Coverage Profile¶
| Canonical | ../StructureDefinition/nexus-emr-core-coverage |
|---|---|
| Status | draft (experimental) · 1.26.0 |
| Base | Coverage (constraint) |
| Source | FSH · JSON |
Nexus EMR profile for Coverage -- the payor context for billing and the demo dataset. First pass: the Ontario-GP shape (public plan keyed by the patient's health-card number, payor as a logical Organization reference). Private/extended plans and coordination of benefits are deliberately unmodelled. Closed to SMART apps pending an exposure decision.
Elements / Snapshot
The full effective definition: base Coverage with this profile's constraints applied.
| Element | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Coverage | 0..* | Nexus EMR Coverage Core i Invariants: dom-2, dom-3, dom-4, dom-5, dom-6 |
||
| id | 0..1 | http://hl7.org/fhirpath/System.String | Logical id of this artifact i | |
| meta | 0..1 | Meta | Metadata about the resource Invariants: ele-1 |
|
| implicitRules | ?! | 0..1 | uri | A set of rules under which this content was created i Invariants: ele-1 |
| language | 0..1 | code | Language of the resource content i Binding: languages ( preferred)Invariants: ele-1 |
|
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation i Invariants: ele-1 |
|
| contained | 0..* | Resource | Contained, inline Resources i | |
| extension | 0..* | Extension | Additional content defined by implementations i Invariants: ele-1, ext-1 |
|
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored i Invariants: ele-1, ext-1 |
| identifier | 0..* | Identifier | Business Identifier for the coverage i Invariants: ele-1 |
|
| status | S ?! | 1..1 | code | active | cancelled | draft | entered-in-error i Binding: fm-status ( required)Invariants: ele-1 |
| type | S | 0..1 | CodeableConcept | Kind of coverage (public provincial plan, private, ...) i Binding: coverage-type ( preferred)Invariants: ele-1 |
| policyHolder | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy i Invariants: ele-1 |
|
| subscriber | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy i Invariants: ele-1 |
|
| subscriberId | S | 0..1 | string | The patient's identifier with the insurance plan i Invariants: ele-1 |
| beneficiary | S | 1..1 | Reference(Patient Profile) | The patient covered Invariants: ele-1 |
| dependent | 0..1 | string | Dependent number i Invariants: ele-1 |
|
| relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber i Binding: subscriber-relationship ( extensible)Invariants: ele-1 |
|
| period | S | 0..1 | Period | Coverage validity period, when the source records one Invariants: ele-1 |
| payor | S | 1..* | Reference(Organization | Patient | RelatedPerson) | Who pays -- typically a LOGICAL Organization reference (e.g. OHIP) i Invariants: ele-1 |
| class | 0..* | BackboneElement | Additional coverage classifications i Invariants: ele-1 |
|
| id | 0..1 | http://hl7.org/fhirpath/System.String | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations i Invariants: ele-1, ext-1 |
|
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored even if unrecognized i Invariants: ele-1, ext-1 |
| type | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: coverage-class ( extensible)Invariants: ele-1 |
|
| value | 1..1 | string | Value associated with the type i Invariants: ele-1 |
|
| name | 0..1 | string | Human readable description of the type and value Invariants: ele-1 |
|
| order | 0..1 | positiveInt | Relative order of the coverage Invariants: ele-1 |
|
| network | 0..1 | string | Insurer network Invariants: ele-1 |
|
| costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products i Invariants: ele-1 |
|
| id | 0..1 | http://hl7.org/fhirpath/System.String | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations i Invariants: ele-1, ext-1 |
|
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored even if unrecognized i Invariants: ele-1, ext-1 |
| type | 0..1 | CodeableConcept | Cost category i Binding: coverage-copay-type ( extensible)Invariants: ele-1 |
|
| value[x] | 1..1 | Quantity(SimpleQuantity), Money | The amount or percentage due from the beneficiary i Invariants: ele-1 |
|
| exception | 0..* | BackboneElement | Exceptions for patient payments Invariants: ele-1 |
|
| id | 0..1 | http://hl7.org/fhirpath/System.String | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations i Invariants: ele-1, ext-1 |
|
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored even if unrecognized i Invariants: ele-1, ext-1 |
| type | 1..1 | CodeableConcept | Exception category Binding: coverage-financial-exception ( example)Invariants: ele-1 |
|
| period | 0..1 | Period | The effective period of the exception Invariants: ele-1 |
|
| subrogation | 0..1 | boolean | Reimbursement to insurer i Invariants: ele-1 |
|
| contract | 0..* | Reference(Contract) | Contract details Invariants: ele-1 |