Nictiz FHIR NL STU3 Zib2017
1.3.15 - CI Build
Nictiz FHIR NL STU3 Zib2017 - Local Development build (v1.3.15) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Active as of 2024-04-09 |
Definitions for the zib-Payer resource profile.
Guidance on how to interpret the contents of this table can be found here
0. Coverage | |
Short | Coverage |
Alternate Names | Verzekering |
2. Coverage.type | |
Definition | Type of insurance policy. Codes as returned in the Check for Right to Insurance |
Short | InsuranceType |
Binding | Unless not suitable, these codes SHALL be taken from VerzekeringssoortCodelijst (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.1.1.1--20171231000000 )InsuranceTypeCodelist |
Alternate Names | VerzekeringsSoort |
4. Coverage.policyHolder | |
Type | Reference(nl-core-patient, nl-core-relatedperson, nl-core-organization) |
6. Coverage.subscriber | |
Type | Reference(nl-core-patient, nl-core-relatedperson) |
8. Coverage.subscriberId | |
Definition | Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8 |
Short | InsurantNumber |
Alternate Names | VerzekerdeNummer |
10. Coverage.beneficiary | |
Type | Reference(nl-core-patient) |
12. Coverage.period | |
14. Coverage.period.start | |
Definition | Date from which the insurance policy coverage applies. |
Short | StartDateTime |
Alternate Names | BeginDatumTijd |
16. Coverage.period.end | |
Definition | Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9. |
Short | EndDateTime |
Control | 1..? |
Alternate Names | EindDatumTijd |
18. Coverage.payor | |
Short | InsuranceCompany / PayerPerson |
Control | 1..? |
Type | Reference(nl-core-organization, nl-core-patient, nl-core-relatedperson) |
Alternate Names | Verzekeraar, BetalerPersoon |
20. Coverage.payor.extension | |
Slicing | This element introduces a set of slices on Coverage.payor.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: |
22. Coverage.payor.extension:bankInformation | |
Slice Name | bankInformation |
Type | Extension(HCIM Payer BankInformation) (Complex Extension) |
24. Coverage.payor.extension:bankInformation.extension:BankName | |
Slice Name | BankName |
Definition | Name of the financial organization. |
Short | BankName |
Alternate Names | BankNaam |
26. Coverage.payor.extension:bankInformation.extension:AccountNumber | |
Slice Name | AccountNumber |
Definition | The payer’s bank account number at the listed organization. For European countries, this is the IBAN. |
Short | AccountNumber |
Alternate Names | Rekeningnummer |
28. Coverage.payor.extension:bankInformation.extension:Bankcode | |
Slice Name | Bankcode |
Definition | Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. |
Short | Bankcode |
Alternate Names | Bankcode |
Guidance on how to interpret the contents of this table can be found here
0. Coverage | |
Definition | Financial instrument which may be used to reimburse or pay for health care products and services. |
Short | CoverageInsurance or medical plan or a payment agreement |
Control | 0..* |
Alternate Names | Verzekering |
Invariants | 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() )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()) |
2. Coverage.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. |
Control | 0..1 |
Type | uri |
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
4. Coverage.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR |
Alternate Names | extensions, user content |
6. Coverage.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
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. |
Control | 0..1 |
Binding | The codes SHALL be taken from Financial Resource Status Codeshttp://hl7.org/fhir/ValueSet/fm-status (required to http://hl7.org/fhir/ValueSet/fm-status )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
8. Coverage.type | |
Definition | Type of insurance policy. Codes as returned in the Check for Right to Insurance The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. |
Short | InsuranceTypeType of coverage such as medical or accident |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from The codes SHOULD be taken from VerzekeringssoortCodelijsthttp://hl7.org/fhir/ValueSet/coverage-type (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.1.1.1--20171231000000 )InsuranceTypeCodelist The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
Type | CodeableConcept |
Summary | true |
Requirements | The order of application of coverages is dependent on the types of coverage. |
Alternate Names | VerzekeringsSoort |
10. Coverage.policyHolder | |
Definition | The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. |
Short | Owner of the policy |
Control | 0..1 |
Type | Reference(nl-core-patient, nl-core-relatedperson, nl-core-organization, Patient, RelatedPerson, Organization) |
Summary | true |
12. Coverage.subscriber | |
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. |
Short | Subscriber to the policy |
Control | 0..1 |
Type | Reference(nl-core-patient, nl-core-relatedperson, Patient, RelatedPerson) |
Summary | true |
14. Coverage.subscriberId | |
Definition | Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8 The insurer assigned ID for the Subscriber. |
Short | InsurantNumberID assigned to the Subscriber |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Alternate Names | VerzekerdeNummer |
16. Coverage.beneficiary | |
Definition | The party who benefits from the insurance coverage., the patient when services are provided. |
Short | Plan Beneficiary |
Control | 0..1 |
Type | Reference(nl-core-patient, Patient) |
Summary | true |
18. Coverage.period | |
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. |
Short | Coverage start and end dates |
Control | 0..1 |
Type | Period |
Summary | true |
20. Coverage.period.start | |
Definition | Date from which the insurance policy coverage applies. The start of the period. The boundary is inclusive. |
Short | StartDateTimeStarting time with inclusive boundary |
Comments | If the low element is missing, the meaning is that the low boundary is not known. |
Control | 0..1 This element is affected by the following invariants: per-1 |
Type | dateTime |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Alternate Names | BeginDatumTijd |
22. Coverage.period.end | |
Definition | Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9. The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time. |
Short | EndDateTimeEnd time with inclusive boundary, if not ongoing |
Comments | The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03. |
Control | 10..1 This element is affected by the following invariants: per-1 |
Type | dateTime |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Alternate Names | EindDatumTijd |
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing |
24. Coverage.payor | |
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). |
Short | InsuranceCompany / PayerPersonIdentifier for the plan or agreement issuer |
Control | 10..* |
Type | Reference(nl-core-organization, nl-core-patient, nl-core-relatedperson, Organization, Patient, RelatedPerson) |
Summary | true |
Requirements | Need to identify the issuer to target for processing and for coordination of benefit processing. |
Alternate Names | Verzekeraar, BetalerPersoon |
26. Coverage.payor.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional Content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Slicing | This element introduces a set of slices on Coverage.payor.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: |
28. Coverage.payor.extension:bankInformation | |
Slice Name | bankInformation |
Definition | An Extension |
Short | BankInformation |
Control | 0..* |
Type | Extension(HCIM Payer BankInformation) (Complex Extension) |
Alternate Names | Bankgegevens |
30. Coverage.payor.extension:bankInformation.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional Content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 10..* |
Type | Extension |
Alternate Names | extensions, user content |
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: |
32. Coverage.payor.extension:bankInformation.extension:BankName | |
Slice Name | BankName |
Definition | Name of the financial organization. |
Short | BankNameAdditional Content defined by implementations |
Control | 0..1* |
Type | Extension |
Alternate Names | BankNaam |
34. Coverage.payor.extension:bankInformation.extension:BankName.url | |
Definition | Source of the definition for the extension code - a logical name or a URL. |
Short | identifies the meaning of the extension |
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
Control | 1..1 |
Type | uri |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
XML Format | In the XML format, this property is represented as an attribute. |
Fixed Value | BankName |
36. Coverage.payor.extension:bankInformation.extension:BankName.value[x] | |
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | Value of extension |
Control | 0..1 |
Type | string, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.value[x] . The slices are unordered and Closed, and can be differentiated using the following discriminators: |
38. Coverage.payor.extension:bankInformation.extension:BankName.value[x]:valueString | |
Slice Name | valueString |
Definition | Name of the financial organization. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | BankNameValue of extension |
Control | 0..1 |
Type | string, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Alternate Names | BankNaam |
40. Coverage.payor.extension:bankInformation.extension:AccountNumber | |
Slice Name | AccountNumber |
Definition | The payer’s bank account number at the listed organization. For European countries, this is the IBAN. |
Short | AccountNumberAdditional Content defined by implementations |
Control | 10..1* |
Type | Extension |
Alternate Names | Rekeningnummer |
42. Coverage.payor.extension:bankInformation.extension:AccountNumber.url | |
Definition | Source of the definition for the extension code - a logical name or a URL. |
Short | identifies the meaning of the extension |
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
Control | 1..1 |
Type | uri |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
XML Format | In the XML format, this property is represented as an attribute. |
Fixed Value | AccountNumber |
44. Coverage.payor.extension:bankInformation.extension:AccountNumber.value[x] | |
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | Value of extension |
Control | 0..1 |
Type | string, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.value[x] . The slices are unordered and Closed, and can be differentiated using the following discriminators: |
46. Coverage.payor.extension:bankInformation.extension:AccountNumber.value[x]:valueString | |
Slice Name | valueString |
Definition | The payer’s bank account number at the listed organization. For European countries, this is the IBAN. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | AccountNumberValue of extension |
Control | 0..1 |
Type | string, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Alternate Names | Rekeningnummer |
48. Coverage.payor.extension:bankInformation.extension:Bankcode | |
Slice Name | Bankcode |
Definition | Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. |
Short | BankcodeAdditional Content defined by implementations |
Control | 0..1* |
Type | Extension |
Alternate Names | Bankcode |
50. Coverage.payor.extension:bankInformation.extension:Bankcode.url | |
Definition | Source of the definition for the extension code - a logical name or a URL. |
Short | identifies the meaning of the extension |
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
Control | 1..1 |
Type | uri |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
XML Format | In the XML format, this property is represented as an attribute. |
Fixed Value | Bankcode |
52. Coverage.payor.extension:bankInformation.extension:Bankcode.value[x] | |
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | Value of extension |
Control | 0..1 |
Type | string, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.value[x] . The slices are unordered and Closed, and can be differentiated using the following discriminators: |
54. Coverage.payor.extension:bankInformation.extension:Bankcode.value[x]:valueString | |
Slice Name | valueString |
Definition | Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | BankcodeValue of extension |
Control | 0..1 |
Type | string, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Alternate Names | Bankcode |
56. Coverage.payor.extension:bankInformation.url | |
Definition | Source of the definition for the extension code - a logical name or a URL. |
Short | identifies the meaning of the extension |
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
Control | 1..1 |
Type | uri |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
XML Format | In the XML format, this property is represented as an attribute. |
Fixed Value | http://nictiz.nl/fhir/StructureDefinition/zib-Payer-BankInformation |
58. Coverage.payor.extension:bankInformation.value[x] | |
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
Short | Value of extension |
Control | 0..01 |
Type | Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Guidance on how to interpret the contents of this table can be found here
0. Coverage | |||||
Definition | Financial instrument which may be used to reimburse or pay for health care products and services. | ||||
Short | Coverage | ||||
Control | 0..* | ||||
Alternate Names | Verzekering | ||||
Invariants | 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() ) | ||||
2. Coverage.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Short | Logical id of this artifact | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
Control | 0..1 | ||||
Type | id | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
4. Coverage.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. | ||||
Short | Metadata about the resource | ||||
Control | 0..1 | ||||
Type | Meta | ||||
Summary | true | ||||
6. Coverage.implicitRules | |||||
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. | ||||
Short | A set of rules under which this content was created | ||||
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
8. Coverage.language | |||||
Definition | The base language in which the resource is written. | ||||
Short | Language of the resource content | ||||
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to http://hl7.org/fhir/ValueSet/languages )A human language.
