| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
Coverage
|
Coverage | |||
Slices for identifier
|
S |
Member ID and other identifiers
Slice: Unordered, Open by pattern:type |
||
identifier:memberid
|
S | 0..1 | Member ID assigned by health plan | |
type
|
1.. |
Member Number identifier type Required Pattern: At least the following |
||
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: MB |
|
|
subscriberId
|
S | ID assigned to the subscriber by the health plan | ||
|
payor
|
S | |||
|
Slices for class
|
S | 0 .. * |
Pharmacy coverage identifiers
Slice: Unordered, Open by value:type |
|
class:All Slices
|
Content/Rules for all slices | |||
type
|
Binding:
Coverage Class Codes
( extensible
): Coverage Class Codes |
|||
|
class:bin
|
S | ..1 | IIN (BIN) number | |
|
type
|
1..1 | Required Pattern: At least the following | ||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: rxbin |
|
|
class:pcn
|
S | ..1 | Processor Control Number (PCN) | |
|
type
|
1..1 | Required Pattern: At least the following | ||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: rxpcn |
|
|
class:rxgroup-id
|
S | ..1 | Pharmacy Benefit Group ID | |
|
type
|
1..1 | Required Pattern: At least the following | ||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: rxgroup |
|
|
class:pbm-member-id
|
S | ..1 | Member ID assigned by the pharmacy benefit manager (PBM) | |
|
type
|
1..1 | Required Pattern: At least the following | ||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: rxid |
|
|
Documentation for this format
|
||||