AKTIN Notfalldokumentation
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AKTIN Notfalldokumentation - Local Development build (v0.5.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: AKTIN_Kostentrager - Detailed Descriptions

Active as of 2024-05-24

Definitions for the aktin-kostentrager resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Coverage
Definition

Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte


Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.

ShortKostenträgerInsurance or medical plan or a payment agreement
Comments

The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.

Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-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 in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: 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.

ShortA 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.

Control0..1
Typeuri
Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-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.

ShortExtensionAdditional 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.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-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())
SlicingThis element introduces a set of slices on Coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. Coverage.extension:kvfall
    Slice Namekvfall
    Definition

    Wurde der Fall über die Kassenärztliche Vereinigung abgerechnet?

    ShortKV-Fall
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(KV-Fall) (Extension Type: boolean)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. 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).

    ShortExtensions 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.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    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 Namesextensions, user content
    Invariantsele-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.status
    Definition

    The status of the resource instance.

    Shortactive | 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.

    Control1..1
    BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

    A code specifying the state of the resource instance.

    Typecode
    Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    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'.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. 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.

    ShortCoverage category such as medical or accident
    Control0..01
    BindingThe 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.

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

    The order of application of coverages is dependent on the types of coverage.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. Coverage.policyHolder
    Definition

    The party who 'owns' the insurance policy.

    ShortOwner of the policy
    Comments

    For example: may be an individual, corporation or the subscriber's employer.

    Control0..01
    TypeReference(Patient, RelatedPerson, Organization)
    Is Modifierfalse
    Summarytrue
    Requirements

    This provides employer information in the case of Worker's Compensation and other policies.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. 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.

    ShortSubscriber to the policy
    Comments

    May be self or a parent in the case of dependants.

    Control0..01
    TypeReference(Patient, RelatedPerson)
    Is Modifierfalse
    Summarytrue
    Requirements

    This is the party who is entitled to the benfits under the policy.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. Coverage.subscriberId
    Definition

    The insurer assigned ID for the Subscriber.

    ShortID assigned to the subscriber
    Control0..01
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    The insurer requires this identifier on correspondance and claims (digital and otherwise).

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. Coverage.beneficiary
    Definition

    The party who benefits from the insurance coverage; the patient when products and/or services are provided.

    ShortNutzung von AKTIN_PR_PatientPlan beneficiary
    Control1..1
    TypeReference(Patient)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    This is the party who receives treatment for which the costs are reimbursed under the coverage.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. Coverage.payor
    Definition

    The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

    ShortIssuer 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.

    Control1..1*
    TypeReference(Organization, Patient, RelatedPerson)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Requirements

    Need to identify the issuer to target for claim processing and for coordination of benefit processing.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Coverage.payor. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ $this
    • 24. Coverage.payor:versicherer
      Slice Nameversicherer
      Definition

      Name (Organization.name) und Id (Organization.identifier) der Versicherungsgesellschaft


      The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

      ShortIssuer of the policy
      Comments

      xxx


      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.

      Control01..1*
      TypeReference(Organization, Patient, RelatedPerson)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Need to identify the issuer to target for claim processing and for coordination of benefit processing.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Coverage.payor:selbstzahler
      Slice Nameselbstzahler
      Definition

      Kostenübernahme durch den Patienten selbst oder durch Dritte


      The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

      ShortIssuer 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.

      Control01..1*
      TypeReference(Patient, RelatedPerson, Organization)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Requirements

      Need to identify the issuer to target for claim processing and for coordination of benefit processing.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. 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.

      ShortRelative order of the coverage
      Control0..01
      TypepositiveInt
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Used in managing the coordination of benefits.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. 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.

      ShortInsurer network
      Control0..01
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Used in referral for treatment and in claims processing.

      Invariantsele-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

      Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte

      ShortKostenträger
      2. Coverage.extension
      SlicingThis element introduces a set of slices on Coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 4. Coverage.extension:kvfall
        Slice Namekvfall
        Control0..1
        TypeExtension(KV-Fall) (Extension Type: boolean)
        6. Coverage.type
        Control0..0
        8. Coverage.policyHolder
        Control0..0
        10. Coverage.subscriber
        Control0..0
        12. Coverage.subscriberId
        Control0..0
        14. Coverage.beneficiary
        ShortNutzung von AKTIN_PR_Patient
        Must Supporttrue
        16. Coverage.payor
        Control0..1
        Must Supporttrue
        SlicingThis element introduces a set of slices on Coverage.payor. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ $this
        • 18. Coverage.payor:versicherer
          Slice Nameversicherer
          Definition

