network	ΣI	0..1	string	Insurer network
costToBeneficiary	I	0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	ΣI	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible)
value[x]	ΣI	1..1		The amount or percentage due from the beneficiary
value[x]:All Types				Content/Rules for all Types
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
data-absent-reason	SI	0..1	code	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception	SI	0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Extension Slice: Unordered, Open by value:url
coverage-exceptionStatus	SI	0..1	CodeableConcept	Extension URL: http://hl7.it/fhir/StructureDefinition/coverage-exceptionStatus
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣI	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	SΣI	0..1	Period	The effective period of the exception
subrogation	I	0..1	boolean	Reimbursement to insurer
contract	I	0..*	Reference(Contract)	Contract details
Documentation for this format

This structure is derived from Coverage

Summary

Must-Support: 5 elements

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
value[x]		1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary
data-absent-reason	S	0..1	code	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
exception	S	0..*	BackboneElement	Exceptions for patient payments
extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
coverage-exceptionStatus	S	0..1	CodeableConcept	Extension URL: http://hl7.it/fhir/StructureDefinition/coverage-exceptionStatus
type	S	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	S	0..1	Period	The effective period of the exception
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage	I	0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	string	Logical id of this artifact
meta	ΣI	0..1	Meta	Metadata about the resource
implicitRules	?!ΣI	0..1	uri	A set of rules under which this content was created
language	I	0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages
text	I	0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!I	0..*	Extension	Extensions that cannot be ignored
identifier	ΣI	0..*	Identifier	Business Identifier for the coverage
status	?!ΣI	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required)
type	ΣI	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred)
policyHolder	ΣI	0..1	Reference(Patient \| RelatedPerson \| Organization)	Owner of the policy
subscriber	ΣI	0..1	Reference(Patient \| RelatedPerson)	Subscriber to the policy
subscriberId	ΣI	0..1	string	ID assigned to the subscriber
beneficiary	ΣI	1..1	Reference(Patient)	Plan beneficiary
dependent	ΣI	0..1	string	Dependent number
relationship	I	0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
period	ΣI	0..1	Period	Coverage start and end dates
payor	ΣI	1..*	Reference(Organization \| Patient \| RelatedPerson)	Issuer of the policy
class	I	0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	ΣI	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible)
value	ΣI	1..1	string	Value associated with the type
name	ΣI	0..1	string	Human readable description of the type and value
order	ΣI	0..1	positiveInt	Relative order of the coverage
network	ΣI	0..1	string	Insurer network
costToBeneficiary	I	0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	ΣI	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible)
value[x]	ΣI	1..1		The amount or percentage due from the beneficiary
value[x]:All Types				Content/Rules for all Types
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
data-absent-reason	SI	0..1	code	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception	SI	0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Extension Slice: Unordered, Open by value:url
coverage-exceptionStatus	SI	0..1	CodeableConcept	Extension URL: http://hl7.it/fhir/StructureDefinition/coverage-exceptionStatus
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣI	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	SΣI	0..1	Period	The effective period of the exception
subrogation	I	0..1	boolean	Reimbursement to insurer
contract	I	0..*	Reference(Contract)	Contract details
Documentation for this format

Other representations of profile: Schematron

Terminology Bindings

Path	Conformance	ValueSet
Coverage.language	preferred	CommonLanguages Max Binding: AllLanguages
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	extensible	VsMinisteroSaluteEsenzioni

Constraints

Id	Path	Details	Requirements
dom-2	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	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	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	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	Coverage.meta	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.implicitRules	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.language	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.identifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.status	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.policyHolder	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.subscriber	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.subscriberId	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.beneficiary	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.dependent	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.relationship	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.payor	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.class.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.class.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.class.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.class.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class.value	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.class.name	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.order	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.network	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.value[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.value[x].extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.value[x].extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.value[x].extension:absenceReason	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.value[x].extension:absenceReason	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.exception	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.exception.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.exception.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.exception.extension:stato-esenzione	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.exception.extension:stato-esenzione	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.exception.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Coverage.costToBeneficiary.exception.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Coverage.costToBeneficiary.exception.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.costToBeneficiary.exception.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.subrogation	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Coverage.contract	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())

IG © 2020+ HL7 Italia. Package hl7.fhir.it.base#0.1.0 based on FHIR 4.0.1. Generated 2020-06-30
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