This page is part of the Argonaut Scheduling Implementation Guide (v1.0.0: Release) based on FHIR R3. This is the current published version in it's permanent home (it will always be available at this URL). 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:
- a status
- a payor
- a plan id and name
The system Must Support if available:
- a Coverage resource ID
- a Subscriber ID
- a Subscriber (in case of dependent)
- type of coverage
- coverage period
Additional Profile specific implementation guidance:
-
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 theRelatedPerson.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
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | |||
id | S | 0..1 | id | |
identifier | S | 0..* | Identifier | |
status | S | 1..1 | code | |
type | S | 0..1 | CodeableConcept | Binding: Coverage Type and Self-Pay Codes (extensible) |
subscriber | S | 0..1 | Reference(US Core Patient Profile | RelatedPerson) | Suscriber (in case dependent is patient) |
subscriberId | S | 0..1 | string | Subscriber ID |
relationship | S | 0..1 | CodeableConcept | Binding: Policyholder Relationship Codes (extensible) |
period | S | 0..1 | Period | |
payor | S | 1..* | Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson) | Payer |
grouping | S | 1..1 | BackboneElement | |
plan | S | 1..1 | string | Plan ID |
planDisplay | S | 1..1 | string | Plan Name |
Documentation for this format |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | I | 0..* | Insurance or medical plan or a payment agreement | |
id | SΣ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the 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: Common Languages (extensible) | |
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | SΣ | 0..* | Identifier | The primary coverage ID |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required) |
type | SΣ | 0..1 | CodeableConcept | Type of coverage such as medical or accident Binding: Coverage Type and Self-Pay Codes (extensible) |
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
subscriber | SΣ | 0..1 | Reference(US Core Patient Profile | RelatedPerson) | Suscriber (in case dependent is patient) |
subscriberId | SΣ | 0..1 | string | Subscriber ID |
beneficiary | Σ | 0..1 | Reference(Patient) | Plan Beneficiary |
relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the Subscriber Binding: Policyholder Relationship Codes (extensible) |
period | SΣ | 0..1 | Period | Coverage start and end dates |
payor | SΣ | 1..* | Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson) | Payer |
grouping | SI | 1..1 | BackboneElement | Additional coverage classifications |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
group | Σ | 0..1 | string | An identifier for the group |
groupDisplay | Σ | 0..1 | string | Display text for an identifier for the group |
subGroup | Σ | 0..1 | string | An identifier for the subsection of the group |
subGroupDisplay | Σ | 0..1 | string | Display text for the subsection of the group |
plan | SΣ | 1..1 | string | Plan ID |
planDisplay | SΣ | 1..1 | string | Plan Name |
subPlan | Σ | 0..1 | string | An identifier for the subsection of the plan |
subPlanDisplay | Σ | 0..1 | string | Display text for the subsection of the plan |
class | Σ | 0..1 | string | An identifier for the class |
classDisplay | Σ | 0..1 | string | Display text for the class |
subClass | Σ | 0..1 | string | An identifier for the subsection of the class |
subClassDisplay | Σ | 0..1 | string | Display text for the subsection of the subclass |
dependent | Σ | 0..1 | string | Dependent number |
sequence | Σ | 0..1 | string | The plan instance or sequence counter |
order | Σ | 0..1 | positiveInt | Relative order of the coverage |
network | Σ | 0..1 | string | Insurer network |
contract | 0..* | Reference(Contract) | Contract details | |
Documentation for this format |
Differential View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | |||
id | S | 0..1 | id | |
identifier | S | 0..* | Identifier | |
status | S | 1..1 | code | |
type | S | 0..1 | CodeableConcept | Binding: Coverage Type and Self-Pay Codes (extensible) |
subscriber | S | 0..1 | Reference(US Core Patient Profile | RelatedPerson) | Suscriber (in case dependent is patient) |
subscriberId | S | 0..1 | string | Subscriber ID |
relationship | S | 0..1 | CodeableConcept | Binding: Policyholder Relationship Codes (extensible) |
period | S | 0..1 | Period | |
payor | S | 1..* | Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson) | Payer |
grouping | S | 1..1 | BackboneElement | |
plan | S | 1..1 | string | Plan ID |
planDisplay | S | 1..1 | string | Plan Name |
Documentation for this format |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | I | 0..* | Insurance or medical plan or a payment agreement | |
id | SΣ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the 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: Common Languages (extensible) | |
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | SΣ | 0..* | Identifier | The primary coverage ID |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required) |
type | SΣ | 0..1 | CodeableConcept | Type of coverage such as medical or accident Binding: Coverage Type and Self-Pay Codes (extensible) |
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy |
subscriber | SΣ | 0..1 | Reference(US Core Patient Profile | RelatedPerson) | Suscriber (in case dependent is patient) |
subscriberId | SΣ | 0..1 | string | Subscriber ID |
beneficiary | Σ | 0..1 | Reference(Patient) | Plan Beneficiary |
relationship | S | 0..1 | CodeableConcept | Beneficiary relationship to the Subscriber Binding: Policyholder Relationship Codes (extensible) |
period | SΣ | 0..1 | Period | Coverage start and end dates |
payor | SΣ | 1..* | Reference(US Core Organization Profile | US Core Patient Profile | RelatedPerson) | Payer |
grouping | SI | 1..1 | BackboneElement | Additional coverage classifications |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
group | Σ | 0..1 | string | An identifier for the group |
groupDisplay | Σ | 0..1 | string | Display text for an identifier for the group |
subGroup | Σ | 0..1 | string | An identifier for the subsection of the group |
subGroupDisplay | Σ | 0..1 | string | Display text for the subsection of the group |
plan | SΣ | 1..1 | string | Plan ID |
planDisplay | SΣ | 1..1 | string | Plan Name |
subPlan | Σ | 0..1 | string | An identifier for the subsection of the plan |
subPlanDisplay | Σ | 0..1 | string | Display text for the subsection of the plan |
class | Σ | 0..1 | string | An identifier for the class |
classDisplay | Σ | 0..1 | string | Display text for the class |
subClass | Σ | 0..1 | string | An identifier for the subsection of the class |
subClassDisplay | Σ | 0..1 | string | Display text for the subsection of the subclass |
dependent | Σ | 0..1 | string | Dependent number |
sequence | Σ | 0..1 | string | The plan instance or sequence counter |
order | Σ | 0..1 | positiveInt | Relative order of the coverage |
network | Σ | 0..1 | string | Insurer network |
contract | 0..* | Reference(Contract) | Contract details | |
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: