HL7 FHIR JP Core ImplementationGuide
2.0.0-dev - ci-build
HL7 FHIR JP Core ImplementationGuide - Local Development build (v2.0.0-dev) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Active as of 2023-10-31 |
Definitions for the jp-coverage resource profile.
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. Includes both insurance and self-payment. Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. |
Short | Insurance or medical plan or a payment agreement 保険または医療費支払いプラン、または合意された支払い方法 |
Comments | The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. |
Control | 0..* |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
4. Coverage.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. 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 can 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 |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
6. Coverage.extension:insuredPersonSymbol | |
Slice Name | insuredPersonSymbol |
Definition | 健康保険における被保険者証記号を示す拡張 |
Short | 健康保険における被保険者証記号 |
Comments | 健康保険における被保険者証記号を示す拡張。被保険者記号の全角文字列。 |
Control | 0..* This element is affected by the following invariants: ele-1 |
Type | Extension(JP Core Coverage InsuredPersonSymbol Extension) (Extension Type: string) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
8. Coverage.extension:insuredPersonNumber | |
Slice Name | insuredPersonNumber |
Definition | 健康保険における被保険者証番号を示す拡張 |
Short | 健康保険における被保険者証番号 |
Comments | 健康保険における被保険者証番号を示す拡張。被保険者記号の全角文字列。 |
Control | 0..* This element is affected by the following invariants: ele-1 |
Type | Extension(JP Core Coverage InsuredPersonNumber Extension) (Extension Type: string) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
10. Coverage.extension:insuredPersonSubNumber | |
Slice Name | insuredPersonSubNumber |
Definition | 健康保険における被保険者証番号の枝番を示す拡張 |
Short | 健康保険における被保険者証番号の枝番 |
Comments | 健康保険における被保険者証番号を示す拡張。2桁の全角数字文字列。一桁の場合には先頭に0をつけて2桁にする。 |
Control | 0..* This element is affected by the following invariants: ele-1 |
Type | Extension(JP Core Coverage InsuredPersonSubNumber Extension) (Extension Type: string) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
12. 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
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 Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Must Support | false |
Summary | false |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
14. Coverage.identifier | |
Definition | A unique identifier assigned to this coverage. A unique identifier assigned to this coverage. |
Short | Business Identifier for the coverage このカバレッジに割り当てられた一意の識別子【詳細参照】 |
Comments | 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 concatenation of the Coverage.SubscriberID and the Coverage.dependent. 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 concatenation of the Coverage.SubscriberID and the Coverage.dependant. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Allows coverages to be distinguished and referenced. Allows coverages to be distinguished and referenced. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
16. Coverage.status | |
Definition | The status of the resource instance. 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. 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 | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.3.0 (required to http://hl7.org/fhir/ValueSet/fm-status|4.3.0 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
18. Coverage.type | |
Definition | The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. |
Short | Coverage category such as medical or accident 医療保険や事故補償のような分類 |
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. |
Control | 0..1 |
Binding | The codes SHOULD be taken from CoverageTypeAndSelf-PayCodeshttp://hl7.org/fhir/ValueSet/coverage-type (preferred to http://hl7.org/fhir/ValueSet/coverage-type )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 |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The order of application of coverages is dependent on the types of coverage. The order of application of coverages is dependent on the types of coverage. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
20. Coverage.policyHolder | |
Definition | The party who 'owns' the insurance policy. The party who 'owns' the insurance policy. |
Short | Owner of the policy ポリシの所有者 |
Comments | For example: may be an individual, corporation or the subscriber's employer. For example: may be an individual, corporation or the subscriber's employer. |
Control | 0..1 |
Type | Reference(JP Core Patient Profile, RelatedPerson, JP Core Organization Profile, Patient, Organization) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | This provides employer information in the case of Worker's Compensation and other policies. This provides employer information in the case of Worker's Compensation and other policies. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
22. 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. 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 被保険者 |
Comments | May be self or a parent in the case of dependents. May be self or a parent in the case of dependants. |
Control | 0..1 |
Type | Reference(JP Core Patient Profile, RelatedPerson, Patient) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | This is the party who is entitled to the benefits under the policy. This is the party who is entitled to the benfits under the policy. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
24. Coverage.subscriberId | |
Definition | The insurer assigned ID for the Subscriber. The insurer assigned ID for the Subscriber. |
Short | ID assigned to the subscriber 被保険者に割り当てられたID |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | The insurer requires this identifier on correspondence and claims (digital and otherwise). The insurer requires this identifier on correspondance and claims (digital and otherwise). |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
26. Coverage.beneficiary | |
Definition | The party who benefits from the insurance coverage; the patient when products and/or services are provided. The party who benefits from the insurance coverage; the patient when products and/or services are provided. |
Short | Plan beneficiary |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (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. |
Control | 1..1 |
Type | Reference(JP Core Patient Profile, Patient) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | This is the party who receives treatment for which the costs are reimbursed under the coverage. This is the party who receives treatment for which the costs are reimbursed under the coverage. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
28. Coverage.dependent | |
Definition | A unique identifier for a dependent under the coverage. A unique identifier for a dependent under the coverage. |
Short | 被保険者証 枝番Dependent number |
Comments | Periodically the member number is constructed from the subscriberId and the dependent number. Periodically the member number is constructed from the subscriberId and the dependant number. |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
30. Coverage.relationship | |
Definition | The relationship of beneficiary (patient) to the subscriber. The relationship of beneficiary (patient) to the subscriber. |
Short | Beneficiary relationship to the subscriber 加入者との受益者関係 |
Comments | Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship )The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To determine relationship between the patient and the subscriber to determine coordination of benefits. To determine relationship between the patient and the subscriber to determine coordination of benefits. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
32. 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. 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 |
Comments | 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").
Period is not used for a duration (a measure of elapsed time). See Duration. |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Some insurers require the submission of the coverage term. Some insurers require the submission of the coverage term. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
34. Coverage.payor | |
Definition | The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. |
Short | Issuer of the policy |
Comments | May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).
For selfpay it may provide multiple paying persons and/or organizations. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. |
Control | 1..* |
Type | Reference(JP Core Organization Profile, JP Core Patient Profile, RelatedPerson, Organization, Patient) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Need to identify the issuer to target for claim processing and for coordination of benefit processing. Need to identify the issuer to target for claim processing and for coordination of benefit processing. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
36. Coverage.class | |
Definition | A suite of underwriter specific classifiers. A suite of underwriter specific classifiers. |
Short | Additional coverage classifications |
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. For example may be used to identify a class of coverage or employer group, Policy, Plan. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. The codes provided on the health card which identify or confirm the specific policy for the insurer. |
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters) |
38. Coverage.class.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
40. Coverage.class.type | |
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. |
Short | Type of class such as 'group' or 'plan' |
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. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class (extensible to http://hl7.org/fhir/ValueSet/coverage-class )The policy classifications, eg. Group, Plan, Class, etc. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The insurer issued label for a specific health card value. The insurer issued label for a specific health card value. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. Coverage.class.value | |
Definition | The alphanumeric string value associated with the insurer issued label. The alphanumeric string value associated with the insurer issued label. |
Short | Value associated with the type |
Comments | For example, the Group or Plan number. For example, the Group or Plan number. |
Control | 1..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | The insurer issued label and value are necessary to identify the specific policy. The insurer issued label and value are necessary to identify the specific policy. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
44. Coverage.class.name | |
Definition | A short description for the class. A short description for the class. |
Short | Human readable description of the type and value |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Used to provide a meaningful description in correspondence to the patient. Used to provide a meaningful description in correspondence to the patient. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
46. Coverage.order | |
Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. |
Short | Relative order of the coverage |
Comments | 32 bit number; for values larger than this, use decimal |
Control | 0..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Used in managing the coordination of benefits. Used in managing the coordination of benefits. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
48. 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. 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 |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Used in referral for treatment and in claims processing. Used in referral for treatment and in claims processing. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
50. Coverage.costToBeneficiary | |
Definition | A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. |
Short | Patient payments for services/products サービスやプロダクトに対する患者支払い |
Comments | For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required by providers to manage financial transaction with the patient. Required by providers to manage financial transaction with the patient. |
Alternate Names | CoPay, Deductible, Exceptions |
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters) |
52. Coverage.costToBeneficiary.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
54. Coverage.costToBeneficiary.type | |
Definition | The category of patient centric costs associated with treatment. The category of patient centric costs associated with treatment. |
Short | Cost category |
Comments | For example visit, specialist visits, emergency, inpatient care, etc. For example visit, specialist visits, emergency, inpatient care, etc. |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from CoverageCopayTypeCodeshttp://hl7.org/fhir/ValueSet/coverage-copay-type (extensible to http://hl7.org/fhir/ValueSet/coverage-copay-type )The types of services to which patient copayments are specified. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Needed to identify the category associated with the amount for the patient. Needed to identify the category associated with the amount for the patient. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
56. Coverage.costToBeneficiary.value[x] | |
Definition | The amount due from the patient for the cost category. The amount due from the patient for the cost category. |
Short | The amount or percentage due from the beneficiary |
Comments | Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. |
Control | 1..1 |
Type | Choice of: Quantity(SimpleQuantity), Money |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Needed to identify the amount for the patient associated with the category. Needed to identify the amount for the patient associated with the category. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
58. Coverage.costToBeneficiary.exception | |
Definition | A suite of codes indicating exceptions or reductions to patient costs and their effective periods. A suite of codes indicating exceptions or reductions to patient costs and their effective periods. |
Short | Exceptions for patient payments |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required by providers to manage financial transaction with the patient. Required by providers to manage financial transaction with the patient. |
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters) |
60. Coverage.costToBeneficiary.exception.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
62. Coverage.costToBeneficiary.exception.type | |
Definition | The code for the specific exception. The code for the specific exception. |
Short | Exception category |
Control | 1..1 |
Binding | For example codes, see ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception (example to http://hl7.org/fhir/ValueSet/coverage-financial-exception )The types of exceptions from the part or full value of financial obligations such as copays. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Needed to identify the exception associated with the amount for the patient. Needed to identify the exception associated with the amount for the patient. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
64. Coverage.costToBeneficiary.exception.period | |
Definition | The timeframe during when the exception is in force. The timeframe during when the exception is in force. |
Short | The effective period of the exception |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
66. Coverage.subrogation | |
Definition | When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. |
Short | Reimbursement to insurer 保険者への償還 |
Comments | Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. |
Control | 0..1 |
Type | boolean |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | See definition for when to be used. See definition for when to be used. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
68. Coverage.contract | |
Definition | The policy(s) which constitute this insurance coverage. The policy(s) which constitute this insurance coverage. |
Short | Contract details 契約の詳細 |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (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. |
Control | 0..* |
Type | Reference(Contract) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To reference the legally binding contract between the policy holder and the insurer. To reference the legally binding contract between the policy holder and the insurer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
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. Includes both insurance and self-payment. |
Short | Insurance or medical plan or a payment agreement 保険または医療費支払いプラン、または合意された支払い方法 |
Comments | The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. |
2. Coverage.extension | |
Slicing | This element introduces a set of slices on Coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
4. Coverage.extension:insuredPersonSymbol | |
Slice Name | insuredPersonSymbol |
Control | 0..* |
Type | Extension(JP Core Coverage InsuredPersonSymbol Extension) (Extension Type: string) |
6. Coverage.extension:insuredPersonNumber | |
Slice Name | insuredPersonNumber |
Control | 0..* |
Type | Extension(JP Core Coverage InsuredPersonNumber Extension) (Extension Type: string) |
8. Coverage.extension:insuredPersonSubNumber | |
Slice Name | insuredPersonSubNumber |
Control | 0..* |
Type | Extension(JP Core Coverage InsuredPersonSubNumber Extension) (Extension Type: string) |
10. Coverage.identifier | |
Definition | A unique identifier assigned to this coverage. |
Short | Business Identifier for the coverage このカバレッジに割り当てられた一意の識別子【詳細参照】 |
Comments | 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 concatenation of the Coverage.SubscriberID and the Coverage.dependent. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Requirements | Allows coverages to be distinguished and referenced. |
12. Coverage.status | |
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. |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
14. Coverage.type | |
Definition | The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. |
Short | Coverage category such as medical or accident 医療保険や事故補償のような分類 |
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. |
Requirements | The order of application of coverages is dependent on the types of coverage. |
16. Coverage.policyHolder | |
Definition | The party who 'owns' the insurance policy. |
Short | Owner of the policy ポリシの所有者 |
Comments | For example: may be an individual, corporation or the subscriber's employer. |
Type | Reference(JP Core Patient Profile, RelatedPerson, JP Core Organization Profile) |
Requirements | This provides employer information in the case of Worker's Compensation and other policies. |
18. 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 被保険者 |
Comments | May be self or a parent in the case of dependents. |
Type | Reference(JP Core Patient Profile, RelatedPerson) |
Requirements | This is the party who is entitled to the benefits under the policy. |
20. Coverage.subscriberId | |
Definition | The insurer assigned ID for the Subscriber. |
Short | ID assigned to the subscriber 被保険者に割り当てられたID |
Requirements | The insurer requires this identifier on correspondence and claims (digital and otherwise). |
22. Coverage.beneficiary | |
Definition | The party who benefits from the insurance coverage; the patient when products and/or services are provided. |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (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. |
Type | Reference(JP Core Patient Profile) |
Requirements | This is the party who receives treatment for which the costs are reimbursed under the coverage. |
24. Coverage.dependent | |
Definition | A unique identifier for a dependent under the coverage. |
Short | 被保険者証 枝番 |
Comments | Periodically the member number is constructed from the subscriberId and the dependent number. |
Requirements | For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. |
26. Coverage.relationship | |
Definition | The relationship of beneficiary (patient) to the subscriber. |
Short | Beneficiary relationship to the subscriber 加入者との受益者関係 |
Comments | Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. |
Requirements | To determine relationship between the patient and the subscriber to determine coordination of benefits. |
28. 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. |
Comments | 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").
Period is not used for a duration (a measure of elapsed time). See Duration. |
Requirements | Some insurers require the submission of the coverage term. |
30. Coverage.payor | |
Definition | The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. |
Comments | May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).
For selfpay it may provide multiple paying persons and/or organizations. |
Type | Reference(JP Core Organization Profile, JP Core Patient Profile, RelatedPerson) |
Requirements | Need to identify the issuer to target for claim processing and for coordination of benefit processing. |
32. Coverage.class | |
Definition | A suite of underwriter specific classifiers. |
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. |
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. |
34. Coverage.class.type | |
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. |
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. |
Requirements | The insurer issued label for a specific health card value. |
36. Coverage.class.value | |
Definition | The alphanumeric string value associated with the insurer issued label. |
Comments | For example, the Group or Plan number. |
Requirements | The insurer issued label and value are necessary to identify the specific policy. |
38. Coverage.class.name | |
Definition | A short description for the class. |
Requirements | Used to provide a meaningful description in correspondence to the patient. |
40. Coverage.order | |
Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. |
Comments | 32 bit number; for values larger than this, use decimal |
Requirements | Used in managing the coordination of benefits. |
42. 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. |
Requirements | Used in referral for treatment and in claims processing. |
44. Coverage.costToBeneficiary | |
Definition | A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. |
Short | Patient payments for services/products サービスやプロダクトに対する患者支払い |
Comments | For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. |
Requirements | Required by providers to manage financial transaction with the patient. |
46. Coverage.costToBeneficiary.type | |
Definition | The category of patient centric costs associated with treatment. |
Comments | For example visit, specialist visits, emergency, inpatient care, etc. |
Requirements | Needed to identify the category associated with the amount for the patient. |
48. Coverage.costToBeneficiary.type.coding | |
50. Coverage.costToBeneficiary.type.coding.system | |
Comments | The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. |
52. Coverage.costToBeneficiary.type.coding.code | |
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size |
54. Coverage.costToBeneficiary.value[x] | |
Definition | The amount due from the patient for the cost category. |
Comments | Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Requirements | Needed to identify the amount for the patient associated with the category. |
56. Coverage.costToBeneficiary.exception | |
Definition | A suite of codes indicating exceptions or reductions to patient costs and their effective periods. |
Requirements | Required by providers to manage financial transaction with the patient. |
58. Coverage.costToBeneficiary.exception.type | |
Definition | The code for the specific exception. |
Requirements | Needed to identify the exception associated with the amount for the patient. |
60. Coverage.costToBeneficiary.exception.period | |
Definition | The timeframe during when the exception is in force. |
Requirements | Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. |
62. Coverage.subrogation | |
Definition | When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. |
Short | Reimbursement to insurer 保険者への償還 |
Comments | Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. |
Requirements | See definition for when to be used. |
64. Coverage.contract | |
Definition | The policy(s) which constitute this insurance coverage. |
Short | Contract details 契約の詳細 |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (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. |
Requirements | To reference the legally binding contract between the policy holder and the insurer. |
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. Includes both insurance and self-payment. | ||||
Short | Insurance or medical plan or a payment agreement 保険または医療費支払いプラン、または合意された支払い方法 | ||||
Comments | The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource ( contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) | ||||
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 | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
4. Coverage.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
Short | Metadata about the resource | ||||
Control | 0..1 | ||||
Type | Meta | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
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 | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages )IETF language tag
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
10. Coverage.text | |||||
Definition | A human-readable narrative that contains a summary of the resource and can 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 information is added later. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
Invariants | dom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic) ) | ||||
14. Coverage.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
16. Coverage.extension:insuredPersonSymbol | |||||
Slice Name | insuredPersonSymbol | ||||
Definition | 健康保険における被保険者証記号を示す拡張 | ||||
Short | 健康保険における被保険者証記号 | ||||
Comments | 健康保険における被保険者証記号を示す拡張。被保険者記号の全角文字列。 | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(JP Core Coverage InsuredPersonSymbol Extension) (Extension Type: string) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
18. Coverage.extension:insuredPersonNumber | |||||
Slice Name | insuredPersonNumber | ||||
Definition | 健康保険における被保険者証番号を示す拡張 | ||||
Short | 健康保険における被保険者証番号 | ||||
Comments | 健康保険における被保険者証番号を示す拡張。被保険者記号の全角文字列。 | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(JP Core Coverage InsuredPersonNumber Extension) (Extension Type: string) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
20. Coverage.extension:insuredPersonSubNumber | |||||
Slice Name | insuredPersonSubNumber | ||||
Definition | 健康保険における被保険者証番号の枝番を示す拡張 | ||||
Short | 健康保険における被保険者証番号の枝番 | ||||
Comments | 健康保険における被保険者証番号を示す拡張。2桁の全角数字文字列。一桁の場合には先頭に0をつけて2桁にする。 | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(JP Core Coverage InsuredPersonSubNumber Extension) (Extension Type: string) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
22. 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
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 Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
24. Coverage.identifier | |||||
Definition | A unique identifier assigned to this coverage. | ||||
Short | Business Identifier for the coverage このカバレッジに割り当てられた一意の識別子【詳細参照】 | ||||
Comments | 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 concatenation of the Coverage.SubscriberID and the Coverage.dependent. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Allows coverages to be distinguished and referenced. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
26. 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 | 1..1 | ||||
Binding | The codes SHALL be taken from FinancialResourceStatusCodes (required to http://hl7.org/fhir/ValueSet/fm-status|4.3.0 )A code specifying the state of the resource instance. | ||||
Type | code | ||||
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
28. Coverage.type | |||||
Definition | The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. | ||||
Short | Coverage category such as medical or accident 医療保険や事故補償のような分類 | ||||
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. | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CoverageTypeAndSelf-PayCodes (preferred to http://hl7.org/fhir/ValueSet/coverage-type )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 | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | The order of application of coverages is dependent on the types of coverage. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
30. Coverage.policyHolder | |||||
Definition | The party who 'owns' the insurance policy. | ||||
Short | Owner of the policy ポリシの所有者 | ||||
Comments | For example: may be an individual, corporation or the subscriber's employer. | ||||
Control | 0..1 | ||||
Type | Reference(JP Core Patient Profile, RelatedPerson, JP Core Organization Profile) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | This provides employer information in the case of Worker's Compensation and other policies. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
32. 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 被保険者 | ||||
Comments | May be self or a parent in the case of dependents. | ||||
Control | 0..1 | ||||
Type | Reference(JP Core Patient Profile, RelatedPerson) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | This is the party who is entitled to the benefits under the policy. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
34. Coverage.subscriberId | |||||
Definition | The insurer assigned ID for the Subscriber. | ||||
Short | ID assigned to the subscriber 被保険者に割り当てられたID | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | The insurer requires this identifier on correspondence and claims (digital and otherwise). | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
36. Coverage.beneficiary | |||||
Definition | The party who benefits from the insurance coverage; the patient when products and/or services are provided. | ||||
Short | Plan beneficiary | ||||
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (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. | ||||
Control | 1..1 | ||||
Type | Reference(JP Core Patient Profile) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | This is the party who receives treatment for which the costs are reimbursed under the coverage. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
38. Coverage.dependent | |||||
Definition | A unique identifier for a dependent under the coverage. | ||||
Short | 被保険者証 枝番 | ||||
Comments | Periodically the member number is constructed from the subscriberId and the dependent number. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
40. Coverage.relationship | |||||
Definition | The relationship of beneficiary (patient) to the subscriber. | ||||
Short | Beneficiary relationship to the subscriber 加入者との受益者関係 | ||||
Comments | Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from SubscriberRelationshipCodes (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship )The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | To determine relationship between the patient and the subscriber to determine coordination of benefits. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
42. 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 | ||||
Comments | 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").
Period is not used for a duration (a measure of elapsed time). See Duration. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Some insurers require the submission of the coverage term. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
44. Coverage.payor | |||||
Definition | The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. | ||||
Short | Issuer of the policy | ||||
Comments | May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).
For selfpay it may provide multiple paying persons and/or organizations. | ||||
Control | 1..* | ||||
Type | Reference(JP Core Organization Profile, JP Core Patient Profile, RelatedPerson) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Need to identify the issuer to target for claim processing and for coordination of benefit processing. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
46. Coverage.class | |||||
Definition | A suite of underwriter specific classifiers. | ||||
Short | Additional coverage classifications | ||||
Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters ) | ||||
48. Coverage.class.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 | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
50. Coverage.class.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. 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 can 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 | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
52. Coverage.class.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
54. Coverage.class.type | |||||
Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
Short | Type of class such as 'group' or 'plan' | ||||
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. | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from CoverageClassCodes (extensible to http://hl7.org/fhir/ValueSet/coverage-class )The policy classifications, eg. Group, Plan, Class, etc. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | The insurer issued label for a specific health card value. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
56. Coverage.class.value | |||||
Definition | The alphanumeric string value associated with the insurer issued label. | ||||
Short | Value associated with the type | ||||
Comments | For example, the Group or Plan number. | ||||
Control | 1..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
58. Coverage.class.name | |||||
Definition | A short description for the class. | ||||
Short | Human readable description of the type and value | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
60. Coverage.order | |||||
Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. | ||||
Short | Relative order of the coverage | ||||
Comments | 32 bit number; for values larger than this, use decimal | ||||
Control | 0..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Used in managing the coordination of benefits. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
62. 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 | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Used in referral for treatment and in claims processing. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
64. Coverage.costToBeneficiary | |||||
Definition | A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. | ||||
Short | Patient payments for services/products サービスやプロダクトに対する患者支払い | ||||
Comments | For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | Required by providers to manage financial transaction with the patient. | ||||
Alternate Names | CoPay, Deductible, Exceptions | ||||
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters ) | ||||
66. Coverage.costToBeneficiary.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 | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
68. Coverage.costToBeneficiary.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. 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 can 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 | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
70. Coverage.costToBeneficiary.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
72. Coverage.costToBeneficiary.type | |||||
Definition | The category of patient centric costs associated with treatment. | ||||
Short | Cost category | ||||
Comments | For example visit, specialist visits, emergency, inpatient care, etc. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from CoverageCopayTypeCodes (extensible to http://hl7.org/fhir/ValueSet/coverage-copay-type )The types of services to which patient copayments are specified. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Needed to identify the category associated with the amount for the patient. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
74. Coverage.costToBeneficiary.type.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 | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
76. Coverage.costToBeneficiary.type.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. 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 can 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 | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Coverage.costToBeneficiary.type.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
78. Coverage.costToBeneficiary.type.coding | |||||
Definition | A reference to a code defined by a terminology system. | ||||
Short | Code defined by a terminology system | ||||
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. | ||||
Control | 0..* | ||||
Type | Coding | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Allows for alternative encodings within a code system, and translations to other code systems. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
80. Coverage.costToBeneficiary.type.coding.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 | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
82. Coverage.costToBeneficiary.type.coding.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. 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 can 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 | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Coverage.costToBeneficiary.type.coding.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
84. Coverage.costToBeneficiary.type.coding.system | |||||
Definition | The identification of the code system that defines the meaning of the symbol in the code. | ||||
Short | Identity of the terminology system | ||||
Comments | The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to be unambiguous about the source of the definition of the symbol. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
86. Coverage.costToBeneficiary.type.coding.version | |||||
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. | ||||
Short | Version of the system - if relevant | ||||
Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. | ||||
Note | This is a business version Id, not a resource version Id (see discussion) | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
88. Coverage.costToBeneficiary.type.coding.code | |||||
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). | ||||
Short | Symbol in syntax defined by the system | ||||
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size | ||||
Control | 0..1 | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to refer to a particular code in the system. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
90. Coverage.costToBeneficiary.type.coding.display | |||||
Definition | A representation of the meaning of the code in the system, following the rules of the system. | ||||
Short | Representation defined by the system | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
92. Coverage.costToBeneficiary.type.coding.userSelected | |||||
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). | ||||
Short | If this coding was chosen directly by the user | ||||
Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
94. Coverage.costToBeneficiary.type.text | |||||
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. | ||||
Short | Plain text representation of the concept | ||||
Comments | Very often the text is the same as a displayName of one of the codings. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
96. Coverage.costToBeneficiary.value[x] | |||||
Definition | The amount due from the patient for the cost category. | ||||
Short | The amount or percentage due from the beneficiary | ||||
Comments | Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. | ||||
Control | 1..1 | ||||
Type | Choice of: Quantity(SimpleQuantity), Money | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Needed to identify the amount for the patient associated with the category. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
98. Coverage.costToBeneficiary.exception | |||||
Definition | A suite of codes indicating exceptions or reductions to patient costs and their effective periods. | ||||
Short | Exceptions for patient payments | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | Required by providers to manage financial transaction with the patient. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters ) | ||||
100. Coverage.costToBeneficiary.exception.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 | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
102. Coverage.costToBeneficiary.exception.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. 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 can 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 | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
104. Coverage.costToBeneficiary.exception.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
106. Coverage.costToBeneficiary.exception.type | |||||
Definition | The code for the specific exception. | ||||
Short | Exception category | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleCoverageFinancialExceptionCodes (example to http://hl7.org/fhir/ValueSet/coverage-financial-exception )The types of exceptions from the part or full value of financial obligations such as copays. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Needed to identify the exception associated with the amount for the patient. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
108. Coverage.costToBeneficiary.exception.period | |||||
Definition | The timeframe during when the exception is in force. | ||||
Short | The effective period of the exception | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | true | ||||
Requirements | Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
110. Coverage.subrogation | |||||
Definition | When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. | ||||
Short | Reimbursement to insurer 保険者への償還 | ||||
Comments | Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | See definition for when to be used. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
112. Coverage.contract | |||||
Definition | The policy(s) which constitute this insurance coverage. | ||||
Short | Contract details 契約の詳細 | ||||
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (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. | ||||
Control | 0..* | ||||
Type | Reference(Contract) | ||||
Is Modifier | false | ||||
Must Support | false | ||||
Summary | false | ||||
Requirements | To reference the legally binding contract between the policy holder and the insurer. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |