LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
| Official URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-coverage | Version: 8.0.0 | |||
| Active as of 2022-11-10 | Computable Name: CDMCoverage | |||
Describes the healthcare benefit coverage of a member as it relates to a health plan. Coverage determines how the health care products and services the member receives may be paid. The CDMCoverage profile extends the base FHIR Coverage resource with additional benefit coverage details.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
| Path | Conformance | ValueSet |
| Coverage.extension:benefitStatus.valueCodeableConcept | extensible | HipaaBenefitStatusValueSet (a valid code from HIPAA Benefit Status Codes) |
| Coverage.extension:employeeEducationLevel.valueCodeableConcept | extensible | PayerEducationLevelValueSet (a valid code from Payer Education Level Codes) |
| Coverage.extension:employeeGender.valueCodeableConcept | extensible | PayerGenderValueSet (a valid code from Payer Gender Codes) |
| Coverage.extension:employeeJobTitle.valueCodeableConcept | extensible | PayerJobTitleValueSet |
| Coverage.extension:medicareCoverage.valueCodeableConcept | extensible | PayerMedicareCoverageValueSet (a valid code from Payer Medicare Coverage Codes) |
| Coverage.extension:ssiStatus.valueCodeableConcept | extensible | PayerSsiStatusValueSet (a valid code from Payer SSI Status Codes) |
| Coverage.extension:tanfBenefits.valueCodeableConcept | extensible | PayerTanfBenefitValueSet (a valid code from Payer TANF Benefit codes) |
| Coverage.class.type | extensible | PayerCoverageClassValueSet |
| Path | Conformance | ValueSet |
| Coverage.extension:benefitStatus.value[x]:valueCodeableConcept | extensible | HipaaBenefitStatusValueSet (a valid code from HIPAA Benefit Status Codes) |
| Coverage.extension:employeeEducationLevel.value[x]:valueCodeableConcept | extensible | PayerEducationLevelValueSet (a valid code from Payer Education Level Codes) |
| Coverage.extension:employeeGender.value[x]:valueCodeableConcept | extensible | PayerGenderValueSet (a valid code from Payer Gender Codes) |
| Coverage.extension:employeeJobTitle.value[x]:valueCodeableConcept | extensible | PayerJobTitleValueSet |
| Coverage.extension:medicareCoverage.value[x]:valueCodeableConcept | extensible | PayerMedicareCoverageValueSet (a valid code from Payer Medicare Coverage Codes) |
| Coverage.extension:ssiStatus.value[x]:valueCodeableConcept | extensible | PayerSsiStatusValueSet (a valid code from Payer SSI Status Codes) |
| Coverage.extension:tanfBenefits.value[x]:valueCodeableConcept | extensible | PayerTanfBenefitValueSet (a valid code from Payer TANF Benefit codes) |
| Coverage.status | required | FinancialResourceStatusCodes |
| Path | Conformance | ValueSet | ||||
| Coverage.language | preferred | CommonLanguages
| ||||
| Coverage.extension:benefitStatus.value[x]:valueCodeableConcept | extensible | HipaaBenefitStatusValueSet (a valid code from HIPAA Benefit Status Codes) | ||||
| Coverage.extension:employeeEducationLevel.value[x]:valueCodeableConcept | extensible | PayerEducationLevelValueSet (a valid code from Payer Education Level Codes) | ||||
| Coverage.extension:employeeGender.value[x]:valueCodeableConcept | extensible | PayerGenderValueSet (a valid code from Payer Gender Codes) | ||||
| Coverage.extension:employeeJobTitle.value[x]:valueCodeableConcept | extensible | PayerJobTitleValueSet | ||||
| Coverage.extension:medicareCoverage.value[x]:valueCodeableConcept | extensible | PayerMedicareCoverageValueSet (a valid code from Payer Medicare Coverage Codes) | ||||
| Coverage.extension:ssiStatus.value[x]:valueCodeableConcept | extensible | PayerSsiStatusValueSet (a valid code from Payer SSI Status Codes) | ||||
| Coverage.extension:tanfBenefits.value[x]:valueCodeableConcept | extensible | PayerTanfBenefitValueSet (a valid code from Payer TANF Benefit codes) | ||||
| Coverage.status | required | FinancialResourceStatusCodes | ||||
| Coverage.type | preferred | CoverageTypeAndSelf-PayCodes | ||||
| Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
| Coverage.class.type | extensible | PayerCoverageClassValueSet | ||||
| Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
| Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
This structure is derived from Coverage
Summary
Mandatory: 1 element
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
  meta | 0..1 | ProcessMeta | Metadata about a resource | |
 contained | 0..0 | |||
 Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
 snapshotAgeInMonths | 0..1 | unsignedInt | Age in months at the time of the coverage period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-months | |
| snapshotAgeInYears | 0..1 | unsignedInt | The age of the person in years for the month of eligibility or service URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years | |
| employeeSnapshotAgeInYears | 0..1 | unsignedInt | The age of the employee in years for the month of eligibility or service URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-snapshot-age-in-years | |
| ageGroup | 0..1 | CodeableConcept | Standard code for age groupings URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-group Binding: Age Group Value Set (extensible) | |
| ageGenderGroup | 0..1 | CodeableConcept | Standard code for groupings that combine age and gender URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-gender-group Binding: Age and Gender Group Value Set (extensible) | |
| attributedProviderReferenceWithPeriod | 0..1 | Reference() | Attributed provider reference with period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/attributed-provider-with-period | |
 benefitStatus | 0..1 | CodeableConcept | HIPAA standard code for the benefit status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status | |
  valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: HIPAA Benefit Status Value Set (extensible) | |
| claimGroupIdentifier | 0..1 | string | Group ID of the plan member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-group-identifier | |
| cobraIndicator | 0..1 | string | Indicator of Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cobra-indicator | |
| coverageDays | 0..1 | unsignedInt | Number of covered days of eligibility URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-days | |
| coverageMonth | 0..1 | date | Date which reflects the month of eligibility URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month | |
| coverageInsurancePlan | 0..1 | Reference(InsurancePlan) | Reference to the insurance plan for this coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-insurance-plan | |
| dualEligibilityIndicator | 0..1 | string | Indicator of dual eligibility for the Medicaid market URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/dual-eligibility-indicator | |
| enrollmentPcp | 0..1 | string | Provider identifier of the primary care physician for the plan member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp | |
| enrollmentPcpNameOnEnrollment | 0..1 | string | Original primary care physician (PCP) name as reporting on the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-name-on-enrollment | |
| enrollmentPcpZipOnEnrollment | 0..1 | string | Original primary care physician (PCP) zip as reporting on the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-zip-on-enrollment | |
| employeeAverageScheduledHours | 0..1 | decimal | Average number of hours the employee is scheduled to work per day URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-average-scheduled-hours | |
| employeeBirthDate | 0..1 | date | Birthdate of the employee or contract holder URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-birth-date | |
| employeeCompany | 0..1 | CodeableConcept | Code for the company of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-company | |
| employeeCostCenter | 0..1 | CodeableConcept | Code for the cost center of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-cost-center | |
| employeeCount | 0..1 | unsignedInt | Flag of the employees in the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-count | |
| employeeBusinessUnit | 0..1 | CodeableConcept | Code for the business unit of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-business-unit | |
| employeeDepartment | 0..1 | CodeableConcept | Code for the department of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-department | |
| employeeDivision | 0..1 | CodeableConcept | Code for the division of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-division | |
| employeeExemptIndicator | 0..1 | string | Indicator of whether the employee status is exempt or non-exempt URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-exempt-indicator | |
| employeeFamilySize | 0..1 | integer | Total family size of the employee, whether or not dependents are insured or participating in any programs URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-family-size | |
| employeeFTECount | 0..1 | decimal | Full Time Equivalent calculation for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-fte-count | |
| employeeId | 0..* | Identifier | Identifier for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-id | |
| employeeJobFamily | 0..1 | CodeableConcept | Code for the job family of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-family | |
| employeeJobGrade | 0..1 | CodeableConcept | Code for the job grade of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-grade | |
| employeeJobLocation | 0..* | CodeableConcept | Code for the physical location where the employee works URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-location | |
| employeePayFrequency | 0..1 | CodeableConcept | Code indicating the frequency with which the employee is paid (e.g., daily, weekly, monthly) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-pay-frequency | |
| employeePerformanceRating | 0..1 | CodeableConcept | Code indicating the performance rating of the employee, assigned as of the last review period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-performance-rating | |
| employeeShift | 0..1 | CodeableConcept | Code indicating the regular shift which the employee is scheduled to work URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-shift | |
| employeeSubBusinessUnit | 0..1 | CodeableConcept | Code of the sub business unit of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-sub-business-unit | |
| salaryIndicator | 0..1 | string | Indicator of whether the employee status is salaried URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/salary-indicator | |
| unionWorkerIndicator | 0..1 | string | Indicator that the contract holder (subscriber) belongs to a union URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/union-worker-indicator | |
| employeeEducationLevel | 0..1 | CodeableConcept | Code indicating the highest level of education that the employee has completed URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-education-level | |
| valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Education Level Value Set (extensible) | |
| employeeGender | 0..1 | CodeableConcept | Employee gender code URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-gender | |
| valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Gender Value Set (extensible) | |
| employeeHireDate | 0..* | date | First date of employment for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-hire-date | |
| employeeTerminationDate | 0..* | date | Last date of employment for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-date | |
| employeeTerminationReason | 0..* | CodeableConcept | Code indicating the reason for employee termination URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-reason | |
| employeeJobTitle | 0..1 | CodeableConcept | Job title of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-title | |
| valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Job Title Value Set (extensible) | |
| employeeLaborUnion | 0..1 | CodeableConcept | Code for the labor union of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-labor-union | |
| employeeRetirementDate | 0..1 | date | Date of retirement for the employee or contract holder URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-retirement-date | |
| employeeStatus | 0..1 | CodeableConcept | Status of the employee based on one or more code systems URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-status | |
| employeeUnionId | 0..1 | string | Identification for the labor union member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-union-id | |
| employeeWageAmount | 0..1 | decimal | Wage amount of the employee for the time period represented by the Wage Basis field URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-amount | |
| employeeWageBasis | 0..1 | CodeableConcept | Code indicating the basis on which the wages of the employee are calculated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-basis | |
| employeeYearOfService | 0..1 | unsignedInt | Net credited service in years for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-year-of-service | |
| employer | 0..1 | CodeableConcept | Code for the employer URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employer | |
| familyIncomeLevel | 0..1 | CodeableConcept | Code for the family income level of the person based on the Federal Poverty Level (FPL) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/family-income-level | |
| jobClassCode | 0..1 | CodeableConcept | Classifcation group of the job role of the employee, for example, Top Executives, Post-secondary teachers, and Engineers URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-class-code | |
| jobLocationZipcode | 0..1 | string | 5-digit zip code of the facility where the employee works URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-location-zipcode | |
| longTermDisabilityBenefitRate | 0..1 | decimal | Long term disability (LTD) benefit rate, expressed as a percentage of base wages (for example, 50.00%, 60.00%, 70.00%) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-disability-benefit-rate | |
| medicareCoverage | 0..1 | CodeableConcept | Standard code for the type of Medicare coverage, if any, for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-coverage | |
| valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Medicare Coverage Value Set (extensible) | |
| medicareIndicator | 0..1 | string | Indicator of Medicare coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-indicator | |
| memberEmployeeIndicator | 0..1 | CodeableConcept | Code indicates whether the member is either an employee of the health plan, or the dependent of an employee of the health plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/member-employee-indicator | |
| planEmployeeCode | 0..1 | string | Code indicating whether the member is an employee of the health plan or the dependent of an employee of the health plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/plan-employee-code | |
| regionCode | 0..1 | CodeableConcept | Customer-specific code for the geographic region of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/region-code | |
| restrictedBenefits | 0..1 | CodeableConcept | Code of the scope of Medicaid or CHIP benefits for a person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/restricted-benefits | |
| shortTermDisabilityBenefitRate | 0..1 | decimal | Short term disability (STD) benefit rate, expressed as a percentage of base wages or benefit amount (for example, 50.00%, 60.00%, 70.00%) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-disability-benefit-rate | |
| ssiIndicator | 0..1 | string | Indicates if the person receives Supplemental Security Income (SSI) administered via the Social Security Administration (SSA), at the time of coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-indicator | |
| ssiStatus | 0..1 | CodeableConcept | Standard code of the Supplemental Security Income (SSI) status for the person, at the time of coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-status | |
| valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer SSI Status Value Set (extensible) | |
| tanfBenefits | 0..1 | CodeableConcept | Standard code of the Temporary Assistance for Needy Families (TANF) benefits for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/tanf-benefits | |
| valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer TANF Benefit Value Set (extensible) | |
| totalDependentCount | 0..1 | integer | Number of dependents covered by the group health medical plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/total-dependent-count | |
| subscriberIdEncrypted | 0..1 | string | Encrypted identifier of the subscriber or family URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/subscriberId-encrypted | |
| payerRecordPopulationCount | 0..1 | integer | Specifies whether the member should be counted as eligible for the coverage period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-record-population-count | |
| identifier | 0..* | CDMIdentifier | An identifier intended for computation | |
| period | 1..1 | Period | Coverage start and end dates | |
| payor | 1..1 | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | |
 class | ||||
  type | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: Payer Coverage Class Value Set (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| Coverage.extension:benefitStatus.valueCodeableConcept | extensible | HipaaBenefitStatusValueSet (a valid code from HIPAA Benefit Status Codes) |
| Coverage.extension:employeeEducationLevel.valueCodeableConcept | extensible | PayerEducationLevelValueSet (a valid code from Payer Education Level Codes) |
| Coverage.extension:employeeGender.valueCodeableConcept | extensible | PayerGenderValueSet (a valid code from Payer Gender Codes) |
| Coverage.extension:employeeJobTitle.valueCodeableConcept | extensible | PayerJobTitleValueSet |
| Coverage.extension:medicareCoverage.valueCodeableConcept | extensible | PayerMedicareCoverageValueSet (a valid code from Payer Medicare Coverage Codes) |
| Coverage.extension:ssiStatus.valueCodeableConcept | extensible | PayerSsiStatusValueSet (a valid code from Payer SSI Status Codes) |
| Coverage.extension:tanfBenefits.valueCodeableConcept | extensible | PayerTanfBenefitValueSet (a valid code from Payer TANF Benefit codes) |
| Coverage.class.type | extensible | PayerCoverageClassValueSet |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |
| meta | 0..1 | ProcessMeta | Metadata about a resource | |
 implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| snapshotAgeInMonths | 0..1 | unsignedInt | Age in months at the time of the coverage period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-months | |
| snapshotAgeInYears | 0..1 | unsignedInt | The age of the person in years for the month of eligibility or service URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years | |
| employeeSnapshotAgeInYears | 0..1 | unsignedInt | The age of the employee in years for the month of eligibility or service URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-snapshot-age-in-years | |
| ageGroup | 0..1 | CodeableConcept | Standard code for age groupings URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-group Binding: Age Group Value Set (extensible) | |
| ageGenderGroup | 0..1 | CodeableConcept | Standard code for groupings that combine age and gender URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-gender-group Binding: Age and Gender Group Value Set (extensible) | |
| attributedProviderReferenceWithPeriod | 0..1 | Reference() | Attributed provider reference with period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/attributed-provider-with-period | |
| benefitStatus | 0..1 | CodeableConcept | HIPAA standard code for the benefit status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status | |
 extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status" | |
  Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
 value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: HIPAA Benefit Status Value Set (extensible) | |
| claimGroupIdentifier | 0..1 | string | Group ID of the plan member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-group-identifier | |
| cobraIndicator | 0..1 | string | Indicator of Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cobra-indicator | |
| coverageDays | 0..1 | unsignedInt | Number of covered days of eligibility URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-days | |
| coverageMonth | 0..1 | date | Date which reflects the month of eligibility URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month | |
| coverageInsurancePlan | 0..1 | Reference(InsurancePlan) | Reference to the insurance plan for this coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-insurance-plan | |
| dualEligibilityIndicator | 0..1 | string | Indicator of dual eligibility for the Medicaid market URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/dual-eligibility-indicator | |
| enrollmentPcp | 0..1 | string | Provider identifier of the primary care physician for the plan member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp | |
| enrollmentPcpNameOnEnrollment | 0..1 | string | Original primary care physician (PCP) name as reporting on the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-name-on-enrollment | |
| enrollmentPcpZipOnEnrollment | 0..1 | string | Original primary care physician (PCP) zip as reporting on the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-zip-on-enrollment | |
| employeeAverageScheduledHours | 0..1 | decimal | Average number of hours the employee is scheduled to work per day URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-average-scheduled-hours | |
| employeeBirthDate | 0..1 | date | Birthdate of the employee or contract holder URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-birth-date | |
| employeeCompany | 0..1 | CodeableConcept | Code for the company of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-company | |
| employeeCostCenter | 0..1 | CodeableConcept | Code for the cost center of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-cost-center | |
| employeeCount | 0..1 | unsignedInt | Flag of the employees in the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-count | |
| employeeBusinessUnit | 0..1 | CodeableConcept | Code for the business unit of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-business-unit | |
| employeeDepartment | 0..1 | CodeableConcept | Code for the department of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-department | |
| employeeDivision | 0..1 | CodeableConcept | Code for the division of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-division | |
| employeeExemptIndicator | 0..1 | string | Indicator of whether the employee status is exempt or non-exempt URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-exempt-indicator | |
| employeeFamilySize | 0..1 | integer | Total family size of the employee, whether or not dependents are insured or participating in any programs URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-family-size | |
| employeeFTECount | 0..1 | decimal | Full Time Equivalent calculation for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-fte-count | |
| employeeId | 0..* | Identifier | Identifier for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-id | |
| employeeJobFamily | 0..1 | CodeableConcept | Code for the job family of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-family | |
| employeeJobGrade | 0..1 | CodeableConcept | Code for the job grade of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-grade | |
| employeeJobLocation | 0..* | CodeableConcept | Code for the physical location where the employee works URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-location | |
| employeePayFrequency | 0..1 | CodeableConcept | Code indicating the frequency with which the employee is paid (e.g., daily, weekly, monthly) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-pay-frequency | |
| employeePerformanceRating | 0..1 | CodeableConcept | Code indicating the performance rating of the employee, assigned as of the last review period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-performance-rating | |
| employeeShift | 0..1 | CodeableConcept | Code indicating the regular shift which the employee is scheduled to work URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-shift | |
| employeeSubBusinessUnit | 0..1 | CodeableConcept | Code of the sub business unit of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-sub-business-unit | |
| salaryIndicator | 0..1 | string | Indicator of whether the employee status is salaried URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/salary-indicator | |
| unionWorkerIndicator | 0..1 | string | Indicator that the contract holder (subscriber) belongs to a union URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/union-worker-indicator | |
| employeeEducationLevel | 0..1 | CodeableConcept | Code indicating the highest level of education that the employee has completed URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-education-level | |
| extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-education-level" | |
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Education Level Value Set (extensible) | |
| employeeGender | 0..1 | CodeableConcept | Employee gender code URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-gender | |
| extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-gender" | |
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Gender Value Set (extensible) | |
| employeeHireDate | 0..* | date | First date of employment for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-hire-date | |
| employeeTerminationDate | 0..* | date | Last date of employment for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-date | |
| employeeTerminationReason | 0..* | CodeableConcept | Code indicating the reason for employee termination URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-reason | |
| employeeJobTitle | 0..1 | CodeableConcept | Job title of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-title | |
| extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-title" | |
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Job Title Value Set (extensible) | |
| employeeLaborUnion | 0..1 | CodeableConcept | Code for the labor union of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-labor-union | |
| employeeRetirementDate | 0..1 | date | Date of retirement for the employee or contract holder URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-retirement-date | |
| employeeStatus | 0..1 | CodeableConcept | Status of the employee based on one or more code systems URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-status | |
| employeeUnionId | 0..1 | string | Identification for the labor union member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-union-id | |
| employeeWageAmount | 0..1 | decimal | Wage amount of the employee for the time period represented by the Wage Basis field URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-amount | |
| employeeWageBasis | 0..1 | CodeableConcept | Code indicating the basis on which the wages of the employee are calculated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-basis | |
| employeeYearOfService | 0..1 | unsignedInt | Net credited service in years for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-year-of-service | |
| employer | 0..1 | CodeableConcept | Code for the employer URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employer | |
| familyIncomeLevel | 0..1 | CodeableConcept | Code for the family income level of the person based on the Federal Poverty Level (FPL) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/family-income-level | |
| jobClassCode | 0..1 | CodeableConcept | Classifcation group of the job role of the employee, for example, Top Executives, Post-secondary teachers, and Engineers URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-class-code | |
| jobLocationZipcode | 0..1 | string | 5-digit zip code of the facility where the employee works URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-location-zipcode | |
| longTermDisabilityBenefitRate | 0..1 | decimal | Long term disability (LTD) benefit rate, expressed as a percentage of base wages (for example, 50.00%, 60.00%, 70.00%) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-disability-benefit-rate | |
| medicareCoverage | 0..1 | CodeableConcept | Standard code for the type of Medicare coverage, if any, for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-coverage | |
| extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-coverage" | |
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Medicare Coverage Value Set (extensible) | |
| medicareIndicator | 0..1 | string | Indicator of Medicare coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-indicator | |
| memberEmployeeIndicator | 0..1 | CodeableConcept | Code indicates whether the member is either an employee of the health plan, or the dependent of an employee of the health plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/member-employee-indicator | |
| planEmployeeCode | 0..1 | string | Code indicating whether the member is an employee of the health plan or the dependent of an employee of the health plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/plan-employee-code | |
| regionCode | 0..1 | CodeableConcept | Customer-specific code for the geographic region of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/region-code | |
| restrictedBenefits | 0..1 | CodeableConcept | Code of the scope of Medicaid or CHIP benefits for a person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/restricted-benefits | |
| shortTermDisabilityBenefitRate | 0..1 | decimal | Short term disability (STD) benefit rate, expressed as a percentage of base wages or benefit amount (for example, 50.00%, 60.00%, 70.00%) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-disability-benefit-rate | |
| ssiIndicator | 0..1 | string | Indicates if the person receives Supplemental Security Income (SSI) administered via the Social Security Administration (SSA), at the time of coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-indicator | |
| ssiStatus | 0..1 | CodeableConcept | Standard code of the Supplemental Security Income (SSI) status for the person, at the time of coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-status | |
| extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-status" | |
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer SSI Status Value Set (extensible) | |
| tanfBenefits | 0..1 | CodeableConcept | Standard code of the Temporary Assistance for Needy Families (TANF) benefits for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/tanf-benefits | |
| extension | 0..0 | |||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/tanf-benefits" | |
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer TANF Benefit Value Set (extensible) | |
| totalDependentCount | 0..1 | integer | Number of dependents covered by the group health medical plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/total-dependent-count | |
| subscriberIdEncrypted | 0..1 | string | Encrypted identifier of the subscriber or family URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/subscriberId-encrypted | |
| payerRecordPopulationCount | 0..1 | integer | Specifies whether the member should be counted as eligible for the coverage period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-record-population-count | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | 0..* | CDMIdentifier | An identifier intended for computation | |
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
 beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary |
| period | Σ | 1..1 | Period | Coverage start and end dates |
| payor | Σ | 1..1 | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| Coverage.extension:benefitStatus.value[x]:valueCodeableConcept | extensible | HipaaBenefitStatusValueSet (a valid code from HIPAA Benefit Status Codes) |
| Coverage.extension:employeeEducationLevel.value[x]:valueCodeableConcept | extensible | PayerEducationLevelValueSet (a valid code from Payer Education Level Codes) |
| Coverage.extension:employeeGender.value[x]:valueCodeableConcept | extensible | PayerGenderValueSet (a valid code from Payer Gender Codes) |
| Coverage.extension:employeeJobTitle.value[x]:valueCodeableConcept | extensible | PayerJobTitleValueSet |
| Coverage.extension:medicareCoverage.value[x]:valueCodeableConcept | extensible | PayerMedicareCoverageValueSet (a valid code from Payer Medicare Coverage Codes) |
| Coverage.extension:ssiStatus.value[x]:valueCodeableConcept | extensible | PayerSsiStatusValueSet (a valid code from Payer SSI Status Codes) |
| Coverage.extension:tanfBenefits.value[x]:valueCodeableConcept | extensible | PayerTanfBenefitValueSet (a valid code from Payer TANF Benefit codes) |
| Coverage.status | required | FinancialResourceStatusCodes |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Coverage | 0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | 0..1 | ProcessMeta | Metadata about a resource | |||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| snapshotAgeInMonths | 0..1 | unsignedInt | Age in months at the time of the coverage period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-months | |||||
| snapshotAgeInYears | 0..1 | unsignedInt | The age of the person in years for the month of eligibility or service URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years | |||||
| employeeSnapshotAgeInYears | 0..1 | unsignedInt | The age of the employee in years for the month of eligibility or service URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-snapshot-age-in-years | |||||
| ageGroup | 0..1 | CodeableConcept | Standard code for age groupings URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-group Binding: Age Group Value Set (extensible) | |||||
| ageGenderGroup | 0..1 | CodeableConcept | Standard code for groupings that combine age and gender URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-gender-group Binding: Age and Gender Group Value Set (extensible) | |||||
| attributedProviderReferenceWithPeriod | 0..1 | Reference() | Attributed provider reference with period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/attributed-provider-with-period | |||||
| benefitStatus | 0..1 | CodeableConcept | HIPAA standard code for the benefit status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: HIPAA Benefit Status Value Set (extensible) | |||||
| claimGroupIdentifier | 0..1 | string | Group ID of the plan member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-group-identifier | |||||
| cobraIndicator | 0..1 | string | Indicator of Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cobra-indicator | |||||
| coverageDays | 0..1 | unsignedInt | Number of covered days of eligibility URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-days | |||||
| coverageMonth | 0..1 | date | Date which reflects the month of eligibility URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month | |||||
| coverageInsurancePlan | 0..1 | Reference(InsurancePlan) | Reference to the insurance plan for this coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-insurance-plan | |||||
| dualEligibilityIndicator | 0..1 | string | Indicator of dual eligibility for the Medicaid market URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/dual-eligibility-indicator | |||||
| enrollmentPcp | 0..1 | string | Provider identifier of the primary care physician for the plan member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp | |||||
| enrollmentPcpNameOnEnrollment | 0..1 | string | Original primary care physician (PCP) name as reporting on the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-name-on-enrollment | |||||
| enrollmentPcpZipOnEnrollment | 0..1 | string | Original primary care physician (PCP) zip as reporting on the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-zip-on-enrollment | |||||
| employeeAverageScheduledHours | 0..1 | decimal | Average number of hours the employee is scheduled to work per day URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-average-scheduled-hours | |||||
| employeeBirthDate | 0..1 | date | Birthdate of the employee or contract holder URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-birth-date | |||||
| employeeCompany | 0..1 | CodeableConcept | Code for the company of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-company | |||||
| employeeCostCenter | 0..1 | CodeableConcept | Code for the cost center of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-cost-center | |||||
| employeeCount | 0..1 | unsignedInt | Flag of the employees in the eligibility record URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-count | |||||
| employeeBusinessUnit | 0..1 | CodeableConcept | Code for the business unit of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-business-unit | |||||
| employeeDepartment | 0..1 | CodeableConcept | Code for the department of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-department | |||||
| employeeDivision | 0..1 | CodeableConcept | Code for the division of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-division | |||||
| employeeExemptIndicator | 0..1 | string | Indicator of whether the employee status is exempt or non-exempt URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-exempt-indicator | |||||
| employeeFamilySize | 0..1 | integer | Total family size of the employee, whether or not dependents are insured or participating in any programs URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-family-size | |||||
| employeeFTECount | 0..1 | decimal | Full Time Equivalent calculation for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-fte-count | |||||
| employeeId | 0..* | Identifier | Identifier for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-id | |||||
| employeeJobFamily | 0..1 | CodeableConcept | Code for the job family of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-family | |||||
| employeeJobGrade | 0..1 | CodeableConcept | Code for the job grade of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-grade | |||||
| employeeJobLocation | 0..* | CodeableConcept | Code for the physical location where the employee works URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-location | |||||
| employeePayFrequency | 0..1 | CodeableConcept | Code indicating the frequency with which the employee is paid (e.g., daily, weekly, monthly) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-pay-frequency | |||||
| employeePerformanceRating | 0..1 | CodeableConcept | Code indicating the performance rating of the employee, assigned as of the last review period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-performance-rating | |||||
| employeeShift | 0..1 | CodeableConcept | Code indicating the regular shift which the employee is scheduled to work URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-shift | |||||
| employeeSubBusinessUnit | 0..1 | CodeableConcept | Code of the sub business unit of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-sub-business-unit | |||||
| salaryIndicator | 0..1 | string | Indicator of whether the employee status is salaried URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/salary-indicator | |||||
| unionWorkerIndicator | 0..1 | string | Indicator that the contract holder (subscriber) belongs to a union URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/union-worker-indicator | |||||
| employeeEducationLevel | 0..1 | CodeableConcept | Code indicating the highest level of education that the employee has completed URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-education-level | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-education-level" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Education Level Value Set (extensible) | |||||
| employeeGender | 0..1 | CodeableConcept | Employee gender code URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-gender | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-gender" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Gender Value Set (extensible) | |||||
| employeeHireDate | 0..* | date | First date of employment for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-hire-date | |||||
| employeeTerminationDate | 0..* | date | Last date of employment for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-date | |||||
| employeeTerminationReason | 0..* | CodeableConcept | Code indicating the reason for employee termination URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-reason | |||||
| employeeJobTitle | 0..1 | CodeableConcept | Job title of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-title | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-title" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Job Title Value Set (extensible) | |||||
| employeeLaborUnion | 0..1 | CodeableConcept | Code for the labor union of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-labor-union | |||||
| employeeRetirementDate | 0..1 | date | Date of retirement for the employee or contract holder URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-retirement-date | |||||
| employeeStatus | 0..1 | CodeableConcept | Status of the employee based on one or more code systems URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-status | |||||
| employeeUnionId | 0..1 | string | Identification for the labor union member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-union-id | |||||
| employeeWageAmount | 0..1 | decimal | Wage amount of the employee for the time period represented by the Wage Basis field URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-amount | |||||
| employeeWageBasis | 0..1 | CodeableConcept | Code indicating the basis on which the wages of the employee are calculated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-basis | |||||
| employeeYearOfService | 0..1 | unsignedInt | Net credited service in years for the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-year-of-service | |||||
| employer | 0..1 | CodeableConcept | Code for the employer URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/employer | |||||
| familyIncomeLevel | 0..1 | CodeableConcept | Code for the family income level of the person based on the Federal Poverty Level (FPL) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/family-income-level | |||||
| jobClassCode | 0..1 | CodeableConcept | Classifcation group of the job role of the employee, for example, Top Executives, Post-secondary teachers, and Engineers URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-class-code | |||||
| jobLocationZipcode | 0..1 | string | 5-digit zip code of the facility where the employee works URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-location-zipcode | |||||
| longTermDisabilityBenefitRate | 0..1 | decimal | Long term disability (LTD) benefit rate, expressed as a percentage of base wages (for example, 50.00%, 60.00%, 70.00%) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-disability-benefit-rate | |||||
| medicareCoverage | 0..1 | CodeableConcept | Standard code for the type of Medicare coverage, if any, for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-coverage | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-coverage" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer Medicare Coverage Value Set (extensible) | |||||
| medicareIndicator | 0..1 | string | Indicator of Medicare coverage for the member URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-indicator | |||||
| memberEmployeeIndicator | 0..1 | CodeableConcept | Code indicates whether the member is either an employee of the health plan, or the dependent of an employee of the health plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/member-employee-indicator | |||||
| planEmployeeCode | 0..1 | string | Code indicating whether the member is an employee of the health plan or the dependent of an employee of the health plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/plan-employee-code | |||||
| regionCode | 0..1 | CodeableConcept | Customer-specific code for the geographic region of the employee URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/region-code | |||||
| restrictedBenefits | 0..1 | CodeableConcept | Code of the scope of Medicaid or CHIP benefits for a person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/restricted-benefits | |||||
| shortTermDisabilityBenefitRate | 0..1 | decimal | Short term disability (STD) benefit rate, expressed as a percentage of base wages or benefit amount (for example, 50.00%, 60.00%, 70.00%) URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-disability-benefit-rate | |||||
| ssiIndicator | 0..1 | string | Indicates if the person receives Supplemental Security Income (SSI) administered via the Social Security Administration (SSA), at the time of coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-indicator | |||||
| ssiStatus | 0..1 | CodeableConcept | Standard code of the Supplemental Security Income (SSI) status for the person, at the time of coverage URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-status | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-status" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer SSI Status Value Set (extensible) | |||||
| tanfBenefits | 0..1 | CodeableConcept | Standard code of the Temporary Assistance for Needy Families (TANF) benefits for the person URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/tanf-benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..0 | |||||||
| url | 1..1 | uri | "http://linuxforhealth.org/fhir/cdm/StructureDefinition/tanf-benefits" | |||||
| Slices for value[x] | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |||||
| value[x]:valueCodeableConcept | 0..1 | CodeableConcept | Value of extension Binding: Payer TANF Benefit Value Set (extensible) | |||||
| totalDependentCount | 0..1 | integer | Number of dependents covered by the group health medical plan URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/total-dependent-count | |||||
| subscriberIdEncrypted | 0..1 | string | Encrypted identifier of the subscriber or family URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/subscriberId-encrypted | |||||
| payerRecordPopulationCount | 0..1 | integer | Specifies whether the member should be counted as eligible for the coverage period URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-record-population-count | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 0..* | CDMIdentifier | An identifier intended for computation | |||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | ||||
| policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
| subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
| subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
| beneficiary | Σ | 1..1 | Reference(Patient) | Plan beneficiary | ||||
| dependent | Σ | 0..1 | string | Dependent number | ||||
| relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
| period | Σ | 1..1 | Period | Coverage start and end dates | ||||
| payor | Σ | 1..1 | Reference(Organization | Patient | RelatedPerson) | Issuer of the policy | ||||
| class | 0..* | BackboneElement | Additional coverage classifications | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: Payer Coverage Class Value Set (extensible) | ||||
| value | Σ | 1..1 | string | Value associated with the type | ||||
| name | Σ | 0..1 | string | Human readable description of the type and value | ||||
| order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
| network | Σ | 0..1 | string | Insurer network | ||||
| costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
 value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
| valueQuantity | Quantity(SimpleQuantity) | |||||||
| valueMoney | Money | |||||||
| exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
| period | Σ | 0..1 | Period | The effective period of the exception | ||||
| subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
| contract | 0..* | Reference(Contract) | Contract details | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | ||||
| Coverage.language | preferred | CommonLanguages
| ||||
| Coverage.extension:benefitStatus.value[x]:valueCodeableConcept | extensible | HipaaBenefitStatusValueSet (a valid code from HIPAA Benefit Status Codes) | ||||
| Coverage.extension:employeeEducationLevel.value[x]:valueCodeableConcept | extensible | PayerEducationLevelValueSet (a valid code from Payer Education Level Codes) | ||||
| Coverage.extension:employeeGender.value[x]:valueCodeableConcept | extensible | PayerGenderValueSet (a valid code from Payer Gender Codes) | ||||
| Coverage.extension:employeeJobTitle.value[x]:valueCodeableConcept | extensible | PayerJobTitleValueSet | ||||
| Coverage.extension:medicareCoverage.value[x]:valueCodeableConcept | extensible | PayerMedicareCoverageValueSet (a valid code from Payer Medicare Coverage Codes) | ||||
| Coverage.extension:ssiStatus.value[x]:valueCodeableConcept | extensible | PayerSsiStatusValueSet (a valid code from Payer SSI Status Codes) | ||||
| Coverage.extension:tanfBenefits.value[x]:valueCodeableConcept | extensible | PayerTanfBenefitValueSet (a valid code from Payer TANF Benefit codes) | ||||
| Coverage.status | required | FinancialResourceStatusCodes | ||||
| Coverage.type | preferred | CoverageTypeAndSelf-PayCodes | ||||
| Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
| Coverage.class.type | extensible | PayerCoverageClassValueSet | ||||
| Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
| Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
This structure is derived from Coverage
Summary
Mandatory: 1 element
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron