Leitfaden Basis DE (R4)

Krankenversicherungsverhältnis (Coverage)

Basisprofil

Das Basisprofile für die Ressource Coverage stellt die Mindestanforderungen für die Abbildung eines Versicherungsverhältnisses - unabhängig von dessen Art - dar.

Alle spezialisierten Coverage-Profile sind von diesem Basisprofil abgeleitet.

Für Versicherungsverhältnisse, die kein spezialisiertes Profil haben, sollte das Basisprofil verwendet werden.

Name: CoverageDeBasis (Simplifier Projekt Link)

Canonical: http://fhir.de/StructureDefinition/coverage-de-basis

Coverage	I		Coverage	Element Id Coverage Short description Versicherungsdaten Definition Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte. Comments The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. Data Type Coverage Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource 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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:Coverage
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element Id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. 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. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier cdanetv4:C02 v2:IN1-2 rim:.id cpha3pharm:C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. 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. Data Type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:Act.status
type	Σ	1..1	CodeableConceptBinding	Element Id Coverage.type Short description Versicherungsart Definition Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data Type CodeableConcept Binding Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt VersicherungsartDeBasis (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:IN1-15
policyHolder	Σ I	0..0	Reference(Patient \| RelatedPerson \| Organization)	Element Id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments 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 Data Type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	Element Id Coverage.subscriber Short description Hauptversicherte Person / Mitglied Definition Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data Type Reference(Patient \| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
subscriberId	Σ	0..0	string	There are no (further) constraints on this element Element Id Coverage.subscriberId Short description ID assigned to the subscriber Definition The insurer assigned ID for the Subscriber. Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
beneficiary	Σ I	1..1	Reference(Patient)	Element Id Coverage.beneficiary Short description Begünstigte Person Definition Person, auf die sich die Kostenübernahme bezieht (der Patient) Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments 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. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C17 v2:- No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data Type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4:C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.period Short description Coverage start and end dates 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. Requirements Some insurers require the submission of the coverage term. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow:Event.occurrence[x] w5:FiveWs.done[x] v2:IN1-12 / IN1-13 rim:Act.effectiveTime
payor	Σ I	1..*	Reference(Organization \| Patient \| RelatedPerson)	Element Id Coverage.payor Short description Versicherer Definition Versicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. 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. Data Type Reference(Organization \| Patient \| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.author cdanetv4:A05 v2:IN1-3 cpha3pharm:C.30
class		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.class.type Short description Type of class such as 'group' or 'plan' 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. Requirements The insurer issued label for a specific health card value. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
order	Σ	0..0	positiveInt	Element Id Coverage.order Short description Relative order of the coverage 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. Requirements Used in managing the coordination of benefits. Comments 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 Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:- No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..0	string	Element Id Coverage.network Short description Insurer network Definition Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Requirements Used in referral for treatment and in claims processing. Comments 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 Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data Type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data Type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data Type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception Short description Exceptions for patient payments Definition A suite of codes indicating exceptions or reductions to patient costs and their effective periods. Requirements Required by providers to manage financial transaction with the patient. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element Id Coverage.subrogation Short description Reimbursement to insurer Definition When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element Id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments 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. Data Type Reference(Contract) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:D01 through D09 v2:IN1-16, 18, 19 cpha3pharm:C.35

Für die Angabe der Versicherungsart (Coverage.type) wurde ein ValueSet abgestimmt welches unter Versicherungs-Informationen (Coverage) zu finden ist.

GKV-Profil

Für die Abbildung eines gesetzlichen Versicherungsverhältnisses sind die Informationen auf der elektronischen Versichertenkarte (eGK) maßgeblich.

Diese Informationen werden über spezielle Extensions abgebildet, die Informationen den Einlesevorgang der eKG sowie dem Inhalt des darauf gespeicherten Datensatzes enthalten:

Name: CoverageDeGkv (Simplifier Projekt Link)

Canonical: http://fhir.de/StructureDefinition/coverage-de-gkv

Coverage	I		Coverage	Element Id Coverage Short description Versicherungsdaten Definition Kostenübernahme im Rahmen eines gesetzlichen Versicherungsverhältnisses in Deutschland. Comments The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. Data Type Coverage Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource 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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:Coverage
extension	I	0..*	Extension	Element Id Coverage.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. 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. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
einlesedatumKarte	I	0..1	Extension(dateTime)	Element Id Coverage.extension:einlesedatumKarte Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(dateTime) Extension URL http://fhir.de/StructureDefinition/gkv/einlesedatum-karte Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
onlinepruefung	I	0..1	Extension(Complex)	Element Id Coverage.extension:onlinepruefung Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Complex) Extension URL http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
versionEgk	I	0..1	Extension(string)	Element Id Coverage.extension:versionEgk Short description eGK Version (z.B. 5.2.0) Alternate names extensions, user content Definition Extension zur Erfassung der Version des VSDM-Datensatzes auf der eGK 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. Data Type Extension(string) Extension URL http://fhir.de/StructureDefinition/gkv/version-vsdm Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
generationEgk	I	0..*	Extension(string)	Element Id Coverage.extension:generationEgk Short description eGK Generation ( 1 \| 1+ \| 2 ) Alternate names extensions, user content Definition Angabe der Generation der Versichertenkarte 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. Data Type Extension(string) Extension URL http://fhir.de/StructureDefinition/gkv/generation-egk Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
versichertenart	I	0..1	Extension(Coding)	Element Id Coverage.extension:versichertenart Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Coding) Extension URL http://fhir.de/StructureDefinition/gkv/versichertenart Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
kostenerstattung	I	0..1	Extension(Complex)	Element Id Coverage.extension:kostenerstattung Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Complex) Extension URL http://fhir.de/StructureDefinition/gkv/kostenerstattung Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
wop	I	0..1	Extension(Coding)	Element Id Coverage.extension:wop Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Coding) Extension URL http://fhir.de/StructureDefinition/gkv/wop Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
besonderePersonengruppe	I	0..1	Extension(Coding)	Element Id Coverage.extension:besonderePersonengruppe Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Coding) Extension URL http://fhir.de/StructureDefinition/gkv/besondere-personengruppe Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
dmpKennzeichen	I	0..1	Extension(Coding)	Element Id Coverage.extension:dmpKennzeichen Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Coding) Extension URL http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
ruhenderLeistungsanspruch	I	0..1	Extension(Complex)	Element Id Coverage.extension:ruhenderLeistungsanspruch Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Complex) Extension URL http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
zuzahlungsstatus	I	0..1	Extension(Complex)	Element Id Coverage.extension:zuzahlungsstatus Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Complex) Extension URL http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
identifier	Σ	1..*	Identifier	Element Id Coverage.identifier Short description Primärer Identifier der Versicherung Definition Ein 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. Requirements Allows coverages to be distinguished and referenced. Comments TODO: Constraint, der prüft, dass mindestens entweder eine VersichertenID oder eine Krankenversichertennummer angegeben wurde. Data Type Identifier Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier cdanetv4:C02 v2:IN1-2 rim:.id cpha3pharm:C.32, C.33, C.39
KrankenversichertenID	Σ	0..1	Identifier-Profil für die 10-stellige Krankenversichertennummer	Element Id Coverage.identifier:KrankenversichertenID Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Requirements Allows coverages to be distinguished and referenced. 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. Data Type Identifier-Profil für die 10-stellige Krankenversichertennummer Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "type": { "coding": [ { "system": "http://fhir.de/CodeSystem/identifier-type-de-basis", "code": "GKV" } ] } } Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier cdanetv4:C02 v2:IN1-2 rim:.id cpha3pharm:C.32, C.33, C.39
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.identifier:KrankenversichertenID.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.identifier:KrankenversichertenID.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "system": "http://fhir.de/CodeSystem/identifier-type-de-basis", "code": "GKV" } ] } Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	1..1	uriFixed Value	There are no (further) constraints on this element Element Id Coverage.identifier:KrankenversichertenID.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value http://fhir.de/sid/gkv/kvid-10 Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ I	1..1	string	There are no (further) constraints on this element Element Id Coverage.identifier:KrankenversichertenID.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` kvid-1:Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen `matches('^[A-Z][0-9]{9}$')` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.identifier:KrankenversichertenID.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Coverage.identifier:KrankenversichertenID.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
pseudo-Krankenversichertennummer	Σ	0..1	Identifier-Profil für die pseudonymisierte Krankenversichertennummer	Element Id Coverage.identifier:pseudo-Krankenversichertennummer Short description pseudonymisierte Krankenversichertennummer Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Requirements Allows coverages to be distinguished and referenced. 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. Data Type Identifier-Profil für die pseudonymisierte Krankenversichertennummer Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "ANON" } ] } } Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier cdanetv4:C02 v2:IN1-2 rim:.id cpha3pharm:C.32, C.33, C.39
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.identifier:pseudo-Krankenversichertennummer.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.identifier:pseudo-Krankenversichertennummer.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "ANON" } ] } Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	1..1	uriFixed Value	There are no (further) constraints on this element Element Id Coverage.identifier:pseudo-Krankenversichertennummer.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed Value http://fhir.de/sid/gkv/pseudo-kvid Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Coverage.identifier:pseudo-Krankenversichertennummer.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.identifier:pseudo-Krankenversichertennummer.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Coverage.identifier:pseudo-Krankenversichertennummer.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. 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. Data Type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:Act.status
type	Σ	1..1	CodeableConceptBinding	Element Id Coverage.type Short description Versicherungsart Definition Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt Requirements The order of application of coverages is dependent on the types of coverage. Comments 28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dortigen Codes nicht passen. Data Type CodeableConcept Binding Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt VersicherungsartDeBasis (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:IN1-15
coding	Σ	1..*	Coding	Element Id Coverage.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
VersicherungsArtDeBasis	Σ	1..1	Coding	Element Id Coverage.type.coding:VersicherungsArtDeBasis Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://fhir.de/CodeSystem/versicherungsart-de-basis", "code": "GKV" } Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
policyHolder	Σ I	0..0	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element Id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments 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 Data Type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element Id Coverage.subscriber Short description Hauptversicherte Person / Mitglied Definition Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data Type Reference(Patient \| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id Coverage.subscriber.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id Coverage.subscriber.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	Element Id Coverage.subscriber.identifier Short description VersichertenID (10-stellig) des Hauptversicherten Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://fhir.de/sid/gkv/kvid-10" } Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier rim:.identifier
display	Σ	0..1	string	Element Id Coverage.subscriber.display Short description Name des Hauptversicherten Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
subscriberId	Σ	0..0	string	There are no (further) constraints on this element Element Id Coverage.subscriberId Short description ID assigned to the subscriber Definition The insurer assigned ID for the Subscriber. Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
beneficiary	Σ I	1..1	Reference(Patient)	Element Id Coverage.beneficiary Short description Begünstigte Person Definition Person, auf die sich die Kostenübernahme bezieht (der Patient) Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments Die Angabe der 10-stelligen Krankenversichertennummer ist verpflichtend. Durch die Referenz auf eine Patient-Resource können weitere Informationen zum Patienten hinterlegt werden. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id Coverage.beneficiary.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id Coverage.beneficiary.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	Element Id Coverage.beneficiary.identifier Short description Identifier der versicherten Person Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://fhir.de/sid/gkv/kvid-10" } Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier rim:.identifier
display	Σ	0..1	string	Element Id Coverage.beneficiary.display Short description Name der Versicherten Person Definition Die Angabe des Namens des Versicherten dient der geeigenten Darstellung für den Benutzer und hat keine technische Bedeutung. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
dependent	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C17 v2:- No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data Type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4:C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.period Short description Coverage start and end dates 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. Requirements Some insurers require the submission of the coverage term. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow:Event.occurrence[x] w5:FiveWs.done[x] v2:IN1-12 / IN1-13 rim:Act.effectiveTime
start	Σ I	0..1	dateTime	Element Id Coverage.period.start Short description Starting time with inclusive boundary Definition The start of the period. The boundary is inclusive. Comments If the low element is missing, the meaning is that the low boundary is not known. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:DR.1 rim:./low KVDT:4133
end	Σ I	0..1	dateTime	Element Id Coverage.period.end Short description End time with inclusive boundary, if not ongoing Definition The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. 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. Comments The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:DR.2 rim:./high KVDT:4110
payor	Σ I	1..1	Reference(Organization \| Patient \| RelatedPerson)	Element Id Coverage.payor Short description Versicherer Definition Gibt den Kostenträger des Versicherten an. Die Angabe der IK-Nummer als logische Referenz sowie des Namens 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, kann diese durch die Extension 'Abrechnende IK' angegeben werden. Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. Comments 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. Data Type Reference(Organization \| Patient \| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.author cdanetv4:A05 v2:IN1-3 cpha3pharm:C.30
extension	I	0..*	Extension	Element Id Coverage.payor.extension Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
abrechnendeIK	I	0..1	Extension(Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR))	Element Id Coverage.payor.extension:abrechnendeIK Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR)) Extension URL http://fhir.de/StructureDefinition/AbrechnendeIK Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id Coverage.payor.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id Coverage.payor.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR)	Element Id Coverage.payor.identifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier rim:.identifier
display	Σ	1..1	string	There are no (further) constraints on this element Element Id Coverage.payor.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
class		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.class.type Short description Type of class such as 'group' or 'plan' 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. Requirements The insurer issued label for a specific health card value. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
order	Σ	0..0	positiveInt	There are no (further) constraints on this element Element Id Coverage.order Short description Relative order of the coverage 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. Requirements Used in managing the coordination of benefits. Comments 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 Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:- No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..0	string	There are no (further) constraints on this element Element Id Coverage.network Short description Insurer network Definition Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Requirements Used in referral for treatment and in claims processing. Comments 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 Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data Type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data Type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data Type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception Short description Exceptions for patient payments Definition A suite of codes indicating exceptions or reductions to patient costs and their effective periods. Requirements Required by providers to manage financial transaction with the patient. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element Id Coverage.subrogation Short description Reimbursement to insurer Definition When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element Id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments 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. Data Type Reference(Contract) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:D01 through D09 v2:IN1-16, 18, 19 cpha3pharm:C.35

Übersicht über die Extensions

Hinweis	offene Punkte
	Die Abbildung von Daten, die von der Versichertenkarte (eGK) eingelesen werden, als Extensions muss in Zukunft weiter diskutiert und ggf. in Frage gestellt werden. Eventuell wäre alternativ die Abbildung der eGK-Daten als ein separates Datenobjekt geeignet, um auf Versionsänderungen des eGK-Formates schneller reagieren und erweiterte Informationen (Notfalldaten, Medikationsplan) ebenfalls abdecken zu können. Aktuell werden nur die Informationen auf der eGK berücksichtigt, die im Kontext der Coverage/des Versicherungsverhältnisses relevant sind. Wir bitten hierzu um Meinungen und Vorschläge aus der Community.

Hinweis

offene Punkte

Die Abbildung von Daten, die von der Versichertenkarte (eGK) eingelesen werden, als Extensions muss in Zukunft weiter diskutiert und ggf. in Frage gestellt werden. Eventuell wäre alternativ die Abbildung der eGK-Daten als ein separates Datenobjekt geeignet, um auf Versionsänderungen des eGK-Formates schneller reagieren und erweiterte Informationen (Notfalldaten, Medikationsplan) ebenfalls abdecken zu können. Aktuell werden nur die Informationen auf der eGK berücksichtigt, die im Kontext der Coverage/des Versicherungsverhältnisses relevant sind. Wir bitten hierzu um Meinungen und Vorschläge aus der Community.

Siehe Extensions für Coverage.

Beispiel

Folgendes Beispiel deckt das GKV-Profil vollständig ab:

<Coverage xmlns="http://hl7.org/fhir">
    <id value="Example-coverage-example" />
    <meta>
        <profile value="http://fhir.de/StructureDefinition/coverage-de-gkv" />
    </meta>
    <extension url="http://fhir.de/StructureDefinition/gkv/einlesedatum-karte">
        <valueDateTime value="2019-12-03" />
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/version-vsdm">
        <valueString value="5.2.1" />
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/generation-egk">
        <valueString value="1+" />
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/versichertenart">
        <valueCoding>
            <system value="https://fhir.kbv.de/CodeSystem/74_CS_SFHIR_KBV_VERSICHERTENSTATUS" />
            <code value="1" />
        </valueCoding>
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/kostenerstattung">
        <extension url="aerztlicheVersorgung">
            <valueBoolean value="true" />
        </extension>
        <extension url="zahnaerztlicheVersorgung">
            <valueBoolean value="false" />
        </extension>
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/wop">
        <valueCoding>
            <system value="https://fhir.kbv.de/CodeSystem/CS_AW_Krankenversicherung_WOP" />
            <code value="38" />
            <display value="Nordrhein" />
        </valueCoding>
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/besondere-personengruppe">
        <valueCoding>
            <system value="https://fhir.kbv.de/CodeSystem/74_CS_SFHIR_KBV_PERSONENGRUPPE" />
            <code value="06" />
            <display value="BVG (Gesetz &#252;ber die Versorgung der Opfer des Krieges)" />
        </valueCoding>
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch">
        <extension url="art">
            <valueCoding>
                <code value="1" />
            </valueCoding>
        </extension>
        <extension url="dauer">
            <valuePeriod>
                <start value="2018-01-01" />
            </valuePeriod>
        </extension>
    </extension>
    <extension url="http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus">
        <extension url="status">
            <valueBoolean value="true" />
        </extension>
        <extension url="gueltigBis">
            <valueDate value="2020-12-31" />
        </extension>
    </extension>
    <identifier>
        <system value="http://fhir.de/sid/gkv/kvid-10" />
        <value value="A123454321" />
    </identifier>
    <status value="active" />
    <type>
        <coding>
            <system value="http://fhir.de/CodeSystem/versicherungsart-de-basis" />
            <code value="GKV" />
        </coding>
    </type>
    <subscriber>
        <reference value="Patient/example" />
        <display value="Max Mustermann" />
    </subscriber>
    <beneficiary>
        <reference value="Patient/example" />
        <display value="Max Mustermann" />
    </beneficiary>
    <payor>
        <extension url="http://fhir.de/StructureDefinition/AbrechnendeIK">
            <valueIdentifier>
                <system value="http://fhir.de/sid/arge-ik/iknr" />
                <value value="756756324" />
            </valueIdentifier>
        </extension>
        <identifier>
            <system value="http://fhir.de/sid/arge-ik/iknr" />
            <value value="823746876" />
        </identifier>
        <display value="Krankenkasse A" />
    </payor>
</Coverage>

Selbstzahler-Profil

Unter den Begriff "Selbstzahler" fallen hier auch Fälle mit abweichendem Rechnungsempfänger (z.B. bei Minderjährigen).

Für die Abbildung eines Selbstzahler-Verhältnisses sind über das Basisprofil hinaus folgende Mindestangaben erforderlich:

Name: CoverageDeSel (Simplifier Projekt Link)

Canonical: http://fhir.de/StructureDefinition/coverage-de-sel

Coverage	I		Coverage	There are no (further) constraints on this element Element Id Coverage Short description Versicherungsdaten Definition Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte. Comments The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. Data Type Coverage Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource 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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:Coverage
identifier	Σ	0..*	Identifier	Element Id Coverage.identifier Short description Business Identifier for the coverage Definition A unique identifier assigned to this coverage. Requirements Allows coverages to be distinguished and referenced. 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. Data Type Identifier Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier cdanetv4:C02 v2:IN1-2 rim:.id cpha3pharm:C.32, C.33, C.39
pkv	Σ	0..1	Identifier-Profil für die Abbildung einer Privatversichertennummer	Element Id Coverage.identifier:pkv Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Requirements Allows coverages to be distinguished and referenced. 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. Data Type Identifier-Profil für die Abbildung einer Privatversichertennummer Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "type": { "coding": [ { "system": "http://fhir.de/CodeSystem/identifier-type-de-basis", "code": "PKV" } ] } } Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier cdanetv4:C02 v2:IN1-2 rim:.id cpha3pharm:C.32, C.33, C.39
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Coverage.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. 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'. 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. Data Type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:Act.status
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.type Short description Versicherungsart Definition Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt Requirements The order of application of coverages is dependent on the types of coverage. Comments 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. Data Type CodeableConcept Binding Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt VersicherungsartDeBasis (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.class v2:IN1-15
coding	Σ	1..*	Coding	Element Id Coverage.type.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
VersicherungsArtDeBasis	Σ	1..1	Coding	Element Id Coverage.type.coding:VersicherungsArtDeBasis Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://fhir.de/CodeSystem/versicherungsart-de-basis", "code": "SEL" } Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.type.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
policyHolder	Σ I	0..0	Reference(Patient \| RelatedPerson \| Organization)	There are no (further) constraints on this element Element Id Coverage.policyHolder Short description Owner of the policy Definition The party who 'owns' the insurance policy. Requirements This provides employer information in the case of Worker's Compensation and other policies. Comments 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 Data Type Reference(Patient \| RelatedPerson \| Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
subscriber	Σ I	0..1	Reference(Patient \| RelatedPerson)	Element Id Coverage.subscriber Short description Unterzeichner der Kostenübernahme Definition Person, die dies Kostenübernahme zusichert (entweder der Patient selbst oder eine andere Person, z.B. ein Elternteil) Requirements This is the party who is entitled to the benfits under the policy. Comments May be self or a parent in the case of dependants. Data Type Reference(Patient \| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
subscriberId	Σ	0..0	string	There are no (further) constraints on this element Element Id Coverage.subscriberId Short description ID assigned to the subscriber Definition The insurer assigned ID for the Subscriber. Requirements The insurer requires this identifier on correspondance and claims (digital and otherwise). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
beneficiary	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id Coverage.beneficiary Short description Begünstigte Person Definition Person, auf die sich die Kostenübernahme bezieht (der Patient) Requirements This is the party who receives treatment for which the costs are reimbursed under the coverage. Comments 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. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] cdanetv4:D01 through D09 v2:IN1-16, 18, 19-name of insured, address, date of birth cpha3pharm:C.35 w5:FiveWs.subject
dependent	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.dependent Short description Dependent number Definition A unique identifier for a dependent under the coverage. Requirements For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. Comments Periodically the member number is constructed from the subscriberId and the dependant number. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C17 v2:- No exact HL7 v2 equivalent concept seems to exist;
relationship		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.relationship Short description Beneficiary relationship to the subscriber Definition The relationship of beneficiary (patient) to the subscriber. Requirements To determine relationship between the patient and the subscriber to determine coordination of benefits. Comments Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. Data Type CodeableConcept Binding The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). SubscriberRelationshipCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD cdanetv4:C03
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.period Short description Coverage start and end dates 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. Requirements Some insurers require the submission of the coverage term. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow:Event.occurrence[x] w5:FiveWs.done[x] v2:IN1-12 / IN1-13 rim:Act.effectiveTime
payor	Σ I	1..*	Reference(Organization \| RelatedPerson \| Patient)	Element Id Coverage.payor Short description Kostenübernehmer Definition Person, 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 Requirements Need to identify the issuer to target for claim processing and for coordination of benefit processing. 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. Data Type Reference(Organization \| RelatedPerson \| Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.author cdanetv4:A05 v2:IN1-3 cpha3pharm:C.30
class		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.class Short description Additional coverage classifications Definition A suite of underwriter specific classifiers. Requirements The codes provided on the health card which identify or confirm the specific policy for the insurer. Comments For example may be used to identify a class of coverage or employer group, Policy, Plan. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.class.type Short description Type of class such as 'group' or 'plan' 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. Requirements The insurer issued label for a specific health card value. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The policy classifications, eg. Group, Plan, Class, etc. CoverageClassCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
value	Σ	1..1	string	There are no (further) constraints on this element Element Id Coverage.class.value Short description Value associated with the type Definition The alphanumeric string value associated with the insurer issued label. Requirements The insurer issued label and value are necessary to identify the specific policy. Comments For example, the Group or Plan number. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
name	Σ	0..1	string	There are no (further) constraints on this element Element Id Coverage.class.name Short description Human readable description of the type and value Definition A short description for the class. Requirements Used to provide a meaningful description in correspondence to the patient. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
order	Σ	0..0	positiveInt	There are no (further) constraints on this element Element Id Coverage.order Short description Relative order of the coverage 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. Requirements Used in managing the coordination of benefits. Comments 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 Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:- No exact HL7 v2 equivalent concept seems to exist;
network	Σ	0..0	string	There are no (further) constraints on this element Element Id Coverage.network Short description Insurer network Definition Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden Requirements Used in referral for treatment and in claims processing. Comments 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 Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:D10
costToBeneficiary		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary Short description Patient payments for services/products Alternate names CoPay, Deductible, Exceptions 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. Requirements Required by providers to manage financial transaction with the patient. Comments For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.type Short description Cost category Definition The category of patient centric costs associated with treatment. Requirements Needed to identify the category associated with the amount for the patient. Comments For example visit, specialist visits, emergency, inpatient care, etc. Data Type CodeableConcept Binding The types of services to which patient copayments are specified. CoverageCopayTypeCodes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
value[x]	Σ	1..1		There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.value[x] Short description The amount or percentage due from the beneficiary Definition The amount due from the patient for the cost category. Requirements Needed to identify the amount for the patient associated with the category. Comments Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a cdanetv4:C11 (Division,Section) v2:IN1-8 cpha3pharm:C.31
valueQuantity			SimpleQuantity	There are no (further) constraints on this element Data Type SimpleQuantity
valueMoney			Money	There are no (further) constraints on this element Data Type Money
exception		0..*	BackboneElement	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception Short description Exceptions for patient payments Definition A suite of codes indicating exceptions or reductions to patient costs and their effective periods. Requirements Required by providers to manage financial transaction with the patient. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
type	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception.type Short description Exception category Definition The code for the specific exception. Requirements Needed to identify the exception associated with the amount for the patient. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The types of exceptions from the part or full value of financial obligations such as copays. ExampleCoverageFinancialExceptionCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id Coverage.costToBeneficiary.exception.period Short description The effective period of the exception Definition The timeframe during when the exception is in force. Requirements Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
subrogation		0..1	boolean	There are no (further) constraints on this element Element Id Coverage.subrogation Short description Reimbursement to insurer Definition When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. Requirements See definition for when to be used. Comments Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
contract	I	0..*	Reference(Contract)	There are no (further) constraints on this element Element Id Coverage.contract Short description Contract details Definition The policy(s) which constitute this insurance coverage. Requirements To reference the legally binding contract between the policy holder and the insurer. Comments 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. Data Type Reference(Contract) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) cdanetv4:D01 through D09 v2:IN1-16, 18, 19 cpha3pharm:C.35

Hinweis	offene Punkte
	Die Differenzierung zwischen Selbstzahlern und Privatversicherten ist von komplexen Faktoren abhängig und wird im ambulanten/stationären Kontext unterschiedlich gehandhabt. Die Modellierung der Coverage bedarf hier in Zukunft einer genaueren Betrachtung der verschiedenen Konstellationen.