Canonical URL: http://fhir.de/StructureDefinition/coverage-de-basis/0.2
| Coverage | 0..* | Coverage | Short description Versicherungsdaten DefinitionAngaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte
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| identifier | Σ | 0..* | Identifier | Short description The primary coverage ID DefinitionThe main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant. This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.
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| status | Σ ?! | 1..1 | codeBinding | Short description active | cancelled | draft | entered-in-error DefinitionThe status of the resource instance. This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
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| type | Σ | 0..1 | CodeableConceptBinding | Short description Versicherungsart DefinitionArt der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The order of application of coverages is dependent on the types of coverage. 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen. versicherungsart-de-basis (required) Constraints
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| policyHolder | Σ | 0..0 | Reference(Patient | RelatedPerson | Organization) | Short description Owner of the policy DefinitionThe party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org Reference(Patient | RelatedPerson | Organization) Constraints
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| subscriber | Σ | 0..1 | Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Hauptversicherte Person / Mitglied DefinitionHauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| subscriberId | Σ | 0..0 | string | Short description ID assigned to the Subscriber DefinitionThe insurer assigned ID for the Subscriber. Note that FHIR strings may not exceed 1MB in size
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| beneficiary | Σ | 1..1 | Reference(Patient, deutsches Basisprofil (Version 0.2)) | Short description Begünstigte Person DefinitionPerson, auf die sich die Kostenübernahme bezieht (der Patient) References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| relationship | 0..1 | CodeableConcept | Short description Beneficiary relationship to the Subscriber DefinitionThe relationship of beneficiary (patient) to the subscriber. To determine relationship between the patient and the subscriber. 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. policyholder-relationship (example) Constraints
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| period | Σ | 0..1 | Period | Short description Coverage start and end dates DefinitionTime 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. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| payor | Σ | 1..* | Reference(http://fhir.de/StructureDefinition/organization-de-basis | RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Versicherer DefinitionVersicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. Need to identify the issuer to target for processing and for coordination of benefit processing. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://fhir.de/StructureDefinition/organization-de-basis | RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| grouping | 0..0 | BackboneElement | Short description Additional coverage classifications DefinitionA suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| dependent | Σ | 0..0 | string | Short description Dependent number DefinitionIdentifikation einer unter dieser Police versicherten Partei Bsp: eine Familie ist mit der Police mit dem Identifier "12345" versichert Vater 12345a Mutter 12345b Kind 12345c a, b und c wären dann jeweils die "dependents" For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| sequence | Σ | 0..0 | string | Short description The plan instance or sequence counter DefinitionAn optional counter for a particular instance of the identified coverage which increments upon each renewal. Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| order | Σ | 0..0 | positiveInt | Short description Relative order of the coverage DefinitionThe order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care. Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| network | Σ | 0..0 | string | Short description Insurer network DefinitionDie Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| contract | 0..* | Reference(Contract) | Short description Contract details DefinitionThe policy(s) which constitute this insurance coverage. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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Canonical URL: http://fhir.de/StructureDefinition/coverage-de-gkv/0.2
| Coverage | 0..* | Coverage | Short description Versicherungsdaten DefinitionKostenübernahme im Rahmen eines gesetzlichen Versicherungsverhältnisses in Deutschland
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| extension | 0..* | Extension | Short description Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Constraints
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| einlesedatum-karte | 0..* | Extension(dateTime) | Short description Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. http://fhir.de/StructureDefinition/gkv/einlesedatum-karte/0.2 Constraints
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| generation-egk | 0..1 | Extension(code) | Short description eGK Generation ( 1 | 1+ | 2 ) Alternate namesextensions, user content DefinitionAngabe der Generation der Versichertenkarte 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. http://fhir.de/StructureDefinition/gkv/generation-egk/0.2 Constraints
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| version-egk | 0..* | Extension(code) | Short description eGK Version (z.B. 5.2.0) Alternate namesextensions, user content DefinitionExtension zur Erfassung der Version des VSDM-Datensatzes auf der eGK 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. http://fhir.de/StructureDefinition/gkv/version-egk/0.2 Constraints
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| gkv-zusatzinfo-geschuetzt | 0..1 | Extension(Complex) | Short description Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Complex) Extension URLhttp://fhir.de/StructureDefinition/gkv/zusatzinfos-geschuetzt/0.2 Constraints
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| gkv-zusatzinfos-allgemein | 0..1 | Extension(Complex) | Short description Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Complex) Extension URLhttp://fhir.de/StructureDefinition/gkv/zusatzinfos-allgemein/0.2 Constraints
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| gkv-onlinepruefung-egk | 0..* | Extension(Complex) | Short description Informationen zur Onlineprüfung und -aktualisierung Alternate namesextensions, user content DefinitionInformationen zur Onlineprüfung und -aktualisierung 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. Extension(Complex) Extension URLhttp://fhir.de/StructureDefinition/gkv/onlinepruefung-egk/0.2 Constraints
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| identifier | Σ | 1..* | Identifier | Short description Primärer Identifier der Versicherung DefinitionEin gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet. This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below. TODO: Constraint, der prüft, dass mindestens entweder eine VersichertenID oder eine Krankenversichertennummer angegeben wurde. Unordered, Open, by system(Value) Constraints
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| use | Σ ?! | 0..1 | codeBinding | Short description usual | official | temp | secondary (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
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| type | Σ | 0..0 | CodeableConceptBinding | Short description Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
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| system | Σ | 0..1 | uri | Short description The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
General http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri Mappings
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| value | Σ | 0..1 | string | Short description The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
General 123456 Mappings
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| period | Σ | 0..1 | Period | Short description Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| assigner | Σ | 0..1 | Reference(Organization) | Short description Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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| VersichertenID | Σ | 0..1 | Identifier | Short description Versicherten-ID DefinitionDie Versicherten-ID ist der 10-stellige unveränderliche Teil der 30-stelligen Krankenversichertennummer. Sie wird häufig ebenfalls als Krankenversichertennummer bezeichnet. Der Term 'Versicherten-ID' wird hier in Übereinstimmung mit der Gematik-Spezifikation für das VSDM verwendet. This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.
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| use | Σ ?! | 0..0 | codeBinding | Short description usual | official | temp | secondary (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
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| type | Σ | 0..0 | CodeableConceptBinding | Short description Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
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| system | Σ | 1..1 | uriFixed Value | Short description The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://fhir.de/NamingSystem/gkv/kvid-10
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| value | Σ | 1..1 | string | Short description The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
General 123456 Mappings
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| period | Σ | 0..1 | Period | Short description Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| assigner | Σ | 0..1 | Reference(Organization) | Short description Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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| Krankenversichertennummer | Σ | 0..1 | Identifier | Short description Krankenversichertennummer DefinitionDie vollständige, bis zu 30-stellige Krankenversichertennummer. This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.
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| use | Σ ?! | 0..0 | codeBinding | Short description usual | official | temp | secondary (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
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| type | Σ | 0..0 | CodeableConceptBinding | Short description Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
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| system | Σ | 1..1 | uriFixed Value | Short description The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://fhir.de/NamingSystem/gkv/kvnr-30
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| value | Σ | 1..1 | string | Short description The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
General 123456 Mappings
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| period | Σ | 0..1 | Period | Short description Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| assigner | Σ | 0..1 | Reference(Organization) | Short description Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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| PseudoVersichertenID | Σ | 0..1 | Identifier | Short description pseudonymisierte VersichertenID DefinitionWird für Registermeldungen verwendet This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.
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| use | Σ ?! | 0..0 | codeBinding | Short description usual | official | temp | secondary (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
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| type | Σ | 0..0 | CodeableConceptBinding | Short description Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
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| system | Σ | 1..1 | uriFixed Value | Short description The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://fhir.de/NamingSystem/gkv/pseudo-kvid
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| value | Σ | 1..1 | string | Short description The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
General 123456 Mappings
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| period | Σ | 0..1 | Period | Short description Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| assigner | Σ | 0..1 | Reference(Organization) | Short description Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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| status | Σ ?! | 1..1 | codeBinding | Short description active | cancelled | draft | entered-in-error DefinitionThe status of the resource instance. This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
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| type | Σ | 1..1 | CodeableConceptBinding | Short description Versicherungsart DefinitionArt der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The order of application of coverages is dependent on the types of coverage. 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dortigen Codes nicht passen. versicherungsart-de-basis (required) Constraints
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| coding | Σ | 0..* | Coding | Short description Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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.
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| system | Σ | 0..1 | uriFixed Value | Short description Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously.
http://fhir.de/CodeSystem/versicherungsart-de-basis
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| version | Σ | 0..1 | string | Short description Version of the system - if relevant DefinitionThe 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. 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.
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| code | Σ | 0..1 | codeFixed Value | Short description Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
GKV
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| display | Σ | 0..1 | string | Short description Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | Short description If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). 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. 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.
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| text | Σ | 0..1 | string | Short description Plain text representation of the concept DefinitionA 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. 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. Very often the text is the same as a displayName of one of the codings.
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| policyHolder | Σ | 0..0 | Reference(Patient | RelatedPerson | Organization) | Short description Owner of the policy DefinitionThe party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org Reference(Patient | RelatedPerson | Organization) Constraints
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| subscriber | Σ | 0..1 | Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Hauptversicherte Person / Mitglied DefinitionHauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| reference | Σ | 0..1 | string | Short description Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
|
| identifier | Σ | 0..1 | Identifier | Short description VersichertenID (10-stellig) des Hauptversicherten DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
{
"system": "http://fhir.de/NamingSystem/gkv/kvid-10"
}
|
| display | Σ | 0..1 | string | Short description Name des Hauptversicherten DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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| subscriberId | Σ | 0..0 | string | Short description ID assigned to the Subscriber DefinitionThe insurer assigned ID for the Subscriber. Note that FHIR strings may not exceed 1MB in size
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| beneficiary | Σ | 1..1 | Reference(Patient, deutsches Basisprofil (Version 0.2)) | Short description Begünstigte Person DefinitionPerson, auf die sich die Kostenübernahme bezieht (der Patient) Die Angabe der 10-stelligen Krankenversichertennummer ist verpflichtend. Durch die Referenz auf eine Patient-Resource können weitere Informationen zum Patienten hinterlegt werden. Reference(Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| reference | Σ | 0..1 | string | Short description Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
|
| identifier | Σ | 0..1 | Identifier | Short description Identifier der versicherten Person DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
{
"system": "http://fhir.de/NamingSystem/gkv/kvid-10"
}
|
| display | Σ | 0..1 | string | Short description Name der Versicherten Person DefinitionDie Angabe des Namens des Versicherten dient der geeigenten Darstellung für den Benutzer und hat keine technische Bedeutung. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
|
| relationship | 0..1 | CodeableConcept | Short description Beneficiary relationship to the Subscriber DefinitionThe relationship of beneficiary (patient) to the subscriber. To determine relationship between the patient and the subscriber. 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. policyholder-relationship (example) Constraints
| |
| period | Σ | 0..1 | Period | Short description Coverage start and end dates DefinitionTime 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. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| start | Σ | 0..1 | dateTime | Short description Starting time with inclusive boundary DefinitionThe start of the period. The boundary is inclusive. If the low element is missing, the meaning is that the low boundary is not known.
|
| end | Σ | 0..1 | dateTime | Short description End time with inclusive boundary, if not ongoing DefinitionThe end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time. The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.
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| payor | Σ | 1..2 | Reference(http://fhir.de/StructureDefinition/organization-de-basis) | Short description Versicherer DefinitionGibt den Kostenträger des Versicherten an. Die Angabe der IK-Nummer als logische Referenz sowie des Namend als Display ist zwingend erforderlich. Die Referenz auf eine Resource vom Typ Organization, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional. Sofern eine zweite Referenz auf einen Kostenträger existiert, so handelt es sich hierbei um den abrechnenden Kostenträger Need to identify the issuer to target for processing and for coordination of benefit processing. Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird. Reference(http://fhir.de/StructureDefinition/organization-de-basis) Sliced:Ordered, Closed, by Constraints
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| reference | Σ | 0..1 | string | Short description Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
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| identifier | Σ | 1..1 | IdentifierFixed Value | Short description IK-Nummer des Versicherers DefinitionDie Angabe der IK-Nummer des Versicherers ist verpflichtend. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
{
"system": "http://fhir.de/NamingSystem/arge-ik/iknr"
}
|
| display | Σ | 1..1 | string | Short description Name des Versicherers DefinitionDie Angabe des Namens des Versicherers dient der geeigenten Darstellung für den Benutzer. Technisch ist ausschließlich die IK-Nummer relevant This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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| Kostentraeger | Σ | 1..1 | Reference(Organisation, deutsches Basisprofil (Version 0.2)) | Short description Versicherer DefinitionGibt den Kostenträger des Versicherten an. Die Angabe der IK-Nummer als logische Referenz sowie des Namend als Display ist zwingend erforderlich. Die Referenz auf eine Resource vom Typ Organization, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional. Sofern eine zweite Referenz auf einen Kostenträger existiert, so handelt es sich hierbei um den abrechnenden Kostenträger Need to identify the issuer to target for processing and for coordination of benefit processing. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Organisation, deutsches Basisprofil (Version 0.2)) Constraints
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| reference | Σ | 0..1 | string | Short description Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
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| identifier | Σ | 1..1 | Identifier | Short description IK-Nummer des Versicherers DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
{
"system": "http://fhir.de/NamingSystem/arge-ik/iknr"
}
|
| display | Σ | 0..1 | string | Short description Name des Versicherers DefinitionDie Angabe des Namens des Versicherers dient der geeigenten Darstellung für den Benutzer. Technisch ist ausschließlich die IK-Nummer relevant This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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| abrechnenderKostentraeger | Σ | 0..1 | Reference(Organisation, deutsches Basisprofil (Version 0.2)) | Short description Versicherer DefinitionVersicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. Need to identify the issuer to target for processing and for coordination of benefit processing. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Organisation, deutsches Basisprofil (Version 0.2)) Constraints
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| reference | Σ | 0..1 | string | Short description Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
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| identifier | Σ | 1..1 | Identifier | Short description IK-Nummer des abrechnenden Kostenträgers DefinitionDie Angabe der IK-Nummer des abrechnenden Kostenträgers ist verpflichtend. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
{
"system": "http://fhir.de/NamingSystem/arge-ik/iknr"
}
|
| display | Σ | 1..1 | string | Short description Name des Versicherers DefinitionDie Angabe des Namens des Versicherers dient der geeigenten Darstellung für den Benutzer. Technisch ist ausschließlich die IK-Nummer relevant This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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| grouping | 0..0 | BackboneElement | Short description Additional coverage classifications DefinitionA suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
| |
| dependent | Σ | 0..0 | string | Short description Dependent number DefinitionIdentifikation einer unter dieser Police versicherten Partei Bsp: eine Familie ist mit der Police mit dem Identifier "12345" versichert Vater 12345a Mutter 12345b Kind 12345c a, b und c wären dann jeweils die "dependents" For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| sequence | Σ | 0..0 | string | Short description The plan instance or sequence counter DefinitionAn optional counter for a particular instance of the identified coverage which increments upon each renewal. Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| order | Σ | 0..0 | positiveInt | Short description Relative order of the coverage DefinitionThe order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care. Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| network | Σ | 0..0 | string | Short description Insurer network DefinitionDie Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| contract | 0..* | Reference(Contract) | Short description Contract details DefinitionThe policy(s) which constitute this insurance coverage. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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<Coverage> <meta> <profile value="http://fhir.de/StructureDefinition/coverage-de-gkv/0.2" /> </meta> <extension url="http://fhir.de/StructureDefinition/gkv/zusatzinfos-geschuetzt/0.2"> <extension url="besonderePersonengruppe"> <valueCode value="00" /> </extension> <extension url="dmpKennzeichnung"> <valueCode value="00" /> </extension> <extension url="ruhenderLeistungsanspruch"> <extension url="beginn"> <valueDate value="2018-01-01" /> </extension> <extension url="ende"> <valueDate value="2019-01-01" /> </extension> <extension url="art"> <valueCode value="3" /> </extension> </extension> </extension> <identifier> <system value="http://fhir.de/NamingSystem/gkv/kvnr-30" /> <value value="G995030566998765432123456789098" /> </identifier> <status value="active" /> <type> <coding> <system value="http://fhir.de/CodeSystem/versicherungsart-de-basis" /> <code value="GKV" /> </coding> </type> <subscriber> <reference value="Patient/12345" /> <identifier> <system value="http://fhir.de/NamingSystem/gkv/kvid-10" /> <value value="G995030566" /> </identifier> <display value="Mustermann, Max" /> </subscriber> <beneficiary> <reference value="Patient/12345" /> <identifier> <system value="http://fhir.de/NamingSystem/gkv/kvid-10" /> <value value="G995030566" /> </identifier> <display value="Mustermann, Max" /> </beneficiary> <payor> <identifier> <system value="http://fhir.de/NamingSystem/arge-ik/iknr" /> <value value="998765432" /> </identifier> <display value="AOK Mittelbaden" /> </payor> </Coverage>
{ "resourceType":"Coverage", "meta":{ "profile": [ "http://fhir.de/StructureDefinition/coverage-de-gkv/0.2" ] }, "extension": [ { "url":"http://fhir.de/StructureDefinition/gkv/zusatzinfos-geschuetzt/0.2", "extension": [ { "url":"besonderePersonengruppe", "valueCode":"00" }, { "url":"dmpKennzeichnung", "valueCode":"00" }, { "url":"ruhenderLeistungsanspruch", "extension": [ { "url":"beginn", "valueDate":"2018-01-01" }, { "url":"ende", "valueDate":"2019-01-01" }, { "url":"art", "valueCode":"3" } ] } ] } ], "identifier": [ { "system":"http://fhir.de/NamingSystem/gkv/kvnr-30", "value":"G995030566998765432123456789098" } ], "status":"active", "type":{ "coding": [ { "system":"http://fhir.de/CodeSystem/versicherungsart-de-basis", "code":"GKV" } ] }, "subscriber":{ "reference":"Patient/12345", "identifier":{ "system":"http://fhir.de/NamingSystem/gkv/kvid-10", "value":"G995030566" }, "display":"Mustermann, Max" }, "beneficiary":{ "reference":"Patient/12345", "identifier":{ "system":"http://fhir.de/NamingSystem/gkv/kvid-10", "value":"G995030566" }, "display":"Mustermann, Max" }, "payor": [ { "identifier":{ "system":"http://fhir.de/NamingSystem/arge-ik/iknr", "value":"998765432" }, "display":"AOK Mittelbaden" } ] }
Canonical URL: http://fhir.de/StructureDefinition/coverage-de-sel/0.2
| Coverage | 0..* | Coverage | Short description Versicherungsdaten DefinitionAngaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte
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| identifier | Σ | 0..* | Identifier | Short description The primary coverage ID DefinitionThe main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant. This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.
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| status | Σ ?! | 1..1 | codeBinding | Short description active | cancelled | draft | entered-in-error DefinitionThe status of the resource instance. This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
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| type | Σ | 0..1 | CodeableConceptBinding | Short description Versicherungsart DefinitionArt der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The order of application of coverages is dependent on the types of coverage. 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen. versicherungsart-de-basis (required) Constraints
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| coding | Σ | 0..* | Coding | Short description Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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.
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| system | Σ | 0..1 | uriFixed Value | Short description Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously.
http://fhir.de/CodeSystem/versicherungsart-de-basis
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| version | Σ | 0..1 | string | Short description Version of the system - if relevant DefinitionThe 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. 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.
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| code | Σ | 0..1 | codeFixed Value | Short description Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
SEL
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| display | Σ | 0..1 | string | Short description Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | Short description If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). 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. 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.
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| text | Σ | 0..1 | string | Short description Plain text representation of the concept DefinitionA 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. 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. Very often the text is the same as a displayName of one of the codings.
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| policyHolder | Σ | 0..0 | Reference(Patient | RelatedPerson | Organization) | Short description Owner of the policy DefinitionThe party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org Reference(Patient | RelatedPerson | Organization) Constraints
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| subscriber | Σ | 0..1 | Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Unterzeichner der Kostenübernahme DefinitionPerson, die dies Kostenübernahme zusichert (entweder der Patient selbst oder eine andere Person, z.B. ein Elternteil) References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| subscriberId | Σ | 0..0 | string | Short description ID assigned to the Subscriber DefinitionThe insurer assigned ID for the Subscriber. Note that FHIR strings may not exceed 1MB in size
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| beneficiary | Σ | 1..1 | Reference(Patient, deutsches Basisprofil (Version 0.2)) | Short description Begünstigte Person DefinitionPerson, auf die sich die Kostenübernahme bezieht (der Patient) References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| relationship | 0..1 | CodeableConcept | Short description Beneficiary relationship to the Subscriber DefinitionThe relationship of beneficiary (patient) to the subscriber. To determine relationship between the patient and the subscriber. 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. policyholder-relationship (example) Constraints
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| period | Σ | 0..1 | Period | Short description Coverage start and end dates DefinitionTime 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. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| payor | Σ | 1..* | Reference(Organisation, deutsches Basisprofil (Version 0.2) | RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) | Short description Kostenübernehmer DefinitionPerson, die die Kosten übernimmt (beim Selbstzahlerverhältnis i.d.R. identisch mit subscriber) Sonderfall: Die Kostenübernahme wird von einer Person (subscriber) erklärt, die Übernahme erfolgt jedoch durch eine Organisation Need to identify the issuer to target for processing and for coordination of benefit processing. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Organisation, deutsches Basisprofil (Version 0.2) | RelatedPerson | Patient, deutsches Basisprofil (Version 0.2)) Constraints
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| grouping | 0..0 | BackboneElement | Short description Additional coverage classifications DefinitionA suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| dependent | Σ | 0..0 | string | Short description Dependent number DefinitionIdentifikation einer unter dieser Police versicherten Partei Bsp: eine Familie ist mit der Police mit dem Identifier "12345" versichert Vater 12345a Mutter 12345b Kind 12345c a, b und c wären dann jeweils die "dependents" For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| sequence | Σ | 0..0 | string | Short description The plan instance or sequence counter DefinitionAn optional counter for a particular instance of the identified coverage which increments upon each renewal. Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| order | Σ | 0..0 | positiveInt | Short description Relative order of the coverage DefinitionThe order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care. Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| network | Σ | 0..0 | string | Short description Insurer network DefinitionDie Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
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| contract | 0..* | Reference(Contract) | Short description Contract details DefinitionThe policy(s) which constitute this insurance coverage. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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<Coverage> <meta> <profile value="http://fhir.de/StructureDefinition/coverage-de-sel/0.2" /> </meta> <status value="active" /> <type> <coding> <system value="http://fhir.de/CodeSystem/versicherungsart-de-basis" /> <code value="SEL" /> </coding> </type> <subscriber> <reference value="RelatedPerson/22334" /> <display value="Zahlemann, Heinz" /> </subscriber> <beneficiary> <reference value="Patient/12345" /> <display value="Zahlemann, Jeanette" /> </beneficiary> <payor> <reference value="RelatedPerson/22334" /> <display value="Zahlemann, Heinz" /> </payor> </Coverage>
{ "resourceType":"Coverage", "meta":{ "profile": [ "http://fhir.de/StructureDefinition/coverage-de-sel/0.2" ] }, "status":"active", "type":{ "coding": [ { "system":"http://fhir.de/CodeSystem/versicherungsart-de-basis", "code":"SEL" } ] }, "subscriber":{ "reference":"RelatedPerson/22334", "display":"Zahlemann, Heinz" }, "beneficiary":{ "reference":"Patient/12345", "display":"Zahlemann, Jeanette" }, "payor": [ { "reference":"RelatedPerson/22334", "display":"Zahlemann, Heinz" } ] }
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