LTC Monthly Event Coverage - CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG v2.0.0-cibuild

Logical id of this artifact

Meta

Metadata about the resource

id

0..1

Unique id for inter-element referencing

Slices for extension

0..*

extension:link-received-date-extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

0..1

dateTime

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

versionId

Σ

0..1

Version specific identifier

lastUpdated

Σ

0..1

instant

When the resource version last changed

source

Σ

0..1

canonical(StructureDefinition)

Identifies where the resource comes from

profile

Σ

0..*

Profiles this resource claims to conform to

security

Σ

0..*

Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.

tag

Σ

0..*

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

A set of rules under which this content was created

language

0..1

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

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

0..*

Additional content defined by implementations

?!

0..*

Extensions that cannot be ignored

Slices for identifier

SΣ

0..*

(USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type

identifier:memberid

SΣC

0..1

(USCDI) Member ID

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

use

?!Σ

0..1

usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

SΣ

1..1

(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

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: MB

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

Σ

0..1

The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient

Σ

0..1

The value that is unique
Example General: 123456

Σ

0..1

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

(USCDI) active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

SΣ

0..1

(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

SΣ

0..1

Reference(Patient | RelatedPerson)

Subscriber to the policy

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

reference

SΣC

1..1

Literal reference, Relative, internal or absolute URL

Σ

0..1

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

Logical reference, when literal reference is not known

Σ

0..1

Text alternative for the resource

subscriberId

SΣC

0..1

Reference(QICore Patient)

(QI-Core)(USCDI) ID assigned to the subscriber

beneficiary

SΣ

1..1

(QI-Core)(USCDI) Plan beneficiary

dependent

Σ

0..1

Dependent number

relationship

S

1..1

(USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible)

SΣ

0..1

(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

Slices for class

S

0..*

(USCDI) Additional coverage classifications
Slice: Unordered, Open by pattern:type

class:All Slices

Content/Rules for all slices

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

Σ

1..1

Value associated with the type

Σ

0..1

Human readable description of the type and value

class:group

S

0..1

(USCDI) Group

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

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

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: group

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

SΣ

1..1

(USCDI) Group Number

SΣ

0..1

(USCDI) Group Name

class:plan

S

0..1

(USCDI) Plan

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

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

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: plan

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

SΣ

1..1

(USCDI) Plan Number

SΣ

0..1

(USCDI) Plan Name

order

Σ

0..1

positiveInt

Relative order of the coverage

network

Σ

0..1

Insurer network

costToBeneficiary

0..*

Patient payments for services/products

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

0..1

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..*

Exceptions for patient payments

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

Σ

0..1

The effective period of the exception

subrogation

0..1

Documentation for this format

Reimbursement to insurer

contract

0..*

Reference(Contract)

Contract details

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.subscriber.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📦4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.
Coverage.class:group.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.
Coverage.class:plan.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.type	Base	extensible	Coverage Copay Type Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.exception.type	Base	example	Example Coverage Financial Exception Codes	📦4.0.1	FHIR Std.

Constraints

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

This structure is derived from QICoreCoverage

Summary

Mandatory: 1 element(1 nested mandatory element)
Must-Support: 2 elements

Extensions

This structure refers to these extensions:

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

Maturity: 1

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
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
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
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)
subscriber	SΣ	0..1	Reference(Patient \| RelatedPerson)	Subscriber to the policy
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
subscriberId	SΣC	0..1	string	(QI-Core)(USCDI) ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(QICore Patient)	(QI-Core)(USCDI) Plan beneficiary
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
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
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
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)
subscriber	S	0..1	Reference(Patient \| RelatedPerson)	Subscriber to the policy
reference	S	1..1	string	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

Description & Constraints Filter: Filters

Coverage

C

0..*

QICoreCoverage(6.0.0)

Insurance or medical plan or a payment agreement
Constraints: us-core-15

id

Σ

1..1

Logical id of this artifact

Meta

Metadata about the resource

id

0..1

Unique id for inter-element referencing

Slices for extension

0..*

extension:link-received-date-extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

0..1

dateTime

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

versionId

Σ

0..1

Version specific identifier

lastUpdated

Σ

0..1

instant

When the resource version last changed

source

Σ

0..1

canonical(StructureDefinition)

Identifies where the resource comes from

profile

Σ

0..*

Profiles this resource claims to conform to

security

Σ

0..*

Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.

tag

Σ

0..*

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

A set of rules under which this content was created

language

0..1

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

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

0..*

Additional content defined by implementations

?!

0..*

Extensions that cannot be ignored

Slices for identifier

SΣ

0..*

(USCDI) Member ID and other identifiers
Slice: Unordered, Open by pattern:type

identifier:memberid

SΣC

0..1

(USCDI) Member ID

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

use

?!Σ

0..1

usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

SΣ

1..1

(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

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: MB

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

Σ

0..1

The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient

Σ

0..1

The value that is unique
Example General: 123456

Σ

0..1

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

(USCDI) active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

SΣ

0..1

(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

SΣ

0..1

Reference(Patient | RelatedPerson)

Subscriber to the policy

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

reference

SΣC

1..1

Literal reference, Relative, internal or absolute URL

Σ

0..1

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

Logical reference, when literal reference is not known

Σ

0..1

Text alternative for the resource

subscriberId

SΣC

0..1

Reference(QICore Patient)

(QI-Core)(USCDI) ID assigned to the subscriber

beneficiary

SΣ

1..1

(QI-Core)(USCDI) Plan beneficiary

dependent

Σ

0..1

Dependent number

relationship

S

1..1

(USCDI) Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible)

SΣ

0..1

(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

Slices for class

S

0..*

(USCDI) Additional coverage classifications
Slice: Unordered, Open by pattern:type

class:All Slices

Content/Rules for all slices

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

Σ

1..1

Value associated with the type

Σ

0..1

Human readable description of the type and value

class:group

S

0..1

(USCDI) Group

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

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

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: group

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

SΣ

1..1

(USCDI) Group Number

SΣ

0..1

(USCDI) Group Name

class:plan

S

0..1

(USCDI) Plan

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

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

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: plan

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

SΣ

1..1

(USCDI) Plan Number

SΣ

0..1

(USCDI) Plan Name

order

Σ

0..1

positiveInt

Relative order of the coverage

network

Σ

0..1

Insurer network

costToBeneficiary

0..*

Patient payments for services/products

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

0..1

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..*

Exceptions for patient payments

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

Σ

0..1

The effective period of the exception

subrogation

0..1