| Active as of 2025-12-17 |
Definitions for the ISiKVersicherungsverhaeltnisGesetzlich resource profile.
Guidance on how to interpret the contents of this table can be foundhere
| 0. Coverage | |
| Definition | Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte. Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment. |
| Short | VersicherungsdatenInsurance or medical plan or a payment agreement |
| Comments | The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. |
| Control | 0..* |
| Is Modifier | false |
| Summary | false |
| Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
| 2. Coverage.implicitRules | |
| Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
| Short | A set of rules under which this content was created |
| Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
| Control | 0..1 |
| Type | uri |
| Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 4. Coverage.modifierExtension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
| Short | Extensions that cannot be ignored |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
| Summary | false |
| Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
| Alternate Names | extensions, user content |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
| 6. Coverage.status | |
| Definition | The status of the resource instance. |
| Short | Statusactive | cancelled | draft | entered-in-error |
| Comments | Zeigt den aktuellen Status der Ressource an.
This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid. |
| Control | 1..1 |
| Binding | The codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)A code specifying the state of the resource instance. |
| Type | code |
| Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 8. Coverage.type | |
| Definition | Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization. |
| Short | VersicherungsartCoverage category such as medical or accident |
| Comments | Die Angabe der Versicherungsart |
| Control | 10..1 |
| Binding | The codes SHALL be taken from The codes SHOULD be taken from VersicherungsartDeBasisVShttp://hl7.org/fhir/ValueSet/coverage-type|4.0.1 (required to http://fhir.de/ValueSet/versicherungsart-de-basis)Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
| Type | CodeableConcept |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Requirements | The order of application of coverages is dependent on the types of coverage. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 10. Coverage.type.coding | |
| Definition | A reference to a code defined by a terminology system. |
| Short | Code defined by a terminology system |
| Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. |
| Control | 10..* |
| Type | Coding |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Requirements | Allows for alternative encodings within a code system, and translations to other code systems. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| Slicing | This element introduces a set of slices on Coverage.type.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 12. Coverage.type.coding:VersicherungsArtDeBasis | |
| Slice Name | VersicherungsArtDeBasis |
| Definition | A reference to a code defined by a terminology system. |
| Short | Codierte Darstellung der VersicherungsartCode defined by a terminology system |
| Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. |
| Control | 10..1* |
| Type | Coding |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Requirements | Allows for alternative encodings within a code system, and translations to other code systems. |
| Pattern Value | { |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 14. Coverage.type.coding:VersicherungsArtDeBasis.system | |
| Definition | The identification of the code system that defines the meaning of the symbol in the code. |
| Short | Codier-SchemaIdentity of the terminology system |
| Comments | Hier ist stets der Wert The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. |
| Control | 10..1 |
| Type | uri |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Requirements | Need to be unambiguous about the source of the definition of the symbol. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 16. Coverage.type.coding:VersicherungsArtDeBasis.code | |
| Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). |
| Short | CodeSymbol in syntax defined by the system |
| Comments | Hier ist stets der Code |
| Control | 10..1 |
| Type | code |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Requirements | Need to refer to a particular code in the system. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 18. Coverage.policyHolder | |
| Definition | The party who 'owns' the insurance policy. |
| Short | Owner of the policy |
| Comments | Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org For example: may be an individual, corporation or the subscriber's employer. |
| Control | 0..01 |
| Type | Reference(Patient, RelatedPerson, Organization, Patient, RelatedPerson, Organization) |
| Is Modifier | false |
| Summary | true |
| Requirements | This provides employer information in the case of Worker's Compensation and other policies. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 20. Coverage.subscriber | |
| Definition | Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due. |
| Short | Hauptversicherte PersonSubscriber to the policy |
| Comments | Die hauptversicherte Person kann der Patient selbst sein, oder (z.B. im Falle einer Familienversicherung) auch ein Angehöriger ( Hinweis: Die Angabe der VersichertenID des Hauptversicherten in May be self or a parent in the case of dependants. |
| Control | 0..1 |
| Type | Reference(Patient, RelatedPerson, Patient, RelatedPerson) |
| Is Modifier | false |
| Must Support | true |
| Must Support Types | No must-support rules about the choice of types/profiles |
| Summary | true |
| Requirements | This is the party who is entitled to the benfits under the policy. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 22. Coverage.subscriber.reference | |
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. |
| Short | Literal reference, Relative, internal or absolute URL |
| Comments | Die Verlinkung auf eine Patienten- oder RelatedPerson-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten/Angehörigen und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. |
| Control | 0..1 This element is affected by the following invariants: ref-1 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 24. Coverage.subscriber.identifier | |
| Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. |
| Short | Lebenslange Krankenversichertennummer der HauptversichertenLogical reference, when literal reference is not known |
| Comments | Die als 'KVZ10' kodierte Versichertennummer ist der 10-stellige,
unveränderbare Teil der Versichertennummer,
der lesbar auf die Elektronische Gesundheitskarte aufgedruckt ist.
