# US Quality Core Coverage - 2026 US Quality Core Implementation Guide v0.5.0

## Resource Profile: US Quality Core Coverage 

 
Profile of Coverage for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors. 

### USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V1 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V1 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the [Must Support](must-support.md) section of this guide for more information. These elements are tagged as (USCDI+ Quality) in the formal profile views.

**USCDI+ Quality Elements:**

* identifier: (USCDI+ Quality) (USCDI) Member ID and other identifiers
* identifier:memberid: (USCDI+ Quality) (USCDI) Member ID
* identifier:memberid.type: (USCDI+ Quality) (USCDI) Member Number identifier type
* status: (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error
* type: (USCDI+ Quality) (USCDI) Coverage category such as medical or accident
* subscriberId: (USCDI+ Quality) (USCDI) ID assigned to the subscriber
* beneficiary: (USCDI+ Quality) (USCDI) Plan beneficiary
* relationship: (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber
* period: (USCDI+ Quality) (USCDI) Coverage start and end dates
* payor: (USCDI+ Quality) (USCDI) Issuer of the policy
* class: (USCDI+ Quality) (USCDI) Additional coverage classifications
* class:group: (USCDI+ Quality) (USCDI) Group
* class:group.value: (USCDI+ Quality) (USCDI) Group Identifier
* class:group.name: (USCDI+ Quality) (USCDI) Human readable description of the type and value
* class:plan: (USCDI+ Quality) (USCDI) Plan
* class:plan.value: (USCDI+ Quality) (USCDI) Plan Number
* class:plan.name: (USCDI+ Quality) (USCDI) Plan Name

Because this profile is derived from US Core, systems are also expected to support Must Support requirements and (USCDI) tagged elements inherited from US Core. The [Formal Views](#profile) section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

### Profile Specific Implementation Guidance

Additional informational guidance for authoring CQL using this profile is provided in the [CQL Authoring Usage (Informational)](#cql-authoring-usage-informational) section of this page.

**Usages:**

* Examples for this Profile: [Coverage/example](Coverage-example.md)
* CapabilityStatements using this Profile: [US Quality Core Client CapabilityStatement](CapabilityStatement-us-quality-core-client.md) and [US Quality Core Server CapabilityStatement](CapabilityStatement-us-quality-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/fhir.onc.us-quality-core|current/StructureDefinition/StructureDefinition-us-quality-core-coverage.json)

### Formal Views of Profile Content

 [Description Differentials, Snapshots, and other representations](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](../StructureDefinition-us-quality-core-coverage.csv), [Excel](../StructureDefinition-us-quality-core-coverage.xlsx), [Schematron](../StructureDefinition-us-quality-core-coverage.sch) 

### Notes:

#### CQL Authoring Usage (Informational)

```
define "SDE Payer":
  [Coverage: type in "Payer"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

```



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-quality-core-coverage",
  "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-coverage",
  "version" : "0.5.0",
  "name" : "USQualityCoreCoverage",
  "title" : "US Quality Core Coverage",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-06-05",
  "publisher" : "Office of the National Coordinator for Health Information Technology (ONC)",
  "contact" : [{
    "name" : "Office of the National Coordinator for Health Information Technology (ONC)",
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.healthit.gov/feedback"
    }]
  }],
  "description" : "Profile of Coverage for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }],
    "text" : "USA"
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "cdanetv4",
    "uri" : "http://www.cda-adc.ca/en/services/cdanet/",
    "name" : "Canadian Dental Association eclaims standard"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "cpha3pharm",
    "uri" : "http://www.pharmacists.ca/",
    "name" : "Canadian Pharmacy Associaiton eclaims standard"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Coverage",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|6.1.0",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Coverage",
      "path" : "Coverage"
    },
    {
      "id" : "Coverage.identifier",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.identifier",
      "slicing" : {
        "discriminator" : [{
          "type" : "pattern",
          "path" : "type"
        }],
        "rules" : "open"
      },
      "short" : "(USCDI+ Quality) (USCDI) Member ID and other identifiers"
    },
    {
      "id" : "Coverage.identifier:memberid",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.identifier",
      "sliceName" : "memberid",
      "short" : "(USCDI+ Quality) (USCDI) Member ID"
    },
    {
      "id" : "Coverage.identifier:memberid.type",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.identifier.type",
      "short" : "(USCDI+ Quality) (USCDI) Member Number identifier type"
    },
    {
      "id" : "Coverage.status",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.status",
      "short" : "(USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error"
    },
    {
      "id" : "Coverage.type",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.type",
      "short" : "(USCDI+ Quality) (USCDI) Coverage category such as medical or accident",
      "binding" : {
        "strength" : "extensible",
        "description" : "Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      }
    },
    {
      "id" : "Coverage.policyHolder",
      "path" : "Coverage.policyHolder",
      "short" : "Owner of the policy",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson"]
      }]
    },
    {
      "id" : "Coverage.subscriberId",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.subscriberId",
      "short" : "(USCDI+ Quality) (USCDI) ID assigned to the subscriber",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Coverage.beneficiary",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.beneficiary",
      "short" : "(USCDI+ Quality) (USCDI) Plan beneficiary",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"]
      }]
    },
    {
      "id" : "Coverage.relationship",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.relationship",
      "short" : "(USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber"
    },
    {
      "id" : "Coverage.period",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.period",
      "short" : "(USCDI+ Quality) (USCDI) Coverage start and end dates"
    },
    {
      "id" : "Coverage.payor",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.payor",
      "short" : "(USCDI+ Quality) (USCDI) Issuer of the policy",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson"]
      }]
    },
    {
      "id" : "Coverage.class",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class",
      "slicing" : {
        "discriminator" : [{
          "type" : "pattern",
          "path" : "type"
        }],
        "description" : "Slice based on value pattern",
        "ordered" : false,
        "rules" : "open"
      },
      "short" : "(USCDI+ Quality) (USCDI) Additional coverage classifications"
    },
    {
      "id" : "Coverage.class:group",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class",
      "sliceName" : "group",
      "short" : "(USCDI+ Quality) (USCDI) Group"
    },
    {
      "id" : "Coverage.class:group.value",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class.value",
      "short" : "(USCDI+ Quality) (USCDI) Group Identifier"
    },
    {
      "id" : "Coverage.class:group.name",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class.name",
      "short" : "(USCDI+ Quality) (USCDI) Human readable description of the type and value"
    },
    {
      "id" : "Coverage.class:plan",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class",
      "sliceName" : "plan",
      "short" : "(USCDI+ Quality) (USCDI) Plan"
    },
    {
      "id" : "Coverage.class:plan.value",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class.value",
      "short" : "(USCDI+ Quality) (USCDI) Plan Number"
    },
    {
      "id" : "Coverage.class:plan.name",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Coverage.class.name",
      "short" : "(USCDI+ Quality) (USCDI) Plan Name"
    }]
  }
}

```
