ZD Coverage

Resources conforming to this profile are requested by ZorgDomein when SSO to ZorgDomein has succeeded and patient details are fetched from the source system.

Queries on the https://[FHIRServerUrl]/Coverage endpoint may include the following query parameters:

subscriber=[PatientID]: [PatientID] will refer to the patient ID as provided in the Task resource that is requested by ZorgDomein during SSO.
_include=Coverage:payor: indicates that the search result must also contain the Organization resource that is referred to by Coverage.payor.

The canonical URL for this profile is:

http://zorgdomein.nl/fhir/StructureDefinition/zd-coverage

This profile builds on Coverage.

diffhybridsnap

Coverage	S	0..*	Coverage	There are no (further) constraints on this element Element Id Coverage Short description Insurance or medical plan or a payment agreement Definition Financial instrument which may be used to reimburse or pay for health care products and services. Data Type Coverage Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.empty()` dom-4: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-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:Coverage w5:financial.support
identifier	Σ	0..*	Identifier	Element Id Coverage.identifier Short description The policy number of the insurance of the patient (fallback) Definition The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant. Requirements This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier cdanetv4:C02 v2:IN1-2 cpha3pharm:C.32, C.33, C.39 w5:id
status	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. Comments This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. Data Type code Binding Financial Resource Status Codes (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:status
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.type Short description Type of coverage such as medical or accident Definition The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. Requirements The order of application of coverages is dependent on the types of coverage. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Coverage Type and Self-Pay Codes (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:IN1-15 w5:class
policyHolder	Σ	0..1	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element Id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:who.focus
subscriber	S Σ	1..1	Reference(Patient \| RelatedPerson)	Element Id Coverage.subscriber Short description The insured person Definition The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Patient \| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:who.focus
subscriberId	S Σ	0..1	string	Element Id Coverage.subscriberId Short description The policy number of the insurance of the patient Definition The insurer assigned ID for the Subscriber. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:who.focus
beneficiary	Σ	0..1	Reference(Patient)	There are no (further) constraints on this element Element Id Coverage.beneficiary Short description Plan Beneficiary Definition The party who benefits from the insurance coverage., the patient when services are provided. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:who.focus
relationship		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Coverage.relationship Short description Beneficiary relationship to the Subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding Policyholder Relationship Codes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4:C03
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Coverage.period Short description Coverage start and end dates Definition Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow:Event.occurrence v2:IN1-12 / IN1-13 w5:when.done
payor	S Σ	1..1	Reference(Organization)	Element Id Coverage.payor Short description The insurance company issuing the policy Definition The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). Requirements Need to identify the issuer to target for processing and for coordination of benefit processing. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` zd-cov-1:At least an identifier or a display value for the insurance company must be present `identifier.exists() or display.exists()` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:A05 v2:IN1-3 cpha3pharm:C.30 w5:who.author
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.payor.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	Element Id Coverage.payor.identifier Short description UZOVI-code of insurance company Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier rim:.identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.payor.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.payor.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data Type CodeableConcept Binding Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	1..1	uriFixed Value	Element Id Coverage.payor.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed Value http://nictiz.nl/fhir/NamingSystem/uzovi Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Coverage.payor.identifier.value Short description The value that is unique 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element Id Coverage.payor.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Coverage.payor.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	Element Id Coverage.payor.display Short description Name of insurance company 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a rim:N/A
grouping		0..1	BackboneElement	There are no (further) constraints on this element Element Id Coverage.grouping Short description Additional coverage classifications Definition A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a
group	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.group Short description An identifier for the group Definition Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify an employer group. May also be referred to as a Policy or Group ID. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
groupDisplay	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.groupDisplay Short description Display text for an identifier for the group Definition A short description for the group. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
subGroup	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.subGroup Short description An identifier for the subsection of the group Definition Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer group. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:IN1-8
subGroupDisplay	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.subGroupDisplay Short description Display text for the subsection of the group Definition A short description for the subgroup. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:IN1-8
plan	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.plan Short description An identifier for the plan Definition Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division ID. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C01 v2:IN1-35
planDisplay	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.planDisplay Short description Display text for the plan Definition A short description for the plan. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C01 v2:IN1-35
subPlan	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.subPlan Short description An identifier for the subsection of the plan Definition Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employees. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:IN1-10
subPlanDisplay	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.subPlanDisplay Short description Display text for the subsection of the plan Definition A short description for the subplan. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:IN1-10
class	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.class Short description An identifier for the class Definition Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage such as a level of deductables or co-payment. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C01 v2:IN1-35
classDisplay	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.classDisplay Short description Display text for the class Definition A short description for the class. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C01 v2:IN1-35
subClass	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.subClass Short description An identifier for the subsection of the class Definition Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a subclass of coverage such as a sub-level of deductables or co-payment. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C01 v2:IN1-35
subClassDisplay	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.grouping.subClassDisplay Short description Display text for the subsection of the subclass Definition A short description for the subclass. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C01 v2:IN1-35
dependent	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:C17 v2:- No exact HL7 v2 equivalent concept seems to exist;
sequence	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.sequence Short description The plan instance or sequence counter Definition An optional counter for a particular instance of the identified coverage which increments upon each renewal. Requirements Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:D11 v2:No HL7 v2 equivalent concept seems to exist
order	Σ	0..1	positiveInt	There are no (further) constraints on this element Element Id Coverage.order Short description Relative order of the coverage Definition The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care. Comments 32 bit number; for values larger than this, use decimal Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a v2:- No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.network Short description Insurer network Definition The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply. Comments Note that FHIR strings may not exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim:n/a cdanetv4:D10
contract		0..*	Reference(Contract)	There are no (further) constraints on this element Element Id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Contract) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:D01 through D09 v2:IN1-16, 18, 19 cpha3pharm:C.35

See the profile on simplifier.net for additional details.

Resource example

Below you find an example of a Coverage resource that conforms to the ZD Coverage profile.

{
  "resourceType" : "Coverage",
  "id" : "zd-coverage-1",	
  "meta" : {
    "profile" : [
      "http://zorgdomein.nl/fhir/StructureDefinition/zd-coverage"
    ]
  },
  "subscriber" : {
    "reference" : "Patient/zd-patient-1"
  },
  "subscriberId": "A123456780",
  "payor" : [
    {
      "identifier" : {
        "system" : "http://nictiz.nl/fhir/NamingSystem/uzovi",
        "value" : "0101"
      },
      "display" : "N.V. Univé Zorg"
    }
  ]
}

<Coverage xmlns='http://hl7.org/fhir'>
  <id value='zd-coverage-1'/>
  <meta>
    <profile value='http://zorgdomein.nl/fhir/StructureDefinition/zd-coverage'/>
  </meta>
  <subscriber>
    <reference value='Patient/zd-patient-1'/>
  </subscriber>
  <subscriberId value='A123456780'/>
  <payor>
    <identifier>
      <system value='http://nictiz.nl/fhir/NamingSystem/uzovi'/>
      <value value='0101'/>
    </identifier>
    <display value='N.V. Univé Zorg'/>
  </payor>
</Coverage>

ZD Coverage

Resource example

Questions or comments?

Thank you!