CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
2.0.0-cibuild - Release 2 ci-build United States of America flag

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v2.0.0-cibuild) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: ACH Monthly Event Coverage

Official URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-monthly-coverage Version: 2.0.0-cibuild
Standards status: Trial-use Maturity Level: 1 Computable Name: AcuteCareHospitalMonthlyReportingCoverage

This profile contains Required and Must Support data elements for reporting coverage information to the NHSN Acute Care Hospital (ACH) Monthly Digital Quality Measure. This profile inherits from the QI Core 6.0.0 Coverage profile, which inherits from the US Core 6.1.0 Coverage profile.

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 1.0.0:

  • New Content

    • Formal Views of Profile Content

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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Coverage C 0..* QICoreCoverage(6.0.0) Insurance or medical plan or a payment agreement
    Constraints: us-core-15
    ... id Σ 1..1 id Logical id of this artifact
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    .... identifier:memberid SΣC 0..1 Identifier (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 SΣ 1..1 CodeableConcept (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 ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type SΣ 0..1 CodeableConcept (QI-Core)(USCDI) Coverage category such as medical or accident
    Binding: PayerType (20250419) . (extensible)
    ... subscriberId SΣC 0..1 string (QI-Core)(USCDI) ID assigned to the subscriber
    ... beneficiary SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) Plan beneficiary
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
    Binding: SubscriberRelationshipCodes (extensible)
    ... period SΣ 0..1 Period (QI-Core)(USCDI) Coverage start and end dates
    ... payor SΣ 1..1 Reference(QICore Patient | QICore Organization | QICore RelatedPerson) (QI-Core)(USCDI) Issuer of the policy
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... Slices for class S 0..* BackboneElement (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) 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 SΣ 1..1 string (USCDI) Group Number
    ..... name SΣ 0..1 string (USCDI) Group Name
    .... class:plan S 0..1 BackboneElement (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 SΣ 1..1 string (USCDI) Plan Number
    ..... name SΣ 0..1 string (USCDI) Plan Name

    doco 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 . 📍20250419 VSAC v0.22
    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()

    This structure is derived from QICoreCoverage

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Coverage 0..* QICoreCoverage(6.0.0) Insurance or medical plan or a payment agreement
    ... id 1..1 id Logical id of this artifact
    ... meta
    .... Slices for extension Content/Rules for all slices
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    ... type 0..1 CodeableConcept (QI-Core)(USCDI) Coverage category such as medical or accident
    Binding: PayerType (20250419) . (extensible)
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    ... payor
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Coverage.type Base extensible Payer Type . 📍20250419 VSAC v0.22
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Coverage C 0..* QICoreCoverage(6.0.0) Insurance or medical plan or a payment agreement
    Constraints: us-core-15
    ... id Σ 1..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    .... versionId Σ 0..1 id Version specific identifier
    .... lastUpdated Σ 0..1 instant When the resource version last changed
    .... source Σ 0..1 uri Identifies where the resource comes from
    .... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
    .... security Σ 0..* Coding Security Labels applied to this resource
    Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
    .... tag Σ 0..* Coding Tags applied to this resource
    Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... 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 SΣ 0..* Identifier (USCDI) Member ID and other identifiers
    Slice: Unordered, Open by pattern:type
    .... identifier:memberid SΣC 0..1 Identifier (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 SΣ 1..1 CodeableConcept (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 ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type SΣ 0..1 CodeableConcept (QI-Core)(USCDI) Coverage category such as medical or accident
    Binding: PayerType (20250419) . (extensible)
    ... policyHolder Σ 0..1 Reference(QICore Patient | QICore Organization | QICore RelatedPerson) (QI-Core) Owner of the policy
    ... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
    ... subscriberId SΣC 0..1 string (QI-Core)(USCDI) ID assigned to the subscriber
    ... beneficiary SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) 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 SΣC 1..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
    .... display Σ 0..1 string Text alternative for the resource
    ... dependent Σ 0..1 string Dependent number
    ... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
    Binding: SubscriberRelationshipCodes (extensible)
    ... period SΣ 0..1 Period (QI-Core)(USCDI) Coverage start and end dates
    ... payor SΣ 1..1 Reference(QICore Patient | QICore Organization | QICore RelatedPerson) (QI-Core)(USCDI) 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 SΣC 1..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
    .... display Σ 0..1 string Text alternative for the resource
    ... Slices for class S 0..* BackboneElement (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) 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 SΣ 1..1 string (USCDI) Group Number
    ..... name SΣ 0..1 string (USCDI) Group Name
    .... class:plan S 0..1 BackboneElement (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 SΣ 1..1 string (USCDI) Plan Number
    ..... name SΣ 0..1 string (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

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
    Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
    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 . 📍20250419 VSAC v0.22
    Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
    Coverage.payor.type Base extensible ResourceType 📍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()

    This structure is derived from QICoreCoverage

    Summary

    Mandatory: 3 elements
    Must-Support: 2 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Maturity: 1

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Coverage C 0..* QICoreCoverage(6.0.0) Insurance or medical plan or a payment agreement
    Constraints: us-core-15
    ... id Σ 1..1 id Logical id of this artifact
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    .... identifier:memberid SΣC 0..1 Identifier (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 SΣ 1..1 CodeableConcept (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 ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type SΣ 0..1 CodeableConcept (QI-Core)(USCDI) Coverage category such as medical or accident
    Binding: PayerType (20250419) . (extensible)
    ... subscriberId SΣC 0..1 string (QI-Core)(USCDI) ID assigned to the subscriber
    ... beneficiary SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) Plan beneficiary
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
    Binding: SubscriberRelationshipCodes (extensible)
    ... period SΣ 0..1 Period (QI-Core)(USCDI) Coverage start and end dates
    ... payor SΣ 1..1 Reference(QICore Patient | QICore Organization | QICore RelatedPerson) (QI-Core)(USCDI) Issuer of the policy
    .... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
    ... Slices for class S 0..* BackboneElement (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) 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 SΣ 1..1 string (USCDI) Group Number
    ..... name SΣ 0..1 string (USCDI) Group Name
    .... class:plan S 0..1 BackboneElement (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 SΣ 1..1 string (USCDI) Plan Number
    ..... name SΣ 0..1 string (USCDI) Plan Name

    doco 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 . 📍20250419 VSAC v0.22
    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

    This structure is derived from QICoreCoverage

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Coverage 0..* QICoreCoverage(6.0.0) Insurance or medical plan or a payment agreement
    ... id 1..1 id Logical id of this artifact
    ... meta
    .... Slices for extension Content/Rules for all slices
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    ... type 0..1 CodeableConcept (QI-Core)(USCDI) Coverage category such as medical or accident
    Binding: PayerType (20250419) . (extensible)
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL
    ... payor
    .... reference S 1..1 string Literal reference, Relative, internal or absolute URL

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Coverage.type Base extensible Payer Type . 📍20250419 VSAC v0.22

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Coverage C 0..* QICoreCoverage(6.0.0) Insurance or medical plan or a payment agreement
    Constraints: us-core-15
    ... id Σ 1..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... extension:link-received-date-extension 0..1 dateTime Received Date
    URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
    .... versionId Σ 0..1 id Version specific identifier
    .... lastUpdated Σ 0..1 instant When the resource version last changed
    .... source Σ 0..1 uri Identifies where the resource comes from
    .... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
    .... security Σ 0..* Coding Security Labels applied to this resource
    Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
    .... tag Σ 0..* Coding Tags applied to this resource
    Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... 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 SΣ 0..* Identifier (USCDI) Member ID and other identifiers
    Slice: Unordered, Open by pattern:type
    .... identifier:memberid SΣC 0..1 Identifier (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 SΣ 1..1 CodeableConcept (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 ?!SΣ 1..1 code (USCDI) active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type SΣ 0..1 CodeableConcept (QI-Core)(USCDI) Coverage category such as medical or accident
    Binding: PayerType (20250419) . (extensible)
    ... policyHolder Σ 0..1 Reference(QICore Patient | QICore Organization | QICore RelatedPerson) (QI-Core) Owner of the policy
    ... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
    ... subscriberId SΣC 0..1 string (QI-Core)(USCDI) ID assigned to the subscriber
    ... beneficiary SΣ 1..1 Reference(Cross-Measure Patient Profile) (QI-Core)(USCDI) 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 SΣC 1..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
    .... display Σ 0..1 string Text alternative for the resource
    ... dependent Σ 0..1 string Dependent number
    ... relationship S 1..1 CodeableConcept (USCDI) Beneficiary relationship to the subscriber
    Binding: SubscriberRelationshipCodes (extensible)
    ... period SΣ 0..1 Period (QI-Core)(USCDI) Coverage start and end dates
    ... payor SΣ 1..1 Reference(QICore Patient | QICore Organization | QICore RelatedPerson) (QI-Core)(USCDI) 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 SΣC 1..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
    .... display Σ 0..1 string Text alternative for the resource
    ... Slices for class S 0..* BackboneElement (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) 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 SΣ 1..1 string (USCDI) Group Number
    ..... name SΣ 0..1 string (USCDI) Group Name
    .... class:plan S 0..1 BackboneElement (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 SΣ 1..1 string (USCDI) Plan Number
    ..... name SΣ 0..1 string (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

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
    Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
    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 . 📍20250419 VSAC v0.22
    Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
    Coverage.payor.type Base extensible ResourceType 📍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()

    This structure is derived from QICoreCoverage

    Summary

    Mandatory: 3 elements
    Must-Support: 2 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Maturity: 1

     

    Other representations of profile: CSV, Excel, Schematron