          Name (Organization.name) und Id (Organization.identifier) der Versicherungsgesellschaft

          Comments

          xxx

          Control0..1
          TypeReference(Organization)
          Must Supporttrue
          20. Coverage.payor:selbstzahler
          Slice Nameselbstzahler
          Definition

          Kostenübernahme durch den Patienten selbst oder durch Dritte

          Control0..1
          TypeReference(Patient, RelatedPerson)
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          22. Coverage.order
          Control0..0
          24. Coverage.network
          Control0..0

          Guidance on how to interpret the contents of this table can be found here

          0. Coverage
          Definition

          Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte

          ShortKostenträger
          Comments

          The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.

          Control0..*
          Is Modifierfalse
          Summaryfalse
          Invariantsdom-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 in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
          dom-4: 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.

          ShortLogical 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.

          Control0..1
          Typeid
          Is Modifierfalse
          Summarytrue
          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.

          ShortMetadata about the resource
          Control0..1
          TypeMeta
          Is Modifierfalse
          Summarytrue
          Invariantsele-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.

          ShortA 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.

          Control0..1
          Typeuri
          Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-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.

          ShortLanguage 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).

          Control0..1
          BindingThe codes SHOULD be taken from CommonLanguages
          (preferred to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional BindingsPurpose
          AllLanguagesMax Binding
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-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.

          ShortText 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.

          Control0..1
          TypeNarrative
          Is Modifierfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-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.

          ShortContained, 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.

          Control0..*
          TypeResource
          Is Modifierfalse
          Summaryfalse
          Alternate Namesinline resources, anonymous resources, contained resources
          14. Coverage.extension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-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())
          SlicingThis element introduces a set of slices on Coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. Coverage.extension:kvfall
            Slice Namekvfall
            Definition

            Wurde der Fall über die Kassenärztliche Vereinigung abgerechnet?

            ShortKV-Fall
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(KV-Fall) (Extension Type: boolean)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-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())
            18. 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).

            ShortExtensions 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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summaryfalse
            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 Namesextensions, user content
            Invariantsele-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())
            20. Coverage.identifier
            Definition

            A unique identifier assigned to this coverage.

            ShortBusiness Identifier for the coverage
            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.dependant.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows coverages to be distinguished and referenced.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. Coverage.status
            Definition

            The status of the resource instance.

            Shortactive | 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.

            Control1..1
            BindingThe codes SHALL be taken from FinancialResourceStatusCodes
            (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

            A code specifying the state of the resource instance.

            Typecode
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            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'.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. 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.

            ShortCoverage category such as medical or accident
            Control0..0
            BindingThe 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.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            The order of application of coverages is dependent on the types of coverage.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. Coverage.policyHolder
            Definition

            The party who 'owns' the insurance policy.

            ShortOwner of the policy
            Comments

            For example: may be an individual, corporation or the subscriber's employer.

            Control0..0
            TypeReference(Patient, RelatedPerson, Organization)
            Is Modifierfalse
            Summarytrue
            Requirements

            This provides employer information in the case of Worker's Compensation and other policies.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. 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.

            ShortSubscriber to the policy
            Comments

            May be self or a parent in the case of dependants.

            Control0..0
            TypeReference(Patient, RelatedPerson)
            Is Modifierfalse
            Summarytrue
            Requirements

            This is the party who is entitled to the benfits under the policy.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. Coverage.subscriberId
            Definition

            The insurer assigned ID for the Subscriber.

            ShortID assigned to the subscriber
            Control0..0
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            The insurer requires this identifier on correspondance and claims (digital and otherwise).

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. Coverage.beneficiary
            Definition

            The party who benefits from the insurance coverage; the patient when products and/or services are provided.

            ShortNutzung von AKTIN_PR_Patient
            Control1..1
            TypeReference(Patient)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            This is the party who receives treatment for which the costs are reimbursed under the coverage.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. Coverage.dependent
            Definition

            A unique identifier for a dependent under the coverage.

            ShortDependent number
            Comments

            Periodically the member number is constructed from the subscriberId and the dependant number.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. Coverage.relationship
            Definition

            The relationship of beneficiary (patient) to the subscriber.

            ShortBeneficiary relationship to the subscriber
            Comments

            Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.

            Control0..1
            BindingUnless 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).

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            To determine relationship between the patient and the subscriber to determine coordination of benefits.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. 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.

            ShortCoverage start and end dates
            Control0..1
            TypePeriod
            Is Modifierfalse
            Summarytrue
            Requirements

            Some insurers require the submission of the coverage term.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. Coverage.payor
            Definition

            The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

            ShortIssuer 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.

            Control1..1
            TypeReference(Organization, Patient, RelatedPerson)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Requirements

            Need to identify the issuer to target for claim processing and for coordination of benefit processing.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Coverage.payor. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ $this
            • 42. Coverage.payor:versicherer
              Slice Nameversicherer
              Definition

              Name (Organization.name) und Id (Organization.identifier) der Versicherungsgesellschaft

              ShortIssuer of the policy
              Comments

              xxx

              Control0..1
              TypeReference(Organization)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Need to identify the issuer to target for claim processing and for coordination of benefit processing.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. Coverage.payor:selbstzahler
              Slice Nameselbstzahler
              Definition

              Kostenübernahme durch den Patienten selbst oder durch Dritte

              ShortIssuer 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.

              Control0..1
              TypeReference(Patient, RelatedPerson)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Requirements

              Need to identify the issuer to target for claim processing and for coordination of benefit processing.

              Invariantsele-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.

              ShortAdditional coverage classifications
              Comments

              For example may be used to identify a class of coverage or employer group, Policy, Plan.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Requirements

              The codes provided on the health card which identify or confirm the specific policy for the insurer.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              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.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              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.

              ShortAdditional 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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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).

              ShortExtensions 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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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 Namesextensions, user content, modifiers
              Invariantsele-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.

              ShortType of class such as 'group' or 'plan'
              Control1..1
              BindingUnless 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.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              The insurer issued label for a specific health card value.

              Invariantsele-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.

              ShortValue associated with the type
              Comments

              For example, the Group or Plan number.

              Control1..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              The insurer issued label and value are necessary to identify the specific policy.

              Invariantsele-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.

              ShortHuman readable description of the type and value
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Used to provide a meaningful description in correspondence to the patient.

              Invariantsele-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.

              ShortRelative order of the coverage
              Control0..0
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Used in managing the coordination of benefits.

              Invariantsele-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.

              ShortInsurer network
              Control0..0
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Used in referral for treatment and in claims processing.

              Invariantsele-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.

              ShortPatient payments for services/products
              Comments

              For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required by providers to manage financial transaction with the patient.

              Alternate NamesCoPay, Deductible, Exceptions
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              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.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              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.

              ShortAdditional 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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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).

              ShortExtensions 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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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 Namesextensions, user content, modifiers
              Invariantsele-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.

              ShortCost category
              Comments

              For example visit, specialist visits, emergency, inpatient care, etc.

              Control0..1
              BindingUnless 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.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              Needed to identify the category associated with the amount for the patient.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. Coverage.costToBeneficiary.value[x]
              Definition

              The amount due from the patient for the cost category.

              ShortThe 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.

              Control1..1
              TypeChoice of: Quantity(SimpleQuantity), Money
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summarytrue
              Requirements

              Needed to identify the amount for the patient associated with the category.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. Coverage.costToBeneficiary.exception
              Definition

              A suite of codes indicating exceptions or reductions to patient costs and their effective periods.

              ShortExceptions for patient payments
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required by providers to manage financial transaction with the patient.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              78. 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.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              80. 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.

              ShortAdditional 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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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())
              82. 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).

              ShortExtensions 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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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 Namesextensions, user content, modifiers
              Invariantsele-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())
              84. Coverage.costToBeneficiary.exception.type
              Definition

              The code for the specific exception.

              ShortException category
              Control1..1
              BindingFor 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.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              Needed to identify the exception associated with the amount for the patient.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              86. Coverage.costToBeneficiary.exception.period
              Definition

              The timeframe during when the exception is in force.

              ShortThe effective period of the exception
              Control0..1
              TypePeriod
              Is Modifierfalse
              Summarytrue
              Requirements

              Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              88. 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.

              ShortReimbursement to insurer
              Comments

              Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.

              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              See definition for when to be used.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. Coverage.contract
              Definition

              The policy(s) which constitute this insurance coverage.

              ShortContract details
              Control0..*
              TypeReference(Contract)
              Is Modifierfalse
              Summaryfalse
              Requirements

              To reference the legally binding contract between the policy holder and the insurer.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))