ISiK Basis Implementierungsleitfaden
Version 6.0.0-rc - ci-build

Resource Profile: ISiKVersicherungsverhaeltnisGesetzlich

Official URL: https://gematik.de/fhir/isik/StructureDefinition/ISiKVersicherungsverhaeltnisGesetzlich Version: 6.0.0-rc
Active as of 2025-12-17 Computable Name: ISiKVersicherungsverhaeltnisGesetzlich

Dieses Profil ermöglicht die Darstellung eines gesetzlichen Versicherungsverhältnisses in ISiK Szenarien.

Motivation

ISiK unterstützt Anwendungsszenarien, in denen durch das Krankenhaus erbrachte Leistungen erfasst oder gegenüber Kostenträgern abgerechnet werden. In diesen Anwendungsszenarien wird das Versicherungsverhältnis verwendet, um bspw. den Versicherungsstatus oder die Rechnungsanschrift der Versicherung zu ermitteln.
In FHIR werden Versicherungsverhältnisse mit der Coverage-Ressource repräsentiert.

Kompatibilität

Das Profil ISiKVersicherungsverhaeltnisGesetzlich basiert auf dem GKV-Profil der deutschen Basisprofile. Instanzen, die gegen ISiKVersicherungsverhaeltnisGesetzlich valide sind, sind auch valide gegen

Hinweise zu Inkompatibilitäten können über die Portalseite gemeldet werden.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeBasis Versicherungsdaten
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code Status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
.... Slices for coding SΣ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Codierte Darstellung der Versicherungsart

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: GKV
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... system SΣ 1..1 uri Codier-Schema
...... code SΣ 1..1 code Code
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... identifier SΣ 1..1 IdentifierKvid10 Lebenslange Krankenversichertennummer der Hauptversicherten
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type ΣC 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: KVZ10
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der Versichertennummer
Fixed Value: http://fhir.de/sid/gkv/kvid-10
..... value SΣC 1..1 string Lebenslange Krankenversichertennummer
Constraints: kvid-1
Example General: 123456
.... display SΣ 0..1 string Name des Hauptversicherten
... beneficiary SΣ 1..1 Reference(Patient) Versicherte Person
.... reference SΣC 1..1 string Patienten-Link
... payor SΣ 1..1 Reference(Organization) Kostenträger
.... identifier SΣ 1..1 IdentifierIknr Institutskennzeichern der Versicherung
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: XX
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der IK-Nummer
Fixed Value: http://fhir.de/sid/arge-ik/iknr
..... value SΣC 1..1 string IK-Nummer
Constraints: ik-1
Example General: 123456
.... display SΣ 1..1 string Name der Versicherung

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.subscriber.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.subscriber.​identifier.type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.payor.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.payor.identifier.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ik-1 warning Coverage.payor.identifier.value Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein matches('^[0-9]{9}$')
kvid-1 warning Coverage.subscriber.identifier.value Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen matches('^[A-Z][0-9]{9}$')
kvid-2 warning Coverage.subscriber.identifier.type 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()

This structure is derived from CoverageDeBasis

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeBasis Versicherungsdaten
... status S 1..1 code Status
... type S 1..1 CodeableConcept Versicherungsart
.... Slices for coding S 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis S 1..1 Coding Codierte Darstellung der Versicherungsart
Required Pattern: At least the following
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: GKV
...... system S 1..1 uri Codier-Schema
...... code S 1..1 code Code
... subscriber S 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person
.... reference S 0..1 string Literal reference, Relative, internal or absolute URL
.... identifier S 1..1 IdentifierKvid10 Lebenslange Krankenversichertennummer der Hauptversicherten
..... system S 1..1 uri Namensraum der Versichertennummer
..... value S 1..1 string Lebenslange Krankenversichertennummer
.... display S 0..1 string Name des Hauptversicherten
.... reference S 1..1 string Patienten-Link
... payor S 1..1 Reference(Organization) Kostenträger
.... identifier S 1..1 IdentifierIknr Institutskennzeichern der Versicherung
..... system S 1..1 uri Namensraum der IK-Nummer
..... value S 1..1 string IK-Nummer
.... display S 1..1 string Name der Versicherung

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeBasis Versicherungsdaten
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code Status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding SΣ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Codierte Darstellung der Versicherungsart

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: GKV
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Codier-Schema
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Code
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 1..1 IdentifierKvid10 Lebenslange Krankenversichertennummer der Hauptversicherten
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type ΣC 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: KVZ10
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der Versichertennummer
Fixed Value: http://fhir.de/sid/gkv/kvid-10
..... value SΣC 1..1 string Lebenslange Krankenversichertennummer
Constraints: kvid-1
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display SΣ 0..1 string Name des Hauptversicherten
... beneficiary SΣ 1..1 Reference(Patient) Versicherte Person
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Patienten-Link
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor SΣ 1..1 Reference(Organization) Kostenträger
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 1..1 IdentifierIknr Institutskennzeichern der Versicherung
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: XX
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der IK-Nummer
Fixed Value: http://fhir.de/sid/arge-ik/iknr
..... value SΣC 1..1 string IK-Nummer
Constraints: ik-1
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display SΣ 1..1 string Name der Versicherung
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.subscriber.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.subscriber.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.subscriber.​identifier.type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.payor.type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.payor.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.payor.identifier.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.class.type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ik-1 warning Coverage.payor.identifier.value Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein matches('^[0-9]{9}$')
kvid-1 warning Coverage.subscriber.identifier.value Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen matches('^[A-Z][0-9]{9}$')
kvid-2 warning Coverage.subscriber.identifier.type 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()
ElementShort descriptionNotes
Coverage.beneficiary Versicherte Person

Hier handelt es ich konkret um den Patienten, der unter diesem Versicherungsverhältnis behandelt wird.
Coverage.beneficiary.reference Patienten-Link

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.
Coverage.payor Kostenträger

Die Angabe der IK-Nummer in payor.identifier sowie des Namens der Versicherung in payor.display ist zwingend erforderlich.
Die Referenz auf eine Resource vom Typ Organization in payor.reference, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional.

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.
Coverage.payor.display Name der Versicherung

Begründung Pflichtfeld: Da das Institutskennzeichen nicht zur Darstellung für den Anwender geeignet ist, muss ergänzend der Name der Versicherung angegeben werden.
Coverage.payor.identifier Institutskennzeichern der Versicherung

Begründung Pflichtfeld: Als eindeutiger Identifikator der Versicherung ist in vielen Fällen das Institutskennzeichen ausreichend.
Coverage.payor.identifier.system Namensraum der IK-Nummer

Hier ist stets der Wert http://fhir.de/sid/arge-ik/iknr anzugeben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.
Coverage.payor.identifier.value IK-Nummer

Das Institutskennzeichen der Versicherung
Coverage.status Status

Zeigt den aktuellen Status der Ressource an.
WICHTIGER Hinweis für Implementierer:

  • Alle server-seitigen Implementierungen MÜSSEN in der Lage sein, die systemintern möglichen Statuswerte korrekt in FHIR abzubilden, mindestens jedoch den Wert active.
  • Alle client-seitigen Implementierungen MÜSSEN in der Lage sein, sämtliche Status-Codes zu interpretieren und dem Anwender in angemessener Form darstellen zu können, beispielsweise durch Ausblenden/Durchstreichen von Ressourcen mit dem status entered-in-error und Ausgrauen von Ressourcen, die einen Plan- oder Entwurfs-Status haben.
Coverage.subscriber Hauptversicherte Person

Die hauptversicherte Person kann der Patient selbst sein, oder (z.B. im Falle einer Familienversicherung) auch ein Angehöriger (RelatedPerson) **Begründung MS: Die Information über die hauptversicherte Person ist insbesondere im Kontext der Korrespondenz von Bedeutung, da z.B. bei familienversicherten Kindern i.d.R. über die hauptversicherte Person korrespondiert wird.

Hinweis: Die Angabe der VersichertenID des Hauptversicherten in subscriber.identifier ist verpflichtend. Weitere Angaben zum Versicherten (Name, Adresse) können in einer RelatedPerson-Resource hinterlegt werden, auf die hier referenziert wird.
Coverage.subscriber.display Name des Hauptversicherten

Begründung MS: Da das die Versichertennummer nicht zur Darstellung für den Anwender geeignet ist, sollte ergänzend der Name des Versicherten angegeben werden.
Coverage.subscriber.identifier Lebenslange Krankenversichertennummer der Hauptversicherten

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.
Weitere Hinweise: siehe Deutschen Basisprofile
Coverage.subscriber.identifier.system Namensraum der Versichertennummer

Hier ist stets der Wert http://fhir.de/sid/gkv/kvid-10 anzugeben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.
Coverage.subscriber.identifier.value Lebenslange Krankenversichertennummer

Der 10-stellige, unveränderbare Teil der Versichertennummer.
Coverage.subscriber.reference

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.
Coverage.type

Die Angabe der Versicherungsart GKV dient der Kennzeichnung dieser Coverage-Ressource als gesetzliches Versicherungsverhältnis.
Begründung Pflichtfeld: Die Angabe der Versicherungsart dient der Unterscheidung, wenn zu einem Patienten mehrere Coverage-Ressourcen hinterlegt sind, z.B. gesetzliche Versicherung + Selbszahlerverhältnis und als Suchkriterium, um gezielt nach der in einem konkreten Kontext relevanten Coverage suchen zu können.
Historie:
28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standard definierten preferred bindings, da die dortigen Codes nicht passen.
Coverage.type.coding
Coverage.type.coding:VersicherungsArtDeBasis Codierte Darstellung der Versicherungsart
Coverage.type.coding:VersicherungsArtDeBasis.code Code

Hier ist stets der Code GKV anzugeben.
Coverage.type.coding:VersicherungsArtDeBasis.system Codier-Schema

Hier ist stets der Wert http://fhir.de/CodeSystem/versicherungsart-de-basis anzugeben.

This structure is derived from CoverageDeBasis

Summary

Mandatory: 7 elements(1 nested mandatory element)
Must-Support: 19 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.type.coding

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeBasis Versicherungsdaten
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code Status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
.... Slices for coding SΣ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Codierte Darstellung der Versicherungsart

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: GKV
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... system SΣ 1..1 uri Codier-Schema
...... code SΣ 1..1 code Code
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... identifier SΣ 1..1 IdentifierKvid10 Lebenslange Krankenversichertennummer der Hauptversicherten
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type ΣC 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: KVZ10
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der Versichertennummer
Fixed Value: http://fhir.de/sid/gkv/kvid-10
..... value SΣC 1..1 string Lebenslange Krankenversichertennummer
Constraints: kvid-1
Example General: 123456
.... display SΣ 0..1 string Name des Hauptversicherten
... beneficiary SΣ 1..1 Reference(Patient) Versicherte Person
.... reference SΣC 1..1 string Patienten-Link
... payor SΣ 1..1 Reference(Organization) Kostenträger
.... identifier SΣ 1..1 IdentifierIknr Institutskennzeichern der Versicherung
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: XX
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der IK-Nummer
Fixed Value: http://fhir.de/sid/arge-ik/iknr
..... value SΣC 1..1 string IK-Nummer
Constraints: ik-1
Example General: 123456
.... display SΣ 1..1 string Name der Versicherung

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.subscriber.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.subscriber.​identifier.type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.payor.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.payor.identifier.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ik-1 warning Coverage.payor.identifier.value Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein matches('^[0-9]{9}$')
kvid-1 warning Coverage.subscriber.identifier.value Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen matches('^[A-Z][0-9]{9}$')
kvid-2 warning Coverage.subscriber.identifier.type 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()

Differential View

This structure is derived from CoverageDeBasis

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeBasis Versicherungsdaten
... status S 1..1 code Status
... type S 1..1 CodeableConcept Versicherungsart
.... Slices for coding S 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis S 1..1 Coding Codierte Darstellung der Versicherungsart
Required Pattern: At least the following
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: GKV
...... system S 1..1 uri Codier-Schema
...... code S 1..1 code Code
... subscriber S 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person
.... reference S 0..1 string Literal reference, Relative, internal or absolute URL
.... identifier S 1..1 IdentifierKvid10 Lebenslange Krankenversichertennummer der Hauptversicherten
..... system S 1..1 uri Namensraum der Versichertennummer
..... value S 1..1 string Lebenslange Krankenversichertennummer
.... display S 0..1 string Name des Hauptversicherten
.... reference S 1..1 string Patienten-Link
... payor S 1..1 Reference(Organization) Kostenträger
.... identifier S 1..1 IdentifierIknr Institutskennzeichern der Versicherung
..... system S 1..1 uri Namensraum der IK-Nummer
..... value S 1..1 string IK-Nummer
.... display S 1..1 string Name der Versicherung

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeBasis Versicherungsdaten
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code Status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding SΣ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Codierte Darstellung der Versicherungsart

Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: GKV
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Codier-Schema
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Code
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subscriber SΣ 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 1..1 IdentifierKvid10 Lebenslange Krankenversichertennummer der Hauptversicherten
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type ΣC 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: KVZ10
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der Versichertennummer
Fixed Value: http://fhir.de/sid/gkv/kvid-10
..... value SΣC 1..1 string Lebenslange Krankenversichertennummer
Constraints: kvid-1
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display SΣ 0..1 string Name des Hauptversicherten
... beneficiary SΣ 1..1 Reference(Patient) Versicherte Person
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Patienten-Link
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor SΣ 1..1 Reference(Organization) Kostenträger
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 1..1 IdentifierIknr Institutskennzeichern der Versicherung
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: XX
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system SΣ 1..1 uri Namensraum der IK-Nummer
Fixed Value: http://fhir.de/sid/arge-ik/iknr
..... value SΣC 1..1 string IK-Nummer
Constraints: ik-1
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display SΣ 1..1 string Name der Versicherung
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.subscriber.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.subscriber.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.subscriber.​identifier.type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.payor.type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.payor.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.payor.identifier.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.class.type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
ik-1 warning Coverage.payor.identifier.value Eine IK muss eine numerische 9-stellige Zeichenkette (mit Prüfziffer) sein matches('^[0-9]{9}$')
kvid-1 warning Coverage.subscriber.identifier.value Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen matches('^[A-Z][0-9]{9}$')
kvid-2 warning Coverage.subscriber.identifier.type 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()

This structure is derived from CoverageDeBasis

Summary

Mandatory: 7 elements(1 nested mandatory element)
Must-Support: 19 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.type.coding

 

Other representations of profile: CSV, Excel, Schematron