CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v3.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: ACH Monthly Event Coverage

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:

• Examples for this Profile: Coverage/coverage-example-ach-monthly-pass1, Coverage/coverage-example-ach-monthly-pass2 and Coverage/coverage-example-ach-monthly-pass3

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	QICoreCoverage(6.0.0)	Insurance or medical plan or a payment agreement Constraints: us-core-15
Coverage.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	(NHSN-MS) Logical id of this artifact
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:memberid	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	(USCDI) Member ID
Coverage.Slices for identifier.identifier:memberid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:memberid.type	S This element must be supported. Σ This element is included in summaries.	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
Coverage.Slices for identifier.identifier:memberid.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for identifier.identifier:memberid.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
Coverage.Slices for identifier.identifier:memberid.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for identifier.identifier:memberid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
Coverage.Slices for identifier.identifier:memberid.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for identifier.identifier:memberid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for identifier.identifier:memberid.type.text		0..1	string	Plain text representation of the concept
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(NHSN-MS) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	(NHSN-MS) (QI-Core)(USCDI) Coverage category such as medical or accident Binding: PayerType (20250419) (extensible)
Coverage.subscriberId	S This element must be supported. Σ This element is included in summaries. C	0..1	string	(QI-Core)(USCDI) ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Cross-Measure Patient Profile) {b}	(NHSN-MS) (QI-Core)(USCDI) Plan beneficiary
Coverage.beneficiary.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.relationship	S This element must be supported.	1..1	CodeableConcept	(USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
Coverage.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(NHSN-MS) (QI-Core)(USCDI) Coverage start and end dates
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson) {b}	(NHSN-MS) (QI-Core)(USCDI) Issuer of the policy
Coverage.payor.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.Slices for class	S This element must be supported.	0..*	BackboneElement	(USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for class.class:All Slices				Content/Rules for all slices
Coverage.Slices for class.class:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:All Slices.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.Slices for class.class:All Slices.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.Slices for class.class:group	S This element must be supported.	0..1	BackboneElement	(USCDI) Group
Coverage.Slices for class.class:group.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:group.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:group.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:group.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:group.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:group.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
Coverage.Slices for class.class:group.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:group.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:group.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:group.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Group Number
Coverage.Slices for class.class:group.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(USCDI) Group Name
Coverage.Slices for class.class:plan	S This element must be supported.	0..1	BackboneElement	(USCDI) Plan
Coverage.Slices for class.class:plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:plan.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:plan.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:plan.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:plan.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:plan.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
Coverage.Slices for class.class:plan.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:plan.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:plan.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:plan.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Plan Number
Coverage.Slices for class.class:plan.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(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	📍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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	QICoreCoverage(6.0.0)	Insurance or medical plan or a payment agreement
Coverage.id	S This element must be supported.	1..1	id	(NHSN-MS) Logical id of this artifact
Coverage.meta
Coverage.meta.Slices for extension				Content/Rules for all slices
Coverage.meta.Slices for extension.extension:link-received-date-extension		0..1	dateTime	Received Date URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
Coverage.status		1..1	code	(NHSN-MS)(USCDI) active | cancelled | draft | entered-in-error
Coverage.type		0..1	CodeableConcept	(NHSN-MS)(QI-Core)(USCDI) Coverage category such as medical or accident Binding: PayerType (20250419) (extensible)
Coverage.beneficiary		1..1	Reference(Cross-Measure Patient Profile) {b}	(NHSN-MS)(QI-Core)(USCDI) Plan beneficiary
Coverage.beneficiary.reference	S This element must be supported.	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.period		0..1	Period	(NHSN-MS)(QI-Core)(USCDI) Coverage start and end dates
Coverage.payor		1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson) {b}	(NHSN-MS)(QI-Core)(USCDI) Issuer of the policy
Coverage.payor.reference	S This element must be supported.	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Documentation for this format

Terminology Bindings (Differential)

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	QICoreCoverage(6.0.0)	Insurance or medical plan or a payment agreement Constraints: us-core-15
Coverage.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	(NHSN-MS) Logical id of this artifact
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.meta.id		0..1	string	Unique id for inter-element referencing
Coverage.meta.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.meta.Slices for extension.extension:link-received-date-extension		0..1	dateTime	Received Date URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
Coverage.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
Coverage.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
Coverage.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
Coverage.meta.profile	Σ This element is included in summaries.	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
Coverage.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Coverage.meta.tag	Σ This element is included in summaries.	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".
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.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
Coverage.contained		0..*	Resource	Contained, inline Resources
Coverage.extension		0..*	Extension	Additional content defined by implementations
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:memberid	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	(USCDI) Member ID
Coverage.Slices for identifier.identifier:memberid.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for identifier.identifier:memberid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:memberid.type	S This element must be supported. Σ This element is included in summaries.	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
Coverage.Slices for identifier.identifier:memberid.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for identifier.identifier:memberid.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
Coverage.Slices for identifier.identifier:memberid.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for identifier.identifier:memberid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
Coverage.Slices for identifier.identifier:memberid.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for identifier.identifier:memberid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for identifier.identifier:memberid.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for identifier.identifier:memberid.system	Σ This element is included in summaries.	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
Coverage.Slices for identifier.identifier:memberid.value	Σ This element is included in summaries.	0..1	string	The value that is unique Example General: 123456
Coverage.Slices for identifier.identifier:memberid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Coverage.Slices for identifier.identifier:memberid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(NHSN-MS) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	(NHSN-MS) (QI-Core)(USCDI) Coverage category such as medical or accident Binding: PayerType (20250419) (extensible)
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson)	(QI-Core) Owner of the policy
Coverage.subscriber	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
Coverage.subscriberId	S This element must be supported. Σ This element is included in summaries. C	0..1	string	(QI-Core)(USCDI) ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Cross-Measure Patient Profile) {b}	(NHSN-MS) (QI-Core)(USCDI) Plan beneficiary
Coverage.beneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.beneficiary.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.beneficiary.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.beneficiary.type	Σ This element is included in summaries.	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).
Coverage.beneficiary.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.beneficiary.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship	S This element must be supported.	1..1	CodeableConcept	(USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
Coverage.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(NHSN-MS) (QI-Core)(USCDI) Coverage start and end dates
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson) {b}	(NHSN-MS) (QI-Core)(USCDI) Issuer of the policy
Coverage.payor.id		0..1	string	Unique id for inter-element referencing
Coverage.payor.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.payor.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.payor.type	Σ This element is included in summaries.	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).
Coverage.payor.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.payor.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Coverage.Slices for class	S This element must be supported.	0..*	BackboneElement	(USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for class.class:All Slices				Content/Rules for all slices
Coverage.Slices for class.class:All Slices.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:All Slices.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:All Slices.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.Slices for class.class:All Slices.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.Slices for class.class:All Slices.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.Slices for class.class:group	S This element must be supported.	0..1	BackboneElement	(USCDI) Group
Coverage.Slices for class.class:group.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:group.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:group.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:group.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:group.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:group.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
Coverage.Slices for class.class:group.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:group.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:group.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:group.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Group Number
Coverage.Slices for class.class:group.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(USCDI) Group Name
Coverage.Slices for class.class:plan	S This element must be supported.	0..1	BackboneElement	(USCDI) Plan
Coverage.Slices for class.class:plan.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:plan.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:plan.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:plan.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:plan.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:plan.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
Coverage.Slices for class.class:plan.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:plan.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:plan.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:plan.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Plan Number
Coverage.Slices for class.class:plan.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(USCDI) Plan Name
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
Coverage.costToBeneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type	Σ This element is included in summaries.	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x]	Σ This element is included in summaries.	1..1		The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity			Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney			Money
Coverage.costToBeneficiary.exception		0..*	BackboneElement	Exceptions for patient payments
Coverage.costToBeneficiary.exception.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type	Σ This element is included in summaries.	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period	Σ This element is included in summaries.	0..1	Period	The effective period of the exception
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.contract		0..*	Reference(Contract)	Contract details
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: 3 elements

Structures

This structure refers to these other structures:

• Cross-Measure Patient Profile (http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/cross-measure-patient)
• QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
• QICore Organization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
• QICore RelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)

Extensions

This structure refers to these extensions:

• http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension

Maturity: 2

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	QICoreCoverage(6.0.0)	Insurance or medical plan or a payment agreement Constraints: us-core-15
Coverage.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	(NHSN-MS) Logical id of this artifact
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:memberid	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	(USCDI) Member ID
Coverage.Slices for identifier.identifier:memberid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:memberid.type	S This element must be supported. Σ This element is included in summaries.	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
Coverage.Slices for identifier.identifier:memberid.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for identifier.identifier:memberid.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
Coverage.Slices for identifier.identifier:memberid.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for identifier.identifier:memberid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
Coverage.Slices for identifier.identifier:memberid.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for identifier.identifier:memberid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for identifier.identifier:memberid.type.text		0..1	string	Plain text representation of the concept
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(NHSN-MS) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	(NHSN-MS) (QI-Core)(USCDI) Coverage category such as medical or accident Binding: PayerType (20250419) (extensible)
Coverage.subscriberId	S This element must be supported. Σ This element is included in summaries. C	0..1	string	(QI-Core)(USCDI) ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Cross-Measure Patient Profile) {b}	(NHSN-MS) (QI-Core)(USCDI) Plan beneficiary
Coverage.beneficiary.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.relationship	S This element must be supported.	1..1	CodeableConcept	(USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
Coverage.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(NHSN-MS) (QI-Core)(USCDI) Coverage start and end dates
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson) {b}	(NHSN-MS) (QI-Core)(USCDI) Issuer of the policy
Coverage.payor.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.Slices for class	S This element must be supported.	0..*	BackboneElement	(USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for class.class:All Slices				Content/Rules for all slices
Coverage.Slices for class.class:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:All Slices.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.Slices for class.class:All Slices.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.Slices for class.class:group	S This element must be supported.	0..1	BackboneElement	(USCDI) Group
Coverage.Slices for class.class:group.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:group.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:group.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:group.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:group.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:group.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
Coverage.Slices for class.class:group.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:group.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:group.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:group.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Group Number
Coverage.Slices for class.class:group.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(USCDI) Group Name
Coverage.Slices for class.class:plan	S This element must be supported.	0..1	BackboneElement	(USCDI) Plan
Coverage.Slices for class.class:plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:plan.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:plan.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:plan.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:plan.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:plan.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
Coverage.Slices for class.class:plan.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:plan.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:plan.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:plan.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Plan Number
Coverage.Slices for class.class:plan.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(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	📍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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	QICoreCoverage(6.0.0)	Insurance or medical plan or a payment agreement
Coverage.id	S This element must be supported.	1..1	id	(NHSN-MS) Logical id of this artifact
Coverage.meta
Coverage.meta.Slices for extension				Content/Rules for all slices
Coverage.meta.Slices for extension.extension:link-received-date-extension		0..1	dateTime	Received Date URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
Coverage.status		1..1	code	(NHSN-MS)(USCDI) active | cancelled | draft | entered-in-error
Coverage.type		0..1	CodeableConcept	(NHSN-MS)(QI-Core)(USCDI) Coverage category such as medical or accident Binding: PayerType (20250419) (extensible)
Coverage.beneficiary		1..1	Reference(Cross-Measure Patient Profile) {b}	(NHSN-MS)(QI-Core)(USCDI) Plan beneficiary
Coverage.beneficiary.reference	S This element must be supported.	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.period		0..1	Period	(NHSN-MS)(QI-Core)(USCDI) Coverage start and end dates
Coverage.payor		1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson) {b}	(NHSN-MS)(QI-Core)(USCDI) Issuer of the policy
Coverage.payor.reference	S This element must be supported.	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	QICoreCoverage(6.0.0)	Insurance or medical plan or a payment agreement Constraints: us-core-15
Coverage.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	(NHSN-MS) Logical id of this artifact
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.meta.id		0..1	string	Unique id for inter-element referencing
Coverage.meta.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.meta.Slices for extension.extension:link-received-date-extension		0..1	dateTime	Received Date URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension
Coverage.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
Coverage.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
Coverage.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
Coverage.meta.profile	Σ This element is included in summaries.	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
Coverage.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Coverage.meta.tag	Σ This element is included in summaries.	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".
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.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
Coverage.contained		0..*	Resource	Contained, inline Resources
Coverage.extension		0..*	Extension	Additional content defined by implementations
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..*	Identifier	(USCDI) Member ID and other identifiers Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:memberid	S This element must be supported. Σ This element is included in summaries. C	0..1	Identifier	(USCDI) Member ID
Coverage.Slices for identifier.identifier:memberid.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for identifier.identifier:memberid.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:memberid.type	S This element must be supported. Σ This element is included in summaries.	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