Er gilt für alle Krankenversichertennummern,
unabhängig davon, ob es sich um GKV, PKV oder Sonderkostenträger handelt. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 10..1 |
| Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer) |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 26. Coverage.subscriber.identifier.use | |
| Definition | The purpose of this identifier. |
| Short | usual | official | temp | secondary | old (If known) |
| Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
| Control | 0..1 |
| Binding | The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)Identifies the purpose for this identifier, if known . |
| Type | code |
| Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 28. Coverage.subscriber.identifier.type | |
| Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
| Short | Description of identifier |
| Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
| Control | 0..1 |
| Binding | Unless not suitable, these codes SHALL be taken from Identifier Type DeBasis ValueSethttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1 (extensible to http://fhir.de/ValueSet/identifier-type-de-basis)A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| Type | CodeableConcept |
| Is Modifier | false |
| Summary | true |
| Requirements | Allows users to make use of identifiers when the identifier system is not known. |
| Pattern Value | { |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) kvid-2: Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden ( ($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()) |
| 30. Coverage.subscriber.identifier.system | |
| Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. |
| Short | Namensraum der VersichertennummerThe namespace for the identifier value |
| Comments | Hier ist stets der Wert Identifier.system is always case sensitive. |
| Control | 10..1 |
| Type | uri |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. |
| Fixed Value | http://fhir.de/sid/gkv/kvid-10 |
| Example | General: http://www.acme.com/identifiers/patient |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 32. Coverage.subscriber.identifier.value | |
| Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
| Short | Lebenslange KrankenversichertennummerThe value that is unique |
| Comments | Der 10-stellige, unveränderbare Teil der Versichertennummer. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. |
| Control | 10..1 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Example | General: 123456 |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) kvid-1: Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen ( matches('^[A-Z][0-9]{9}$')) |
| 34. Coverage.subscriber.display | |
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. |
| Short | Name des HauptversichertenText alternative for the resource |
| Comments | Begründung MS: Da das die Versichertennummer nicht zur Darstellung für den Anwender geeignet ist, sollte ergänzend der Name des Versicherten angegeben werden. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. |
| Control | 0..1 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 36. Coverage.subscriberId | |
| Definition | The insurer assigned ID for the Subscriber. |
| Short | ID assigned to the subscriber |
| Control | 0..01 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| Requirements | The insurer requires this identifier on correspondance and claims (digital and otherwise). |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 38. Coverage.beneficiary | |
| Definition | Person, auf die sich die Kostenübernahme bezieht (der Patient) The party who benefits from the insurance coverage; the patient when products and/or services are provided. |
| Short | Versicherte PersonPlan beneficiary |
| Comments | Hier handelt es ich konkret um den Patienten, der unter diesem Versicherungsverhältnis behandelt wird. |
| Control | 1..1 |
| Type | Reference(Patient, Patient) |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Requirements | This is the party who receives treatment for which the costs are reimbursed under the coverage. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 40. Coverage.beneficiary.reference | |
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. |
| Short | Patienten-LinkLiteral reference, Relative, internal or absolute URL |
| Comments | Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. |
| Control | 10..1 This element is affected by the following invariants: ref-1 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 42. Coverage.payor | |
| Definition | Versicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. |
| Short | KostenträgerIssuer of the policy |
| Comments | Die Angabe der IK-Nummer in Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations. |
| Control | 1..1* |
| Type | Reference(Organization, Organization, Patient, RelatedPerson) |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Requirements | Need to identify the issuer to target for claim processing and for coordination of benefit processing. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 44. Coverage.payor.identifier | |
| Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. |
| Short | Institutskennzeichern der VersicherungLogical reference, when literal reference is not known |
| Comments | Begründung Pflichtfeld: Als eindeutiger Identifikator der Versicherung ist in vielen Fällen das Institutskennzeichen ausreichend. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 10..1 |
| Type | Identifier(Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR)) |