| ||||
Type | code | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
10. Coverage.text | |||||
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Short | Text summary of the resource, for human interpretation | ||||
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later. | ||||
Control | 0..1 This element is affected by the following invariants: dom-1 | ||||
Type | Narrative | ||||
Alternate Names | narrative, html, xhtml, display | ||||
12. Coverage.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Short | Contained, inline Resources | ||||
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
14. Coverage.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional Content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
16. Coverage.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. | ||||
Short | Extensions that cannot be ignored | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
Alternate Names | extensions, user content | ||||
18. Coverage.identifier | |||||
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. | ||||
Short | The primary coverage ID | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Summary | true | ||||
Requirements | This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below. | ||||
20. Coverage.status | |||||
Definition | The status of the resource instance. | ||||
Short | active | cancelled | draft | entered-in-error | ||||
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. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from Financial Resource Status Codes (required to http://hl7.org/fhir/ValueSet/fm-status )A code specifying the state of the resource instance. | ||||
Type | code | ||||
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
22. Coverage.type | |||||
Definition | Type of insurance policy. Codes as returned in the Check for Right to Insurance | ||||
Short | InsuranceType | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from VerzekeringssoortCodelijst (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.1.1.1--20171231000000 )InsuranceTypeCodelist | ||||
Type | CodeableConcept | ||||
Summary | true | ||||
Requirements | The order of application of coverages is dependent on the types of coverage. | ||||
Alternate Names | VerzekeringsSoort | ||||
24. Coverage.policyHolder | |||||
Definition | The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. | ||||
Short | Owner of the policy | ||||
Control | 0..1 | ||||
Type | Reference(nl-core-patient, nl-core-relatedperson, nl-core-organization) | ||||
Summary | true | ||||
26. Coverage.subscriber | |||||
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. | ||||
Short | Subscriber to the policy | ||||
Control | 0..1 | ||||
Type | Reference(nl-core-patient, nl-core-relatedperson) | ||||
Summary | true | ||||
28. Coverage.subscriberId | |||||
Definition | Number under which the insured person is registered at the insurance company This item maps the ‘Identification number of the card’ on EHIC field 8 | ||||
Short | InsurantNumber | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | VerzekerdeNummer | ||||
30. Coverage.beneficiary | |||||
Definition | The party who benefits from the insurance coverage., the patient when services are provided. | ||||
Short | Plan Beneficiary | ||||
Control | 0..1 | ||||
Type | Reference(nl-core-patient) | ||||
Summary | true | ||||
32. Coverage.relationship | |||||
Definition | The relationship of beneficiary (patient) to the subscriber. | ||||
Short | Beneficiary relationship to the Subscriber | ||||
Control | 0..1 | ||||
Binding | For example codes, see Policyholder Relationship Codes (example to http://hl7.org/fhir/ValueSet/policyholder-relationship )The relationship between the Policyholder and the Beneficiary (insured/covered party/patient). | ||||
Type | CodeableConcept | ||||
Requirements | To determine relationship between the patient and the subscriber. | ||||
34. Coverage.period | |||||
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. | ||||
Short | Coverage start and end dates | ||||
Control | 0..1 | ||||
Type | Period | ||||
Summary | true | ||||
36. Coverage.period.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
38. Coverage.period.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional Content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Slicing | This element introduces a set of slices on Coverage.period.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: | ||||
40. Coverage.period.start | |||||
Definition | Date from which the insurance policy coverage applies. | ||||
Short | StartDateTime | ||||
Comments | If the low element is missing, the meaning is that the low boundary is not known. | ||||
Control | 0..1 This element is affected by the following invariants: per-1 | ||||
Type | dateTime | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | BeginDatumTijd | ||||
42. Coverage.period.end | |||||
Definition | Date until which the insurance policy coverage applies. This item maps the ‘Expiry date’ on EHIC field 9. | ||||
Short | EndDateTime | ||||
Comments | The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03. | ||||
Control | 1..1 This element is affected by the following invariants: per-1 | ||||
Type | dateTime | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | EindDatumTijd | ||||
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing | ||||
44. Coverage.payor | |||||
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). | ||||
Short | InsuranceCompany / PayerPerson | ||||
Control | 1..* | ||||
Type | Reference(nl-core-organization, nl-core-patient, nl-core-relatedperson) | ||||
Summary | true | ||||
Requirements | Need to identify the issuer to target for processing and for coordination of benefit processing. | ||||
Alternate Names | Verzekeraar, BetalerPersoon | ||||
46. Coverage.payor.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
48. Coverage.payor.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 0..* | ||||
Type | Extension | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: | ||||
50. Coverage.payor.extension:bankInformation | |||||
Slice Name | bankInformation | ||||
Definition | An Extension | ||||
Short | BankInformation | ||||
Control | 0..* | ||||
Type | Extension(HCIM Payer BankInformation) (Complex Extension) | ||||
Alternate Names | Bankgegevens | ||||
52. Coverage.payor.extension:bankInformation.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
54. Coverage.payor.extension:bankInformation.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: | ||||
56. Coverage.payor.extension:bankInformation.extension:BankName | |||||
Slice Name | BankName | ||||
Definition | Name of the financial organization. | ||||
Short | BankName | ||||
Control | 0..1 | ||||
Type | Extension | ||||
Alternate Names | BankNaam | ||||
58. Coverage.payor.extension:bankInformation.extension:BankName.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
60. Coverage.payor.extension:bankInformation.extension:BankName.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional Content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: | ||||
62. Coverage.payor.extension:bankInformation.extension:BankName.url | |||||
Definition | Source of the definition for the extension code - a logical name or a URL. | ||||
Short | identifies the meaning of the extension | ||||
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. | ||||
Control | 1..1 | ||||
Type | uri | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Fixed Value | BankName | ||||
64. Coverage.payor.extension:bankInformation.extension:BankName.value[x] | |||||
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). | ||||
Short | Value of extension | ||||
Control | 0..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.value[x] . The slices are unordered and Closed, and can be differentiated using the following discriminators: | ||||
66. Coverage.payor.extension:bankInformation.extension:BankName.value[x]:valueString | |||||
Slice Name | valueString | ||||
Definition | Name of the financial organization. | ||||
Short | BankName | ||||
Control | 0..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Alternate Names | BankNaam | ||||
68. Coverage.payor.extension:bankInformation.extension:AccountNumber | |||||
Slice Name | AccountNumber | ||||
Definition | The payer’s bank account number at the listed organization. For European countries, this is the IBAN. | ||||
Short | AccountNumber | ||||
Control | 1..1 | ||||
Type | Extension | ||||
Alternate Names | Rekeningnummer | ||||
70. Coverage.payor.extension:bankInformation.extension:AccountNumber.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
72. Coverage.payor.extension:bankInformation.extension:AccountNumber.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional Content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: | ||||
74. Coverage.payor.extension:bankInformation.extension:AccountNumber.url | |||||
Definition | Source of the definition for the extension code - a logical name or a URL. | ||||
Short | identifies the meaning of the extension | ||||
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. | ||||
Control | 1..1 | ||||
Type | uri | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Fixed Value | AccountNumber | ||||
76. Coverage.payor.extension:bankInformation.extension:AccountNumber.value[x] | |||||
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). | ||||
Short | Value of extension | ||||
Control | 0..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.value[x] . The slices are unordered and Closed, and can be differentiated using the following discriminators: | ||||
78. Coverage.payor.extension:bankInformation.extension:AccountNumber.value[x]:valueString | |||||
Slice Name | valueString | ||||
Definition | The payer’s bank account number at the listed organization. For European countries, this is the IBAN. | ||||
Short | AccountNumber | ||||
Control | 0..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Alternate Names | Rekeningnummer | ||||
80. Coverage.payor.extension:bankInformation.extension:Bankcode | |||||
Slice Name | Bankcode | ||||
Definition | Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. | ||||
Short | Bankcode | ||||
Control | 0..1 | ||||
Type | Extension | ||||
Alternate Names | Bankcode | ||||
82. Coverage.payor.extension:bankInformation.extension:Bankcode.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
84. Coverage.payor.extension:bankInformation.extension:Bankcode.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional Content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: | ||||
86. Coverage.payor.extension:bankInformation.extension:Bankcode.url | |||||
Definition | Source of the definition for the extension code - a logical name or a URL. | ||||
Short | identifies the meaning of the extension | ||||
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. | ||||
Control | 1..1 | ||||
Type | uri | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Fixed Value | Bankcode | ||||
88. Coverage.payor.extension:bankInformation.extension:Bankcode.value[x] | |||||
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). | ||||
Short | Value of extension | ||||
Control | 0..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Slicing | This element introduces a set of slices on Coverage.payor.extension.extension.value[x] . The slices are unordered and Closed, and can be differentiated using the following discriminators: | ||||
90. Coverage.payor.extension:bankInformation.extension:Bankcode.value[x]:valueString | |||||
Slice Name | valueString | ||||
Definition | Code indicating the bank and branch. For European countries, this is the organization’s BIC or SWIFT code. | ||||
Short | Bankcode | ||||
Control | 0..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Alternate Names | Bankcode | ||||
92. Coverage.payor.extension:bankInformation.url | |||||
Definition | Source of the definition for the extension code - a logical name or a URL. | ||||
Short | identifies the meaning of the extension | ||||
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. | ||||
Control | 1..1 | ||||
Type | uri | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Fixed Value | http://nictiz.nl/fhir/StructureDefinition/zib-Payer-BankInformation | ||||
94. Coverage.payor.extension:bankInformation.value[x] | |||||
Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). | ||||
Short | Value of extension | ||||
Control | 0..0 | ||||
Type | Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
96. Coverage.payor.reference | |||||
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. | ||||
Short | Literal reference, Relative, internal or absolute URL | ||||
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. | ||||
Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
98. Coverage.payor.identifier | |||||
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. | ||||
Short | Logical reference, when literal reference is not known | ||||
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. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Summary | true | ||||
100. Coverage.payor.display | |||||
Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
Short | Text alternative for the resource | ||||
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. | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
102. Coverage.grouping | |||||
Definition | A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Short | Additional coverage classifications | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()) ) | ||||
104. Coverage.grouping.id | |||||
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | xml:id (or equivalent in JSON) | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
106. Coverage.grouping.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional Content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Alternate Names | extensions, user content | ||||
108. Coverage.grouping.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. | ||||
Short | Extensions that cannot be ignored | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
Summary | true | ||||
Alternate Names | extensions, user content, modifiers | ||||
110. Coverage.grouping.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. | ||||
Short | An identifier for the group | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
112. Coverage.grouping.groupDisplay | |||||
Definition | A short description for the group. | ||||
Short | Display text for an identifier for the group | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
114. Coverage.grouping.subGroup | |||||
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. | ||||
Short | An identifier for the subsection of the group | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
116. Coverage.grouping.subGroupDisplay | |||||
Definition | A short description for the subgroup. | ||||
Short | Display text for the subsection of the group | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
118. Coverage.grouping.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. | ||||
Short | An identifier for the plan | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
120. Coverage.grouping.planDisplay | |||||
Definition | A short description for the plan. | ||||
Short | Display text for the plan | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
122. Coverage.grouping.subPlan | |||||
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. | ||||
Short | An identifier for the subsection of the plan | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
124. Coverage.grouping.subPlanDisplay | |||||
Definition | A short description for the subplan. | ||||
Short | Display text for the subsection of the plan | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
126. Coverage.grouping.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. | ||||
Short | An identifier for the class | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
128. Coverage.grouping.classDisplay | |||||
Definition | A short description for the class. | ||||
Short | Display text for the class | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
130. Coverage.grouping.subClass | |||||
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. | ||||
Short | An identifier for the subsection of the class | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
132. Coverage.grouping.subClassDisplay | |||||
Definition | A short description for the subclass. | ||||
Short | Display text for the subsection of the subclass | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
134. Coverage.dependent | |||||
Definition | A unique identifier for a dependent under the coverage. | ||||
Short | Dependent number | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary. | ||||
136. Coverage.sequence | |||||
Definition | An optional counter for a particular instance of the identified coverage which increments upon each renewal. | ||||
Short | The plan instance or sequence counter | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
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'. | ||||
138. Coverage.order | |||||
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. | ||||
Short | Relative order of the coverage | ||||
Control | 0..1 | ||||
Type | positiveInt | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
140. Coverage.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. | ||||
Short | Insurer network | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
142. Coverage.contract | |||||
Definition | The policy(s) which constitute this insurance coverage. | ||||
Short | Contract details | ||||
Control | 0..* | ||||
Type | Reference(Contract) |