Coverage.Slices for identifier.identifier:memberid.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for identifier.identifier:memberid.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:memberid.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for identifier.identifier:memberid.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
Coverage.Slices for identifier.identifier:memberid.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for identifier.identifier:memberid.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
Coverage.Slices for identifier.identifier:memberid.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for identifier.identifier:memberid.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for identifier.identifier:memberid.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for identifier.identifier:memberid.system	Σ This element is included in summaries.	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
Coverage.Slices for identifier.identifier:memberid.value	Σ This element is included in summaries.	0..1	string	The value that is unique Example General: 123456
Coverage.Slices for identifier.identifier:memberid.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Coverage.Slices for identifier.identifier:memberid.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	(NHSN-MS) (USCDI) active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	(NHSN-MS) (QI-Core)(USCDI) Coverage category such as medical or accident Binding: PayerType (20250419) (extensible)
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson)	(QI-Core) Owner of the policy
Coverage.subscriber	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
Coverage.subscriberId	S This element must be supported. Σ This element is included in summaries. C	0..1	string	(QI-Core)(USCDI) ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Cross-Measure Patient Profile) {b}	(NHSN-MS) (QI-Core)(USCDI) Plan beneficiary
Coverage.beneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.beneficiary.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.beneficiary.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.beneficiary.type	Σ This element is included in summaries.	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).
Coverage.beneficiary.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.beneficiary.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship	S This element must be supported.	1..1	CodeableConcept	(USCDI) Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible)
Coverage.period	S This element must be supported. Σ This element is included in summaries.	0..1	Period	(NHSN-MS) (QI-Core)(USCDI) Coverage start and end dates
Coverage.payor	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(QICore Patient | QICore Organization | QICore RelatedPerson) {b}	(NHSN-MS) (QI-Core)(USCDI) Issuer of the policy
Coverage.payor.id		0..1	string	Unique id for inter-element referencing
Coverage.payor.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.payor.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	(NHSN-MS) Literal reference, Relative, internal or absolute URL
Coverage.payor.type	Σ This element is included in summaries.	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).
Coverage.payor.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.payor.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Coverage.Slices for class	S This element must be supported.	0..*	BackboneElement	(USCDI) Additional coverage classifications Slice: Unordered, Open by pattern:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for class.class:All Slices				Content/Rules for all slices
Coverage.Slices for class.class:All Slices.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:All Slices.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:All Slices.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.Slices for class.class:All Slices.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.Slices for class.class:All Slices.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.Slices for class.class:group	S This element must be supported.	0..1	BackboneElement	(USCDI) Group
Coverage.Slices for class.class:group.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:group.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:group.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:group.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:group.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:group.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:group.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:group.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: group
Coverage.Slices for class.class:group.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:group.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:group.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:group.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Group Number
Coverage.Slices for class.class:group.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(USCDI) Group Name
Coverage.Slices for class.class:plan	S This element must be supported.	0..1	BackboneElement	(USCDI) Plan
Coverage.Slices for class.class:plan.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.Slices for class.class:plan.type	Σ This element is included in summaries.	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
Coverage.Slices for class.class:plan.type.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Coverage.Slices for class.class:plan.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for class.class:plan.type.coding.extension		0..*	Extension	Additional content defined by implementations
Coverage.Slices for class.class:plan.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
Coverage.Slices for class.class:plan.type.coding.version		0..1	string	Version of the system - if relevant
Coverage.Slices for class.class:plan.type.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
Coverage.Slices for class.class:plan.type.coding.display		0..1	string	Representation defined by the system
Coverage.Slices for class.class:plan.type.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for class.class:plan.type.text		0..1	string	Plain text representation of the concept
Coverage.Slices for class.class:plan.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	(USCDI) Plan Number
Coverage.Slices for class.class:plan.name	S This element must be supported. Σ This element is included in summaries.	0..1	string	(USCDI) Plan Name
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
Coverage.costToBeneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type	Σ This element is included in summaries.	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x]	Σ This element is included in summaries.	1..1		The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity			Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney			Money
Coverage.costToBeneficiary.exception		0..*	BackboneElement	Exceptions for patient payments
Coverage.costToBeneficiary.exception.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type	Σ This element is included in summaries.	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period	Σ This element is included in summaries.	0..1	Period	The effective period of the exception
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.contract		0..*	Reference(Contract)	Contract details
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: 3 elements

Structures

This structure refers to these other structures:

• Cross-Measure Patient Profile (http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/cross-measure-patient)
• QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
• QICore Organization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
• QICore RelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)

Extensions

This structure refers to these extensions:

• http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/link-received-date-extension

Maturity: 2