| Is Modifier | false |
| Must Support | true |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 46. Coverage.payor.identifier.use | |
| Definition | The purpose of this identifier. |
| Short | usual | official | temp | secondary | old (If known) |
| Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
| Control | 0..1 |
| Binding | The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)Identifies the purpose for this identifier, if known . |
| Type | code |
| Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 48. Coverage.payor.identifier.type | |
| Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
| Short | Description of identifier |
| Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
| Control | 0..1 |
| Binding | Unless not suitable, these codes SHALL be taken from Identifier Type DeBasis ValueSethttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1 (extensible to http://fhir.de/ValueSet/identifier-type-de-basis)A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| Type | CodeableConcept |
| Is Modifier | false |
| Summary | true |
| Requirements | Allows users to make use of identifiers when the identifier system is not known. |
| Pattern Value | { |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 50. Coverage.payor.identifier.system | |
| Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. |
| Short | Namensraum der IK-NummerThe namespace for the identifier value |
| Comments | Hier ist stets der Wert Identifier.system is always case sensitive. |
| Control | 10..1 |
| Type | uri |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. |
| Fixed Value | http://fhir.de/sid/arge-ik/iknr |
| Example | General: http://www.acme.com/identifiers/patient |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 52. Coverage.payor.identifier.value | |
| Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
| Short | IK-NummerThe value that is unique |
| Comments | Das Institutskennzeichen der Versicherung If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. |
| Control | 10..1 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Example | General: 123456 |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ik-1: Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein ( matches('^[0-9]{9}$')) |
| 54. Coverage.payor.display | |
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. |
| Short | Name der VersicherungText alternative for the resource |
| Comments | Begründung Pflichtfeld: Da das Institutskennzeichen nicht zur Darstellung für den Anwender geeignet ist, muss ergänzend der Name der Versicherung angegeben werden. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. |
| Control | 10..1 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Must Support | true |
| Summary | true |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 56. Coverage.order | |
| Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. |
| Short | Relative order of the coverage |
| Comments | Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org |
| Control | 0..01 |
| Type | positiveInt |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| Requirements | Used in managing the coordination of benefits. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
| 58. Coverage.network | |
| Definition | Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply. |
| Short | Insurer network |
| Comments | Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org |
| Control | 0..01 |
| Type | string |
| Is Modifier | false |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| Requirements | Used in referral for treatment and in claims processing. |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be foundhere
| 0. Coverage | |
| 2. Coverage.status | |
| Short | Status |
| Comments | Zeigt den aktuellen Status der Ressource an.
|
| Must Support | true |
| 4. Coverage.type | |
| Comments | Die Angabe der Versicherungsart |
| Must Support | true |
| 6. Coverage.type.coding | |
| Control | 1..? |
| Must Support | true |
| Slicing | This element introduces a set of slices on Coverage.type.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 8. Coverage.type.coding:VersicherungsArtDeBasis | |
| Slice Name | VersicherungsArtDeBasis |
| Short | Codierte Darstellung der Versicherungsart |
| Control | 1..1 |
| Must Support | true |
| Pattern Value | { |
| 10. Coverage.type.coding:VersicherungsArtDeBasis.system | |
| Short | Codier-Schema |
| Comments | Hier ist stets der Wert |
| Control | 1..? |
| Must Support | true |
| 12. Coverage.type.coding:VersicherungsArtDeBasis.code | |
| Short | Code |
| Comments | Hier ist stets der Code |
| Control | 1..? |
| Must Support | true |
| 14. Coverage.subscriber | |
| Short | Hauptversicherte Person |
| Comments | Die hauptversicherte Person kann der Patient selbst sein, oder (z.B. im Falle einer Familienversicherung) auch ein Angehöriger ( Hinweis: Die Angabe der VersichertenID des Hauptversicherten in |
| Must Support | true |
| 16. Coverage.subscriber.reference | |
| Comments | Die Verlinkung auf eine Patienten- oder RelatedPerson-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten/Angehörigen und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. |
| Must Support | true |
| 18. Coverage.subscriber.identifier | |
| Short | Lebenslange Krankenversichertennummer der Hauptversicherten |
| Comments | Die als 'KVZ10' kodierte Versichertennummer ist der 10-stellige,
unveränderbare Teil der Versichertennummer,
der lesbar auf die Elektronische Gesundheitskarte aufgedruckt ist.
Er gilt für alle Krankenversichertennummern,
unabhängig davon, ob es sich um GKV, PKV oder Sonderkostenträger handelt. |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 1..? |
| Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer) |
| Must Support | true |
| 20. Coverage.subscriber.identifier.system | |
| Short | Namensraum der Versichertennummer |
| Comments | Hier ist stets der Wert |
| Must Support | true |
| 22. Coverage.subscriber.identifier.value | |
| Short | Lebenslange Krankenversichertennummer |
| Comments | Der 10-stellige, unveränderbare Teil der Versichertennummer. |
| Must Support | true |
| 24. Coverage.subscriber.display | |
| Short | Name des Hauptversicherten |
| Comments | Begründung MS: Da das die Versichertennummer nicht zur Darstellung für den Anwender geeignet ist, sollte ergänzend der Name des Versicherten angegeben werden. |
| Must Support | true |
| 26. Coverage.beneficiary | |
| Short | Versicherte Person |
| Comments | Hier handelt es ich konkret um den Patienten, der unter diesem Versicherungsverhältnis behandelt wird. |
| Must Support | true |
| 28. Coverage.beneficiary.reference | |
| Short | Patienten-Link |
| Comments | Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. |
| Control | 1..? |
| Must Support | true |
| 30. Coverage.payor | |
| Short | Kostenträger |
| Comments | Die Angabe der IK-Nummer in Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird. |
| Control | 0..1 |
| Type | Reference(Organization) |
| Must Support | true |
| 32. Coverage.payor.identifier | |
| Short | Institutskennzeichern der Versicherung |
| Comments | Begründung Pflichtfeld: Als eindeutiger Identifikator der Versicherung ist in vielen Fällen das Institutskennzeichen ausreichend. |
| Note | This is a business identifier, not a resource identifier (see discussion) |
| Control | 1..? |
| Type | Identifier(Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR)) |
| Must Support | true |
| 34. Coverage.payor.identifier.system | |
| Short | Namensraum der IK-Nummer |
| Comments | Hier ist stets der Wert |
| Must Support | true |
| 36. Coverage.payor.identifier.value | |
| Short | IK-Nummer |
| Comments | Das Institutskennzeichen der Versicherung |
| Must Support | true |
| 38. Coverage.payor.display | |
| Short | Name der Versicherung |
| Comments | Begründung Pflichtfeld: Da das Institutskennzeichen nicht zur Darstellung für den Anwender geeignet ist, muss ergänzend der Name der Versicherung angegeben werden. |
| Control | 1..? |
| Must Support | true |
Guidance on how to interpret the contents of this table can be foundhere
| 0. Coverage | |||||
| Definition | Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte. | ||||
| Short | Versicherungsdaten | ||||
| Comments | The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers. | ||||
| Control | 0..* | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty())dom-6: A resource should have narrative for robust management ( text.`div`.exists()) | ||||
| 2. Coverage.id | |||||
| Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
| Short | Logical id of this artifact | ||||
| Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
| Control | 0..1 | ||||
| Type | id | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| 4. Coverage.meta | |||||
| Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
| Short | Metadata about the resource | ||||
| Control | 0..1 | ||||
| Type | Meta | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 6. Coverage.implicitRules | |||||
| Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
| Short | A set of rules under which this content was created | ||||
| Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
| Control | 0..1 | ||||
| Type | uri | ||||
| Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 8. Coverage.language | |||||
| Definition | The base language in which the resource is written. | ||||
| Short | Language of the resource content | ||||
| Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
| Control | 0..1 | ||||
| Binding | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages)A human language.
| ||||
| Type | code | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | false | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 10. Coverage.text | |||||
| Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
| Short | Text summary of the resource, for human interpretation | ||||
| Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
| Control | 0..1 | ||||
| Type | Narrative | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | narrative, html, xhtml, display | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 12. Coverage.contained | |||||
| Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
| Short | Contained, inline Resources | ||||
| Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
| Control | 0..* | ||||
| Type | Resource | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | inline resources, anonymous resources, contained resources | ||||
| 14. Coverage.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 16. Coverage.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
| Short | Extensions that cannot be ignored | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
| Summary | false | ||||
| Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 18. Coverage.identifier | |||||
| Definition | A unique identifier assigned to this coverage. | ||||
| Short | Business Identifier for the coverage | ||||
| Comments | The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..* | ||||
| Type | Identifier | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Allows coverages to be distinguished and referenced. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 20. Coverage.status | |||||
| Definition | The status of the resource instance. | ||||
| Short | Status | ||||
| Comments | Zeigt den aktuellen Status der Ressource an.
| ||||
| Control | 1..1 | ||||
| Binding | The codes SHALL be taken from FinancialResourceStatusCodes (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)A code specifying the state of the resource instance. | ||||
| Type | code | ||||
| Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 22. Coverage.type | |||||
| Definition | Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt | ||||
| Short | Versicherungsart | ||||
| Comments | Die Angabe der Versicherungsart | ||||
| Control | 1..1 | ||||
| Binding | The codes SHALL be taken from VersicherungsartDeBasisVS (required to http://fhir.de/ValueSet/versicherungsart-de-basis)Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | The order of application of coverages is dependent on the types of coverage. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 24. Coverage.type.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 26. Coverage.type.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 28. Coverage.type.coding | |||||
| Definition | A reference to a code defined by a terminology system. | ||||
| Short | Code defined by a terminology system | ||||
| Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. | ||||
| Control | 1..* | ||||
| Type | Coding | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | Allows for alternative encodings within a code system, and translations to other code systems. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| Slicing | This element introduces a set of slices on Coverage.type.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 30. Coverage.type.coding:VersicherungsArtDeBasis | |||||
| Slice Name | VersicherungsArtDeBasis | ||||
| Definition | A reference to a code defined by a terminology system. | ||||
| Short | Codierte Darstellung der Versicherungsart | ||||
| Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. | ||||
| Control | 1..1 | ||||
| Type | Coding | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | Allows for alternative encodings within a code system, and translations to other code systems. | ||||
| Pattern Value | { | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 32. Coverage.type.coding:VersicherungsArtDeBasis.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 34. Coverage.type.coding:VersicherungsArtDeBasis.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 36. Coverage.type.coding:VersicherungsArtDeBasis.system | |||||
| Definition | The identification of the code system that defines the meaning of the symbol in the code. | ||||
| Short | Codier-Schema | ||||
| Comments | Hier ist stets der Wert | ||||
| Control | 1..1 | ||||
| Type | uri | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | Need to be unambiguous about the source of the definition of the symbol. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 38. Coverage.type.coding:VersicherungsArtDeBasis.version | |||||
| Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. | ||||
| Short | Version of the system - if relevant | ||||
| Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. | ||||
| Note | This is a business version Id, not a resource version Id (see discussion) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 40. Coverage.type.coding:VersicherungsArtDeBasis.code | |||||
| Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). | ||||
| Short | Code | ||||
| Comments | Hier ist stets der Code | ||||
| Control | 1..1 | ||||
| Type | code | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | Need to refer to a particular code in the system. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 42. Coverage.type.coding:VersicherungsArtDeBasis.display | |||||
| Definition | A representation of the meaning of the code in the system, following the rules of the system. | ||||
| Short | Representation defined by the system | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 44. Coverage.type.coding:VersicherungsArtDeBasis.userSelected | |||||
| Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). | ||||
| Short | If this coding was chosen directly by the user | ||||
| Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. | ||||
| Control | 0..1 | ||||
| Type | boolean | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 46. Coverage.type.text | |||||
| Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. | ||||
| Short | Plain text representation of the concept | ||||
| Comments | Very often the text is the same as a displayName of one of the codings. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 48. Coverage.policyHolder | |||||
| Definition | The party who 'owns' the insurance policy. | ||||
| Short | Owner of the policy | ||||
| Comments | Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org | ||||
| Control | 0..0 | ||||
| Type | Reference(Patient, RelatedPerson, Organization) | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | This provides employer information in the case of Worker's Compensation and other policies. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 50. Coverage.subscriber | |||||
| Definition | Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung | ||||
| Short | Hauptversicherte Person | ||||
| Comments | Die hauptversicherte Person kann der Patient selbst sein, oder (z.B. im Falle einer Familienversicherung) auch ein Angehöriger ( Hinweis: Die Angabe der VersichertenID des Hauptversicherten in | ||||
| Control | 0..1 | ||||
| Type | Reference(Patient, RelatedPerson) | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Must Support Types | No must-support rules about the choice of types/profiles | ||||
| Summary | true | ||||
| Requirements | This is the party who is entitled to the benfits under the policy. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 52. Coverage.subscriber.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 54. Coverage.subscriber.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.subscriber.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 56. Coverage.subscriber.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Die Verlinkung auf eine Patienten- oder RelatedPerson-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten/Angehörigen und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 58. Coverage.subscriber.type | |||||
| Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
| Short | Type the reference refers to (e.g. "Patient") | ||||
| Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)Aa resource (or, for logical models, the URI of the logical model). | ||||
| Type | uri | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 60. Coverage.subscriber.identifier | |||||
| Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Lebenslange Krankenversichertennummer der Hauptversicherten | ||||
| Comments | Die als 'KVZ10' kodierte Versichertennummer ist der 10-stellige,
unveränderbare Teil der Versichertennummer,
der lesbar auf die Elektronische Gesundheitskarte aufgedruckt ist.
Er gilt für alle Krankenversichertennummern,
unabhängig davon, ob es sich um GKV, PKV oder Sonderkostenträger handelt. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 1..1 | ||||
| Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer) | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 62. Coverage.subscriber.identifier.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 64. Coverage.subscriber.identifier.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.subscriber.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 66. Coverage.subscriber.identifier.use | |||||
| Definition | The purpose of this identifier. | ||||
| Short | usual | official | temp | secondary | old (If known) | ||||
| Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
| Control | 0..1 | ||||
| Binding | The codes SHALL be taken from IdentifierUse (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)Identifies the purpose for this identifier, if known . | ||||
| Type | code | ||||
| Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 68. Coverage.subscriber.identifier.type | |||||
| Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| Short | Description of identifier | ||||
| Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from Identifier Type DeBasis ValueSet (extensible to http://fhir.de/ValueSet/identifier-type-de-basis)A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
| Pattern Value | { | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))kvid-2: Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden ( ($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()) | ||||
| 70. Coverage.subscriber.identifier.system | |||||
| Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
| Short | Namensraum der Versichertennummer | ||||
| Comments | Hier ist stets der Wert | ||||
| Control | 1..1 | ||||
| Type | uri | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
| Fixed Value | http://fhir.de/sid/gkv/kvid-10 | ||||
| Example | General: http://www.acme.com/identifiers/patient | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 72. Coverage.subscriber.identifier.value | |||||
| Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
| Short | Lebenslange Krankenversichertennummer | ||||
| Comments | Der 10-stellige, unveränderbare Teil der Versichertennummer. | ||||
| Control | 1..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Example | General: 123456 | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))kvid-1: Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen ( matches('^[A-Z][0-9]{9}$')) | ||||
| 74. Coverage.subscriber.identifier.period | |||||
| Definition | Time period during which identifier is/was valid for use. | ||||
| Short | Time period when id is/was valid for use | ||||
| Control | 0..1 | ||||
| Type | Period | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 76. Coverage.subscriber.identifier.assigner | |||||
| Definition | Organization that issued/manages the identifier. | ||||
| Short | Organization that issued id (may be just text) | ||||
| Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
| Control | 0..1 | ||||
| Type | Reference(Organization) | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 78. Coverage.subscriber.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Name des Hauptversicherten | ||||
| Comments | Begründung MS: Da das die Versichertennummer nicht zur Darstellung für den Anwender geeignet ist, sollte ergänzend der Name des Versicherten angegeben werden. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 80. Coverage.subscriberId | |||||
| Definition | The insurer assigned ID for the Subscriber. | ||||
| Short | ID assigned to the subscriber | ||||
| Control | 0..0 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | The insurer requires this identifier on correspondance and claims (digital and otherwise). | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 82. Coverage.beneficiary | |||||
| Definition | Person, auf die sich die Kostenübernahme bezieht (der Patient) | ||||
| Short | Versicherte Person | ||||
| Comments | Hier handelt es ich konkret um den Patienten, der unter diesem Versicherungsverhältnis behandelt wird. | ||||
| Control | 1..1 | ||||
| Type | Reference(Patient) | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | This is the party who receives treatment for which the costs are reimbursed under the coverage. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 84. Coverage.beneficiary.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 86. Coverage.beneficiary.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.beneficiary.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 88. Coverage.beneficiary.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Patienten-Link | ||||
| Comments | Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. | ||||
| Control | 1..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 90. Coverage.beneficiary.type | |||||
| Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
| Short | Type the reference refers to (e.g. "Patient") | ||||
| Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)Aa resource (or, for logical models, the URI of the logical model). | ||||
| Type | uri | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 92. Coverage.beneficiary.identifier | |||||
| Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 94. Coverage.beneficiary.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 96. Coverage.dependent | |||||
| Definition | A unique identifier for a dependent under the coverage. | ||||
| Short | Dependent number | ||||
| Comments | Periodically the member number is constructed from the subscriberId and the dependant number. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 98. Coverage.relationship | |||||
| Definition | The relationship of beneficiary (patient) to the subscriber. | ||||
| Short | Beneficiary relationship to the subscriber | ||||
| Comments | Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from SubscriberRelationshipCodes (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship)The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Requirements | To determine relationship between the patient and the subscriber to determine coordination of benefits. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 100. Coverage.period | |||||
| Definition | Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force. | ||||
| Short | Coverage start and end dates | ||||
| Control | 0..1 | ||||
| Type | Period | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Some insurers require the submission of the coverage term. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 102. Coverage.payor | |||||
| Definition | Versicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt. | ||||
| Short | Kostenträger | ||||
| Comments | Die Angabe der IK-Nummer in Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird. | ||||
| Control | 1..1 | ||||
| Type | Reference(Organization) | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | Need to identify the issuer to target for claim processing and for coordination of benefit processing. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 104. Coverage.payor.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 106. Coverage.payor.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.payor.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 108. Coverage.payor.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 110. Coverage.payor.type | |||||
| Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
| Short | Type the reference refers to (e.g. "Patient") | ||||
| Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)Aa resource (or, for logical models, the URI of the logical model). | ||||
| Type | uri | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 112. Coverage.payor.identifier | |||||
| Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Institutskennzeichern der Versicherung | ||||
| Comments | Begründung Pflichtfeld: Als eindeutiger Identifikator der Versicherung ist in vielen Fällen das Institutskennzeichen ausreichend. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 1..1 | ||||
| Type | Identifier(Identifier-Profil für die Abbildung eines Institutionskennzeichens (IKNR)) | ||||
| Is Modifier | false | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 114. Coverage.payor.identifier.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 116. Coverage.payor.identifier.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| Slicing | This element introduces a set of slices on Coverage.payor.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 118. Coverage.payor.identifier.use | |||||
| Definition | The purpose of this identifier. | ||||
| Short | usual | official | temp | secondary | old (If known) | ||||
| Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
| Control | 0..1 | ||||
| Binding | The codes SHALL be taken from IdentifierUse (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)Identifies the purpose for this identifier, if known . | ||||
| Type | code | ||||
| Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 120. Coverage.payor.identifier.type | |||||
| Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| Short | Description of identifier | ||||
| Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from Identifier Type DeBasis ValueSet (extensible to http://fhir.de/ValueSet/identifier-type-de-basis)A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
| Pattern Value | { | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 122. Coverage.payor.identifier.system | |||||
| Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
| Short | Namensraum der IK-Nummer | ||||
| Comments | Hier ist stets der Wert | ||||
| Control | 1..1 | ||||
| Type | uri | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
| Fixed Value | http://fhir.de/sid/arge-ik/iknr | ||||
| Example | General: http://www.acme.com/identifiers/patient | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 124. Coverage.payor.identifier.value | |||||
| Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
| Short | IK-Nummer | ||||
| Comments | Das Institutskennzeichen der Versicherung | ||||
| Control | 1..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Example | General: 123456 | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ik-1: Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein ( matches('^[0-9]{9}$')) | ||||
| 126. Coverage.payor.identifier.period | |||||
| Definition | Time period during which identifier is/was valid for use. | ||||
| Short | Time period when id is/was valid for use | ||||
| Control | 0..1 | ||||
| Type | Period | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 128. Coverage.payor.identifier.assigner | |||||
| Definition | Organization that issued/manages the identifier. | ||||
| Short | Organization that issued id (may be just text) | ||||
| Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
| Control | 0..1 | ||||
| Type | Reference(Organization) | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 130. Coverage.payor.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Name der Versicherung | ||||
| Comments | Begründung Pflichtfeld: Da das Institutskennzeichen nicht zur Darstellung für den Anwender geeignet ist, muss ergänzend der Name der Versicherung angegeben werden. | ||||
| Control | 1..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Must Support | true | ||||
| Summary | true | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 132. Coverage.class | |||||
| Definition | A suite of underwriter specific classifiers. | ||||
| Short | Additional coverage classifications | ||||
| Comments | For example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Requirements | The codes provided on the health card which identify or confirm the specific policy for the insurer. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 134. Coverage.class.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 136. Coverage.class.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 138. Coverage.class.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
| Short | Extensions that cannot be ignored even if unrecognized | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
| Summary | true | ||||
| Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 140. Coverage.class.type | |||||
| Definition | The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan. | ||||
| Short | Type of class such as 'group' or 'plan' | ||||
| Control | 1..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from CoverageClassCodes (extensible to http://hl7.org/fhir/ValueSet/coverage-class)The policy classifications, eg. Group, Plan, Class, etc. | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | The insurer issued label for a specific health card value. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 142. Coverage.class.value | |||||
| Definition | The alphanumeric string value associated with the insurer issued label. | ||||
| Short | Value associated with the type | ||||
| Comments | For example, the Group or Plan number. | ||||
| Control | 1..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | The insurer issued label and value are necessary to identify the specific policy. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 144. Coverage.class.name | |||||
| Definition | A short description for the class. | ||||
| Short | Human readable description of the type and value | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Used to provide a meaningful description in correspondence to the patient. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 146. Coverage.order | |||||
| Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. | ||||
| Short | Relative order of the coverage | ||||
| Comments | Es git derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann. Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org | ||||
| Control | 0..0 | ||||
| Type | positiveInt | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Used in managing the coordination of benefits. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 148. Coverage.network | |||||
| Definition | Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden | ||||
| Short | Insurer network | ||||
| Comments | Es gibt derzeit in DE keine Verwendung für dieses Attribut (Konsens Interop-Forum 12.6.2017) Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org | ||||
| Control | 0..0 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Used in referral for treatment and in claims processing. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 150. Coverage.costToBeneficiary | |||||
| Definition | A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card. | ||||
| Short | Patient payments for services/products | ||||
| Comments | For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment. | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Requirements | Required by providers to manage financial transaction with the patient. | ||||
| Alternate Names | CoPay, Deductible, Exceptions | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 152. Coverage.costToBeneficiary.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 154. Coverage.costToBeneficiary.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 156. Coverage.costToBeneficiary.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
| Short | Extensions that cannot be ignored even if unrecognized | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
| Summary | true | ||||
| Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 158. Coverage.costToBeneficiary.type | |||||
| Definition | The category of patient centric costs associated with treatment. | ||||
| Short | Cost category | ||||
| Comments | For example visit, specialist visits, emergency, inpatient care, etc. | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from CoverageCopayTypeCodes (extensible to http://hl7.org/fhir/ValueSet/coverage-copay-type)The types of services to which patient copayments are specified. | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Needed to identify the category associated with the amount for the patient. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 160. Coverage.costToBeneficiary.value[x] | |||||
| Definition | The amount due from the patient for the cost category. | ||||
| Short | The amount or percentage due from the beneficiary | ||||
| Comments | Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency. | ||||
| Control | 1..1 | ||||
| Type | Choice of: Quantity(SimpleQuantity), Money | ||||
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Needed to identify the amount for the patient associated with the category. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 162. Coverage.costToBeneficiary.exception | |||||
| Definition | A suite of codes indicating exceptions or reductions to patient costs and their effective periods. | ||||
| Short | Exceptions for patient payments | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Requirements | Required by providers to manage financial transaction with the patient. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 164. Coverage.costToBeneficiary.exception.id | |||||
| Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | Unique id for inter-element referencing | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Is Modifier | false | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| Summary | false | ||||
| 166. Coverage.costToBeneficiary.exception.extension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
| Short | Additional content defined by implementations | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Alternate Names | extensions, user content | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 168. Coverage.costToBeneficiary.exception.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
| Short | Extensions that cannot be ignored even if unrecognized | ||||
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
| Summary | true | ||||
| Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) | ||||
| 170. Coverage.costToBeneficiary.exception.type | |||||
| Definition | The code for the specific exception. | ||||
| Short | Exception category | ||||
| Control | 1..1 | ||||
| Binding | For example codes, see ExampleCoverageFinancialExceptionCodes (example to http://hl7.org/fhir/ValueSet/coverage-financial-exception)The types of exceptions from the part or full value of financial obligations such as copays. | ||||
| Type | CodeableConcept | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Needed to identify the exception associated with the amount for the patient. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 172. Coverage.costToBeneficiary.exception.period | |||||
| Definition | The timeframe during when the exception is in force. | ||||
| Short | The effective period of the exception | ||||
| Control | 0..1 | ||||
| Type | Period | ||||
| Is Modifier | false | ||||
| Summary | true | ||||
| Requirements | Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 174. Coverage.subrogation | |||||
| Definition | When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. | ||||
| Short | Reimbursement to insurer | ||||
| Comments | Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims. | ||||
| Control | 0..1 | ||||
| Type | boolean | ||||
| Is Modifier | false | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | false | ||||
| Requirements | See definition for when to be used. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||
| 176. Coverage.contract | |||||
| Definition | The policy(s) which constitute this insurance coverage. | ||||
| Short | Contract details | ||||
| Control | 0..* | ||||
| Type | Reference(Contract) | ||||
| Is Modifier | false | ||||
| Summary | false | ||||
| Requirements | To reference the legally binding contract between the policy holder and the insurer. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) | ||||