2026 US Quality Core Implementation Guide
0.5.0 - release

2026 US Quality Core Implementation Guide - Downloaded Version 0.5.0 See the Directory of published versions

## Resource Profile: US Quality Core Coverage

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-coverage | Version: 0.5.0 | Highlight text changes?
Active as of 2026-06-05 | Computable Name: USQualityCoreCoverage

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 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 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) section of this page.

Usages:

- Examples for this Profile: Coverage/example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage | C | 0..* | USCoreCoverageProfile(6.1.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S Σ | 0..* | Identifier | (USCDI+ Quality) (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
identifier:memberid | S Σ C | 0..1 | Identifier | (USCDI+ Quality) (USCDI) Member ID
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Member Number identifier type Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder | Σ | 0..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | Owner of the policy
subscriberId | S Σ C | 0..1 | string | (USCDI+ Quality) (USCDI) ID assigned to the subscriber
beneficiary | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI+ Quality) (USCDI) Plan beneficiary
relationship | S | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
period | S Σ | 0..1 | Period | (USCDI+ Quality) (USCDI) Coverage start and end dates
payor | S Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | (USCDI+ Quality) (USCDI) Issuer of the policy
Slices for class | S | 0..* | BackboneElement | (USCDI+ Quality) (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices |  |  |  | Content/Rules for all slices
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
class:group | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Group
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Group Identifier
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Human readable description of the type and value
class:plan | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Plan
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Plan Number
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Plan Name
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.identifier:memberid.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Coverage.identifier:memberid.​type | Base | extensible | IdentifierType | 📦4.0.1 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Payer Type | 📦20221118 | VSAC v0.18
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📦4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:group.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:plan.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present | `identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | USCoreCoverageProfile(6.1.0) | Insurance or medical plan or a payment agreement
Slices for identifier |  | 0..* | Identifier | (USCDI+ Quality) (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
identifier:memberid |  | 0..1 | Identifier | (USCDI+ Quality) (USCDI) Member ID
type |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Member Number identifier type
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error
type |  | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder |  | 0..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | Owner of the policy
subscriberId |  | 0..1 | string | (USCDI+ Quality) (USCDI) ID assigned to the subscriber
beneficiary |  | 1..1 | Reference(US Quality Core Patient) | (USCDI+ Quality) (USCDI) Plan beneficiary
relationship |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber
period |  | 0..1 | Period | (USCDI+ Quality) (USCDI) Coverage start and end dates
payor |  | 1..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | (USCDI+ Quality) (USCDI) Issuer of the policy
Slices for class |  | 0..* | BackboneElement | (USCDI+ Quality) (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type
class:group |  | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Group
value |  | 1..1 | string | (USCDI+ Quality) (USCDI) Group Identifier
name |  | 0..1 | string | (USCDI+ Quality) (USCDI) Human readable description of the type and value
class:plan |  | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Plan
value |  | 1..1 | string | (USCDI+ Quality) (USCDI) Plan Number
name |  | 0..1 | string | (USCDI+ Quality) (USCDI) Plan Name
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Coverage.type | Base | extensible | Payer Type | 📦20221118 | VSAC v0.18

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage | C | 0..* | USCoreCoverageProfile(6.1.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15
id | Σ | 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: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S Σ | 0..* | Identifier | (USCDI+ Quality) (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
identifier:memberid | S Σ C | 0..1 | Identifier | (USCDI+ Quality) (USCDI) Member ID
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Member Number identifier type Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ | 0..1 | string | The value that is unique Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder | Σ | 0..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | Owner of the policy
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy
subscriberId | S Σ C | 0..1 | string | (USCDI+ Quality) (USCDI) ID assigned to the subscriber
beneficiary | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI+ Quality) (USCDI) Plan beneficiary
dependent | Σ | 0..1 | string | Dependent number
relationship | S | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
period | S Σ | 0..1 | Period | (USCDI+ Quality) (USCDI) Coverage start and end dates
payor | S Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | (USCDI+ Quality) (USCDI) Issuer of the policy
Slices for class | S | 0..* | BackboneElement | (USCDI+ Quality) (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices |  |  |  | Content/Rules for all slices
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
class:group | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Group
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Group Identifier
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Human readable description of the type and value
class:plan | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Plan
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Plan Number
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Plan Name
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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Coverage.identifier:memberid.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Coverage.identifier:memberid.​type | Base | extensible | IdentifierType | 📦4.0.1 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Payer Type | 📦20221118 | VSAC v0.18
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📦4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:group.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:plan.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📦4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present | `identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()`

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Coverage.identifier
- The element 1 is sliced based on the value of Coverage.class

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage | C | 0..* | USCoreCoverageProfile(6.1.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S Σ | 0..* | Identifier | (USCDI+ Quality) (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
identifier:memberid | S Σ C | 0..1 | Identifier | (USCDI+ Quality) (USCDI) Member ID
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Member Number identifier type Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder | Σ | 0..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | Owner of the policy
subscriberId | S Σ C | 0..1 | string | (USCDI+ Quality) (USCDI) ID assigned to the subscriber
beneficiary | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI+ Quality) (USCDI) Plan beneficiary
relationship | S | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
period | S Σ | 0..1 | Period | (USCDI+ Quality) (USCDI) Coverage start and end dates
payor | S Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | (USCDI+ Quality) (USCDI) Issuer of the policy
Slices for class | S | 0..* | BackboneElement | (USCDI+ Quality) (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices |  |  |  | Content/Rules for all slices
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
class:group | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Group
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Group Identifier
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Human readable description of the type and value
class:plan | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Plan
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Plan Number
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Plan Name
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.identifier:memberid.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Coverage.identifier:memberid.​type | Base | extensible | IdentifierType | 📦4.0.1 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Payer Type | 📦20221118 | VSAC v0.18
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📦4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:group.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:plan.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present | `identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | USCoreCoverageProfile(6.1.0) | Insurance or medical plan or a payment agreement
Slices for identifier |  | 0..* | Identifier | (USCDI+ Quality) (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
identifier:memberid |  | 0..1 | Identifier | (USCDI+ Quality) (USCDI) Member ID
type |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Member Number identifier type
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error
type |  | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder |  | 0..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | Owner of the policy
subscriberId |  | 0..1 | string | (USCDI+ Quality) (USCDI) ID assigned to the subscriber
beneficiary |  | 1..1 | Reference(US Quality Core Patient) | (USCDI+ Quality) (USCDI) Plan beneficiary
relationship |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber
period |  | 0..1 | Period | (USCDI+ Quality) (USCDI) Coverage start and end dates
payor |  | 1..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | (USCDI+ Quality) (USCDI) Issuer of the policy
Slices for class |  | 0..* | BackboneElement | (USCDI+ Quality) (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type
class:group |  | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Group
value |  | 1..1 | string | (USCDI+ Quality) (USCDI) Group Identifier
name |  | 0..1 | string | (USCDI+ Quality) (USCDI) Human readable description of the type and value
class:plan |  | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Plan
value |  | 1..1 | string | (USCDI+ Quality) (USCDI) Plan Number
name |  | 0..1 | string | (USCDI+ Quality) (USCDI) Plan Name
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Coverage.type | Base | extensible | Payer Type | 📦20221118 | VSAC v0.18

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage | C | 0..* | USCoreCoverageProfile(6.1.0) | Insurance or medical plan or a payment agreement Constraints: us-core-15
id | Σ | 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: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier | S Σ | 0..* | Identifier | (USCDI+ Quality) (USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type
identifier:memberid | S Σ C | 0..1 | Identifier | (USCDI+ Quality) (USCDI) Member ID
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Member Number identifier type Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: MB
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ | 0..1 | string | The value that is unique Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Coverage category such as medical or accident Binding: Payer Type (extensible): Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
policyHolder | Σ | 0..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | Owner of the policy
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy
subscriberId | S Σ C | 0..1 | string | (USCDI+ Quality) (USCDI) ID assigned to the subscriber
beneficiary | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI+ Quality) (USCDI) Plan beneficiary
dependent | Σ | 0..1 | string | Dependent number
relationship | S | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
period | S Σ | 0..1 | Period | (USCDI+ Quality) (USCDI) Coverage start and end dates
payor | S Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Organization | US Quality Core RelatedPerson) | (USCDI+ Quality) (USCDI) Issuer of the policy
Slices for class | S | 0..* | BackboneElement | (USCDI+ Quality) (USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type
class:All Slices |  |  |  | Content/Rules for all slices
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
class:group | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Group
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: group
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Group Identifier
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Human readable description of the type and value
class:plan | S | 0..1 | BackboneElement | (USCDI+ Quality) (USCDI) Plan
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. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: plan
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
value | S Σ | 1..1 | string | (USCDI+ Quality) (USCDI) Plan Number
name | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Plan Name
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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Coverage.identifier:memberid.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Coverage.identifier:memberid.​type | Base | extensible | IdentifierType | 📦4.0.1 | FHIR Std.
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | extensible | Payer Type | 📦20221118 | VSAC v0.18
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📦4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:group.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.class:plan.​type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📦4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-15 | error | Coverage | Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present | `identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()`

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Coverage.identifier
- The element 1 is sliced based on the value of Coverage.class

Other representations of profile: CSV, Excel, Schematron

### Notes:

#### CQL Authoring Usage (Informational)

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