Argo-Scheduling Implementation Guide Release 1.0.0

This page is part of the Argonaut Scheduling Implementation Guide (v1.0.0: Release) based on FHIR R3. This is the current published version. For a full list of available versions, see the Directory of published versions

SD.10 StructureDefinition-argo-coverage

argo-coverage-intro.md file

This profile sets minimum expectations for Coverage resource to update or create patient coverage information for the use in scheduling appointments.

Mandatory Data Elements

Each Coverage must have:

  1. a status
  2. a payor
  3. a plan id and name

The system Must Support if available:

  1. a Coverage resource ID
  2. a Subscriber ID
  3. a Subscriber (in case of dependent)
  4. type of coverage
  5. coverage period

Additional Profile specific implementation guidance:

  1. The Coverage.subscriber element references a Patient resource directly or indirectly through the RelatedPerson resource. If the Patient Id is unknown:

    • Option 1: Patient must be registered and Patient Id fetched before the Coverage interaction.
    • Option 2: Transmit Patient, Coverage and if needed RelatedPerson as a Bundle transaction following the Bundle resource url rules.
    • Option 3: Don’t transmit the subscriber element when subscriber is the patient (in other words, Coverage.relationship = ‘self’). When subscriber is not the patient (in other words, Coverage.relationship != ‘self’), contain the RelatedPerson resource and don’t transmit the RelatedPerson.patient element.

Examples

SD.10.1 Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://fhir.org/guides/argonaut-scheduling/StructureDefinition/argo-coverage

Published on Tue Nov 07 00:00:00 AEDT 2017 as a active by Argonaut Project.

This profile builds on Coverage

Summary

Mandatory: 5 elements
Must-Support: 12 elements

Structures

This structure refers to these other structures:

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*Insurance or medical plan or a payment agreement
... id SΣ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierThe primary coverage ID
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type SΣ0..1CodeableConceptType of coverage such as medical or accident
Binding: Coverage Type and Self-Pay Codes (extensible)
... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber SΣ0..1Reference(US Core Patient Profile | RelatedPerson)Suscriber (in case dependent is patient)
... subscriberId SΣ0..1stringSubscriber ID
... beneficiary Σ0..1Reference(Patient)Plan Beneficiary
... relationship S0..1CodeableConceptBeneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (extensible)
... period SΣ0..1PeriodCoverage start and end dates
... payor SΣ1..*Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson)Payer
... grouping SI1..1BackboneElementAdditional coverage classifications
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... group Σ0..1stringAn identifier for the group
.... groupDisplay Σ0..1stringDisplay text for an identifier for the group
.... subGroup Σ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay Σ0..1stringDisplay text for the subsection of the group
.... plan SΣ1..1stringPlan ID
.... planDisplay SΣ1..1stringPlan Name
.... subPlan Σ0..1stringAn identifier for the subsection of the plan
.... subPlanDisplay Σ0..1stringDisplay text for the subsection of the plan
.... class Σ0..1stringAn identifier for the class
.... classDisplay Σ0..1stringDisplay text for the class
.... subClass Σ0..1stringAn identifier for the subsection of the class
.... subClassDisplay Σ0..1stringDisplay text for the subsection of the subclass
... dependent Σ0..1stringDependent number
... sequence Σ0..1stringThe plan instance or sequence counter
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Summary

Mandatory: 5 elements
Must-Support: 12 elements

Structures

This structure refers to these other structures:

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage I0..*Insurance or medical plan or a payment agreement
... id SΣ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ0..*IdentifierThe primary coverage ID
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type SΣ0..1CodeableConceptType of coverage such as medical or accident
Binding: Coverage Type and Self-Pay Codes (extensible)
... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber SΣ0..1Reference(US Core Patient Profile | RelatedPerson)Suscriber (in case dependent is patient)
... subscriberId SΣ0..1stringSubscriber ID
... beneficiary Σ0..1Reference(Patient)Plan Beneficiary
... relationship S0..1CodeableConceptBeneficiary relationship to the Subscriber
Binding: Policyholder Relationship Codes (extensible)
... period SΣ0..1PeriodCoverage start and end dates
... payor SΣ1..*Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson)Payer
... grouping SI1..1BackboneElementAdditional coverage classifications
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... group Σ0..1stringAn identifier for the group
.... groupDisplay Σ0..1stringDisplay text for an identifier for the group
.... subGroup Σ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay Σ0..1stringDisplay text for the subsection of the group
.... plan SΣ1..1stringPlan ID
.... planDisplay SΣ1..1stringPlan Name
.... subPlan Σ0..1stringAn identifier for the subsection of the plan
.... subPlanDisplay Σ0..1stringDisplay text for the subsection of the plan
.... class Σ0..1stringAn identifier for the class
.... classDisplay Σ0..1stringDisplay text for the class
.... subClass Σ0..1stringAn identifier for the subsection of the class
.... subClassDisplay Σ0..1stringDisplay text for the subsection of the subclass
... dependent Σ0..1stringDependent number
... sequence Σ0..1stringThe plan instance or sequence counter
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringInsurer network
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron

 

SD.10.2 Quick Start

Below is an overview of the required set of RESTful FHIR interactions - for example, search and read operations - for this profile. See the Conformance requirements for a complete list of supported RESTful interactions for this IG.

Patient and Provider based Scheduling: