HRSA 2023 Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+) FHIR IG
1.1.0 - STU1 Release 1.1 - Standard for Trial-Use International flag

This page is part of the HRSA Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+ or uds-plus) FHIR IG (v1.1.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: DeIdentified UDS Plus Coverage

Official URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-coverage Version: 1.1.0
Standards status: Trial-use Maturity Level: 2 Computable Name: DeIdentifiedUDSPlusCoverage

The UDS+ profile establishes the core elements, extensions, vocabularies and value sets for representing Coverage for UDS+ program.

Introduction

This profile is used to represent de-identified Coverage information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes Coverage.period.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Coverage resource text element may contain information such as the Coverage date, beneficiary information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original Coverage resource id should not be included in the De-identified Coverage instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original Coverage. All resource references to the Coverage submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

  • beneficiary
  • Payor

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

  • period

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage UDS Plus Coverage
... id S 0..1 id The de-identified Coverage identifier created by the health center to send data to HRSA.
... text 0..0
... contained 0..0
.... capitatedMemberMonths S 0..1 Quantity Indicates the capitated member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
.... feeForServiceMemberMonths S 0..1 Quantity Indicates the FeeForService member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
... status S 1..1 code active | cancelled | draft | entered-in-error
Fixed Value: active
... type S 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.

... policyHolder
.... display 0..0
... beneficiary S 1..1 Reference(De-Identified UDS Plus Patient) Plan beneficiary
.... display 0..0
... period SC 0..1 Period Coverage start and end dates
uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources.
uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
... payor S 1..* Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) Issuer of the policy
.... display 0..0

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typeextensibleUdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes)
http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes
from this IG

Constraints

IdGradePath(s)DetailsRequirements
uds-plus-cov-1errorCoverage.periodAll Period.start data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2errorCoverage.periodAll Period.emd data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.end.exists() implies $this.end.toString().length() = 4
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage UDS Plus Coverage
... id SΣ 0..1 id The de-identified Coverage identifier created by the health center to send data to HRSA.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... capitatedMemberMonths S 0..1 Quantity Indicates the capitated member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
.... feeForServiceMemberMonths S 0..1 Quantity Indicates the FeeForService member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.

... beneficiary SΣ 1..1 Reference(De-Identified UDS Plus Patient) Plan beneficiary
... period SΣC 0..1 Period Coverage start and end dates
uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources.
uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
... payor SΣ 1..* Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Coverage.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typeextensibleUdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes)
http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
uds-plus-cov-1errorCoverage.periodAll Period.start data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2errorCoverage.periodAll Period.emd data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.end.exists() implies $this.end.toString().length() = 4
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage UDS Plus Coverage
... id SΣ 0..1 id The de-identified Coverage identifier created by the health center to send data to HRSA.
... meta Σ 0..1 Meta Metadata about the 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
.... capitatedMemberMonths S 0..1 Quantity Indicates the capitated member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
.... feeForServiceMemberMonths S 0..1 Quantity Indicates the FeeForService member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(De-Identified UDS Plus Patient) Plan beneficiary
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
... 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 SΣC 0..1 Period Coverage start and end dates
uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources.
uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
... payor SΣ 1..* Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) Issuer of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
... 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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Coverage.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typeextensibleUdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes)
http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes
from this IG
Coverage.policyHolder.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Coverage.beneficiary.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.payor.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
uds-plus-cov-1errorCoverage.periodAll Period.start data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2errorCoverage.periodAll Period.emd data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage UDS Plus Coverage
... id S 0..1 id The de-identified Coverage identifier created by the health center to send data to HRSA.
... text 0..0
... contained 0..0
.... capitatedMemberMonths S 0..1 Quantity Indicates the capitated member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
.... feeForServiceMemberMonths S 0..1 Quantity Indicates the FeeForService member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
... status S 1..1 code active | cancelled | draft | entered-in-error
Fixed Value: active
... type S 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.

... policyHolder
.... display 0..0
... beneficiary S 1..1 Reference(De-Identified UDS Plus Patient) Plan beneficiary
.... display 0..0
... period SC 0..1 Period Coverage start and end dates
uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources.
uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
... payor S 1..* Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) Issuer of the policy
.... display 0..0

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typeextensibleUdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes)
http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes
from this IG

Constraints

IdGradePath(s)DetailsRequirements
uds-plus-cov-1errorCoverage.periodAll Period.start data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2errorCoverage.periodAll Period.emd data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage UDS Plus Coverage
... id SΣ 0..1 id The de-identified Coverage identifier created by the health center to send data to HRSA.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... capitatedMemberMonths S 0..1 Quantity Indicates the capitated member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
.... feeForServiceMemberMonths S 0..1 Quantity Indicates the FeeForService member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.

... beneficiary SΣ 1..1 Reference(De-Identified UDS Plus Patient) Plan beneficiary
... period SΣC 0..1 Period Coverage start and end dates
uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources.
uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
... payor SΣ 1..* Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Coverage.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typeextensibleUdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes)
http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
uds-plus-cov-1errorCoverage.periodAll Period.start data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2errorCoverage.periodAll Period.emd data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage UDS Plus Coverage
... id SΣ 0..1 id The de-identified Coverage identifier created by the health center to send data to HRSA.
... meta Σ 0..1 Meta Metadata about the 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
.... capitatedMemberMonths S 0..1 Quantity Indicates the capitated member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension
.... feeForServiceMemberMonths S 0..1 Quantity Indicates the FeeForService member months of the Patient.
URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(De-Identified UDS Plus Patient) Plan beneficiary
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
... 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 SΣC 0..1 Period Coverage start and end dates
uds-plus-cov-1: All Period.start data elements should be truncated to a year only for de-identified resources.
uds-plus-cov-2: All Period.emd data elements should be truncated to a year only for de-identified resources.
... payor SΣ 1..* Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) Issuer of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
... 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: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Coverage.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typeextensibleUdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes)
http://fhir.org/guides/hrsa/uds-plus/ValueSet/uds-plus-insurance-codes
from this IG
Coverage.policyHolder.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Coverage.beneficiary.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.payor.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf 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-4errorCoverageIf 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-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
uds-plus-cov-1errorCoverage.periodAll Period.start data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-cov-2errorCoverage.periodAll Period.emd data elements should be truncated to a year only for de-identified resources.
: $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

 

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