<status value="draft"/> <date value="2025-11-27T09:39:09+00:00"/> <publisher value="ELGA GmbH"/> <contact> <name value="ELGA GmbH"/> <telecom> <system value="url"/> <value value="https://elga.gv.at"/> </telecom> </contact> <description value="MOPED Profil der Coverage Ressource für Selbstzahler"/> <fhirVersion value="5.0.0"/> <mapping> <identity value="workflow"/> <uri value="http://hl7.org/fhir/workflow"/> <name value="Workflow Pattern"/> </mapping> <mapping> <identity value="w5"/> <uri value="http://hl7.org/fhir/fivews"/> <name value="FiveWs Pattern Mapping"/> </mapping> <mapping> <identity value="rim"/> <uri value="http://hl7.org/v3"/> <name value="RIM Mapping"/> </mapping> <mapping> <identity value="cdanetv4"/> <uri value="http://www.cda-adc.ca/en/services/cdanet/"/> <name value="Canadian Dental Association eclaims standard"/> </mapping> <mapping> <identity value="cpha3pharm"/> <uri value="http://www.pharmacists.ca/"/> <name value="Canadian Pharmacy Association eclaims standard"/> </mapping> <mapping> <identity value="v2"/> <uri value="http://hl7.org/v2"/> <name value="HL7 V2 Mapping"/> </mapping> <kind value="resource"/> <abstract value="false"/> <type value="Coverage"/> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Coverage"/> <derivation value="constraint"/> <snapshot> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version"> <valueString value="5.0.0"/> </extension> <element id="Coverage"> <path value="Coverage"/> <short value="Insurance or medical plan or a payment agreement"/> <definition value="Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment."/> <comment value="The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage"/> <min value="0"/> <max value="*"/> </base> <constraint> <key value="dom-2"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> <expression value="contained.contained.empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-3"/> <severity value="error"/> <human value="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"/> <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-4"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-5"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/> <expression value="contained.meta.security.empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/> </extension> <key value="dom-6"/> <severity value="warning"/> <human value="A resource should have narrative for robust management"/> <expression value="text.`div`.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="Entity, Role, or Act,Coverage"/> </mapping> <mapping> <identity value="workflow"/> <map value="Event"/> </mapping> <mapping> <identity value="w5"/> <map value="financial.support"/> </mapping> </element> <element id="Coverage.id"> <path value="Coverage.id"/> <short value="Logical id of this artifact"/> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/> <comment value="Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="id"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.meta"> <path value="Coverage.meta"/> <short value="Metadata about the resource"/> <definition value="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."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.meta"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Meta"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.implicitRules"> <path value="Coverage.implicitRules"/> <short value="A set of rules under which this content was created"/> <definition value="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."/> <comment value="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 its narrative along with other profiles, value sets, etc."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.implicitRules"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="true"/> <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation"/> <isSummary value="true"/> </element> <element id="Coverage.language"> <path value="Coverage.language"/> <short value="Language of the resource content"/> <definition value="The base language in which the resource is written."/> <comment value="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)."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.language"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language"/> </extension> <strength value="required"/> <description value="IETF language tag for a human language"/> <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0"/> <additional> <purpose value="starter"/> <valueSet value="http://hl7.org/fhir/ValueSet/languages|5.0.0"/> </additional> </binding> </element> <element id="Coverage.text"> <path value="Coverage.text"/> <short value="Text summary of the resource, for human interpretation"/> <definition value="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."/> <comment value="Contained resources do not have a 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."/> <alias value="narrative"/> <alias value="html"/> <alias value="xhtml"/> <alias value="display"/> <min value="0"/> <max value="1"/> <base> <path value="DomainResource.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Narrative"/> </type> <condition value="dom-6"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="Act.text?"/> </mapping> </element> <element id="Coverage.contained"> <path value="Coverage.contained"/> <short value="Contained, inline Resources"/> <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning."/> <comment value="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."/> <alias value="inline resources"/> <alias value="anonymous resources"/> <alias value="contained resources"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.contained"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Resource"/> </type> <condition value="dom-2"/> <condition value="dom-4"/> <condition value="dom-3"/> <condition value="dom-5"/> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.extension"> <path value="Coverage.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.modifierExtension"> <path value="Coverage.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <mustSupport value="false"/> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.identifier"> <path value="Coverage.identifier"/> <short value="Business identifier(s) for this coverage"/> <definition value="The identifier of the coverage as issued by the insurer."/> <comment value="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 that not all insurers issue unique member IDs therefore searches may result in multiple responses."/> <requirements value="Allows coverages to be distinguished and referenced."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.identifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.identifier"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.identifier"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="C02"/> </mapping> <mapping> <identity value="rim"/> <map value=".id"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.32, C.33, C.39"/> </mapping> </element> <element id="Coverage.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.status"/> <short value="active | cancelled | draft | entered-in-error"/> <definition value="The status of the resource instance."/> <comment value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid."/> <requirements value="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'."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.status"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="true"/> <isModifierReason value="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"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageStatus"/> </extension> <strength value="required"/> <description value="A code specifying the state of the resource instance."/> <valueSet value="http://hl7.org/fhir/ValueSet/fm-status|5.0.0"/> </binding> <mapping> <identity value="workflow"/> <map value="Event.status"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.status"/> </mapping> <mapping> <identity value="rim"/> <map value="Act.status"/> </mapping> </element> <element id="Coverage.kind"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.kind"/> <short value="insurance | self-pay | other"/> <definition value="The nature of the coverage be it insurance, or cash payment such as self-pay."/> <requirements value="This is used to implement conformance on other elements."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.kind"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <patternCode value="self-pay"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageKind"/> </extension> <strength value="required"/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0"/> </binding> </element> <element id="Coverage.paymentBy"> <path value="Coverage.paymentBy"/> <short value="Self-pay parties and responsibility"/> <definition value="Link to the paying party and optionally what specifically they will be responsible to pay."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.paymentBy"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.paymentBy.id"> <path value="Coverage.paymentBy.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.paymentBy.extension"> <path value="Coverage.paymentBy.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.paymentBy.modifierExtension"> <path value="Coverage.paymentBy.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.paymentBy.party"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.paymentBy.party"/> <short value="Parties performing self-payment"/> <definition value="The list of parties providing non-insurance payment for the treatment costs."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.paymentBy.party"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.paymentBy.responsibility"> <path value="Coverage.paymentBy.responsibility"/> <short value="Party's responsibility"/> <definition value=" Description of the financial responsibility."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.paymentBy.responsibility"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.type"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.type"/> <short value="Coverage category such as medical or accident"/> <definition value="The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization."/> <requirements value="The order of application of coverages is dependent on the types of coverage."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/> <code value="pay"/> </coding> </patternCodeableConcept> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageType"/> </extension> <strength value="preferred"/> <description value="The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-type|5.0.0"/> </binding> <mapping> <identity value="w5"/> <map value="FiveWs.class"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-15"/> </mapping> </element> <element id="Coverage.policyHolder"> <path value="Coverage.policyHolder"/> <short value="Owner of the policy"/> <definition value="The party who 'owns' the insurance policy."/> <comment value="For example: may be an individual, corporation or the subscriber's employer."/> <requirements value="This provides employer information in the case of Worker's Compensation and other policies."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.policyHolder"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient|5.0.0"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson|5.0.0"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.subscriber"> <path value="Coverage.subscriber"/> <short value="Subscriber to the policy"/> <definition value="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."/> <comment value="May be self or a parent in the case of dependants. A subscriber is only required on certain types of policies not all policies and that it is appropriate to have just a policyholder and a beneficiary when not other party can join that policy instance."/> <requirements value="This is the party who is entitled to the benfits under the policy."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.subscriber"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient|5.0.0"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.subscriberId"> <path value="Coverage.subscriberId"/> <short value="ID assigned to the subscriber"/> <definition value="The insurer assigned ID for the Subscriber."/> <requirements value="The insurer requires this identifier on correspondance and claims (digital and otherwise)."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.subscriberId"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.beneficiary"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.beneficiary"/> <short value="Plan beneficiary"/> <definition value="The party who benefits from the insurance coverage; the patient when products and/or services are provided."/> <requirements value="This is the party who receives treatment for which the costs are reimbursed under the coverage."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.beneficiary"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.subject"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.dependent"> <path value="Coverage.dependent"/> <short value="Dependent number"/> <definition value="A designator for a dependent under the coverage."/> <comment value="Sometimes the member number is constructed from the subscriberId and the dependant number."/> <requirements value="For some coverages a single identifier is issued to the Subscriber and then an additional dependent number is issued to each beneficiary."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.dependent"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C17"/> </mapping> <mapping> <identity value="v2"/> <map value="- No exact HL7 V2 equivalent concept seems to exist;"/> </mapping> </element> <element id="Coverage.relationship"> <path value="Coverage.relationship"/> <short value="Beneficiary relationship to the subscriber"/> <definition value="The relationship of beneficiary (patient) to the subscriber."/> <comment value="Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others."/> <requirements value="The relationship between the patient and the subscriber to determine coordination of benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.relationship"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Relationship"/> </extension> <strength value="extensible"/> <description value="The relationship between the Subscriber and the Beneficiary (insured/covered party/patient)."/> <valueSet value="http://hl7.org/fhir/ValueSet/subscriber-relationship|5.0.0"/> </binding> <mapping> <identity value="cdanetv4"/> <map value="C03"/> </mapping> </element> <element id="Coverage.period"> <path value="Coverage.period"/> <short value="Coverage start and end dates"/> <definition value="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."/> <requirements value="Some insurers require the submission of the coverage term."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.period"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.occurrence[x]"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.done[x]"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-12 / IN1-13"/> </mapping> <mapping> <identity value="rim"/> <map value="Act.effectiveTime"/> </mapping> </element> <element id="Coverage.insurer"> <path value="Coverage.insurer"/> <short value="Issuer of the policy"/> <definition value="The program or plan underwriter, payor, insurance company."/> <comment value="May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)."/> <requirements value="Need to identify the issuer to target for claim processing and for coordination of benefit processing."/> <min value="0"/> <max value="0"/> <base> <path value="Coverage.insurer"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.class"> <path value="Coverage.class"/> <short value="Additional coverage classifications"/> <definition value="A suite of underwriter specific classifiers."/> <comment value="For example, class may be used to identify a class of coverage or employer group, policy, or plan."/> <requirements value="The codes provided on the health card which identify or confirm the specific policy for the insurer."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.class"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.class.id"> <path value="Coverage.class.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.class.extension"> <path value="Coverage.class.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.class.modifierExtension"> <path value="Coverage.class.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.class.type"> <path value="Coverage.class.type"/> <short value="Type of class such as 'group' or 'plan'"/> <definition value="The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan."/> <requirements value="The insurer issued label for a specific health card value."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.class.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageClass"/> </extension> <strength value="extensible"/> <description value="The policy classifications, e.g. Group, Plan, Class, etc."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-class|5.0.0"/> </binding> </element> <element id="Coverage.class.value"> <path value="Coverage.class.value"/> <short value="Value associated with the type"/> <definition value="The alphanumeric identifier associated with the insurer issued label."/> <comment value="For example, the Group or Plan number."/> <requirements value="The insurer issued label and identifier are necessary to identify the specific policy, group, etc.."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.class.value"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-2"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.class.name"> <path value="Coverage.class.name"/> <short value="Human readable description of the type and value"/> <definition value="A short description for the class."/> <requirements value="Used to provide a meaningful description in correspondence to the patient."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.class.name"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.order"> <path value="Coverage.order"/> <short value="Relative order of the coverage"/> <definition value="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. For example; a patient might have (0) auto insurance (1) their own health insurance and (2) spouse's health insurance. When claiming for treatments which were not the result of an auto accident then only coverages (1) and (2) above would be applicatble and would apply in the order specified in parenthesis."/> <requirements value="Used in managing the coordination of benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.order"/> <min value="0"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.network"> <path value="Coverage.network"/> <short value="Insurer network"/> <definition value="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."/> <requirements value="Used in referral for treatment and in claims processing."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.network"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D10"/> </mapping> </element> <element id="Coverage.costToBeneficiary"> <path value="Coverage.costToBeneficiary"/> <short value="Patient payments for services/products"/> <definition value="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."/> <comment value="For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment."/> <requirements value="Required by providers to manage financial transaction with the patient."/> <alias value="CoPay"/> <alias value="Deductible"/> <alias value="Exceptions"/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.costToBeneficiary"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.costToBeneficiary.id"> <path value="Coverage.costToBeneficiary.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.extension"> <path value="Coverage.costToBeneficiary.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.modifierExtension"> <path value="Coverage.costToBeneficiary.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.costToBeneficiary.type"> <path value="Coverage.costToBeneficiary.type"/> <short value="Cost category"/> <definition value="The category of patient centric costs associated with treatment."/> <comment value="For example visit, specialist visits, emergency, inpatient care, etc."/> <requirements value="Needed to identify the category associated with the amount for the patient."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CopayTypes"/> </extension> <strength value="extensible"/> <description value="The types of services to which patient copayments are specified."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-copay-type|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.category"> <path value="Coverage.costToBeneficiary.category"/> <short value="Benefit classification"/> <definition value="Code to identify the general type of benefits under which products and services are provided."/> <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/> <requirements value="Needed to convey the category of service or product for which eligibility is sought."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitCategory"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.network"> <path value="Coverage.costToBeneficiary.network"/> <short value="In or out of network"/> <definition value="Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers."/> <requirements value="Needed as in or out of network providers are treated differently under the coverage."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.network"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitNetwork"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-network|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.unit"> <path value="Coverage.costToBeneficiary.unit"/> <short value="Individual or family"/> <definition value="Indicates if the benefits apply to an individual or to the family."/> <requirements value="Needed for the understanding of the benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.unit"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitUnit"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-unit|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.term"> <path value="Coverage.costToBeneficiary.term"/> <short value="Annual or lifetime"/> <definition value="The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'."/> <requirements value="Needed for the understanding of the benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.term"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitTerm"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-term|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.value[x]"> <path value="Coverage.costToBeneficiary.value[x]"/> <short value="The amount or percentage due from the beneficiary"/> <definition value="The amount due from the patient for the cost category."/> <comment value="Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency."/> <requirements value="Needed to identify the amount for the patient associated with the category."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.value[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity|5.0.0"/> </type> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception"> <path value="Coverage.costToBeneficiary.exception"/> <short value="Exceptions for patient payments"/> <definition value="A suite of codes indicating exceptions or reductions to patient costs and their effective periods."/> <requirements value="Required by providers to manage financial transaction with the patient."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.costToBeneficiary.exception"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.costToBeneficiary.exception.id"> <path value="Coverage.costToBeneficiary.exception.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception.extension"> <path value="Coverage.costToBeneficiary.exception.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception.modifierExtension"> <path value="Coverage.costToBeneficiary.exception.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception.type"> <path value="Coverage.costToBeneficiary.exception.type"/> <short value="Exception category"/> <definition value="The code for the specific exception."/> <requirements value="Needed to identify the exception associated with the amount for the patient."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.exception.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageFinancialException"/> </extension> <strength value="example"/> <description value="The types of exceptions from the part or full value of financial obligations such as copays."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-financial-exception|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.exception.period"> <path value="Coverage.costToBeneficiary.exception.period"/> <short value="The effective period of the exception"/> <definition value="The timeframe the exception is in force."/> <requirements value="Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.exception.period"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.subrogation"> <path value="Coverage.subrogation"/> <short value="Reimbursement to insurer"/> <definition value="When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs."/> <comment value="Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims."/> <requirements value="See definition for when to be used."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.subrogation"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.contract"> <path value="Coverage.contract"/> <short value="Contract details"/> <definition value="The policy(s) which constitute this insurance coverage."/> <requirements value="To reference the legally binding contract between the policy holder and the insurer."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.contract"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Contract|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19"/> </mapping> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.insurancePlan"> <path value="Coverage.insurancePlan"/> <short value="Insurance plan details"/> <definition value="The insurance plan details, benefits and costs, which constitute this insurance coverage."/> <requirements value="To associate the plan benefits and costs with the coverage which is an instance of that plan."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.insurancePlan"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/InsurancePlan|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> </snapshot> <differential> <element id="Coverage.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> </extension> <path value="Coverage.status"/> </element> <element id="Coverage.kind"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> </extension> <path value="Coverage.kind"/> <patternCode value="self-pay"/> </element> <element id="Coverage.paymentBy.party"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> </extension> <path value="Coverage.paymentBy.party"/> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> </element> <element id="Coverage.type"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> </extension> <path value="Coverage.type"/> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/> <code value="pay"/> </coding> </patternCodeableConcept> </element> <element id="Coverage.beneficiary"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> </extension> <path value="Coverage.beneficiary"/> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> </element> <element id="Coverage.insurer"> <path value="Coverage.insurer"/> <max value="0"/> </element> </differential> </StructureDefinition>

Generated Narrative: StructureDefinition MopedCoverageSelbstzahler

Coverage

status

1..1

code

active | cancelled | draft | entered-in-error

Obligations

Actor

SHALL:populate

Moped KH Actor

SHALL:handle

Moped Device Actor

kind

1..1

code

insurance | self-pay | other
Required Pattern: self-pay

Obligations

Actor

SHALL:populate

Moped KH Actor

paymentBy

party

1..1

Reference(MOPED Patient)

Parties performing self-payment

Obligations

Actor

SHALL:handle

Moped Device Actor

type

0..1

CodeableConcept

Coverage category such as medical or accident
Required Pattern: At least the following

Obligations

Actor

SHALL:populate

Moped KH Actor

coding

1..*

Coding

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

system

1..1

uri

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

code

1..1

code

Symbol in syntax defined by the system
Fixed Value: pay

beneficiary

1..1

Reference(MOPED Patient)

Plan beneficiary

Obligations

Actor

SHALL:handle

Moped Device Actor

insurer

0..0

Issuer of the policy

Documentation for this format

<status value="draft"/> <date value="2025-11-27T09:39:09+00:00"/> <publisher value="ELGA GmbH"/> <contact> <name value="ELGA GmbH"/> <telecom> <system value="url"/> <value value="https://elga.gv.at"/> </telecom> </contact> <description value="MOPED Profil der Coverage Ressource für Selbstzahler"/> <fhirVersion value="5.0.0"/> <mapping> <identity value="workflow"/> <uri value="http://hl7.org/fhir/workflow"/> <name value="Workflow Pattern"/> </mapping> <mapping> <identity value="w5"/> <uri value="http://hl7.org/fhir/fivews"/> <name value="FiveWs Pattern Mapping"/> </mapping> <mapping> <identity value="rim"/> <uri value="http://hl7.org/v3"/> <name value="RIM Mapping"/> </mapping> <mapping> <identity value="cdanetv4"/> <uri value="http://www.cda-adc.ca/en/services/cdanet/"/> <name value="Canadian Dental Association eclaims standard"/> </mapping> <mapping> <identity value="cpha3pharm"/> <uri value="http://www.pharmacists.ca/"/> <name value="Canadian Pharmacy Association eclaims standard"/> </mapping> <mapping> <identity value="v2"/> <uri value="http://hl7.org/v2"/> <name value="HL7 V2 Mapping"/> </mapping> <kind value="resource"/> <abstract value="false"/> <type value="Coverage"/> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Coverage"/> <derivation value="constraint"/> <snapshot> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version"> <valueString value="5.0.0"/> </extension> <element id="Coverage"> <path value="Coverage"/> <short value="Insurance or medical plan or a payment agreement"/> <definition value="Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment."/> <comment value="The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage"/> <min value="0"/> <max value="*"/> </base> <constraint> <key value="dom-2"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> <expression value="contained.contained.empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-3"/> <severity value="error"/> <human value="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"/> <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-4"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-5"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/> <expression value="contained.meta.security.empty()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/> </extension> <key value="dom-6"/> <severity value="warning"/> <human value="A resource should have narrative for robust management"/> <expression value="text.`div`.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="Entity, Role, or Act,Coverage"/> </mapping> <mapping> <identity value="workflow"/> <map value="Event"/> </mapping> <mapping> <identity value="w5"/> <map value="financial.support"/> </mapping> </element> <element id="Coverage.id"> <path value="Coverage.id"/> <short value="Logical id of this artifact"/> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/> <comment value="Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="id"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.meta"> <path value="Coverage.meta"/> <short value="Metadata about the resource"/> <definition value="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."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.meta"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Meta"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.implicitRules"> <path value="Coverage.implicitRules"/> <short value="A set of rules under which this content was created"/> <definition value="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."/> <comment value="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 its narrative along with other profiles, value sets, etc."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.implicitRules"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="true"/> <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation"/> <isSummary value="true"/> </element> <element id="Coverage.language"> <path value="Coverage.language"/> <short value="Language of the resource content"/> <definition value="The base language in which the resource is written."/> <comment value="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)."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.language"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language"/> </extension> <strength value="required"/> <description value="IETF language tag for a human language"/> <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0"/> <additional> <purpose value="starter"/> <valueSet value="http://hl7.org/fhir/ValueSet/languages|5.0.0"/> </additional> </binding> </element> <element id="Coverage.text"> <path value="Coverage.text"/> <short value="Text summary of the resource, for human interpretation"/> <definition value="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."/> <comment value="Contained resources do not have a 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."/> <alias value="narrative"/> <alias value="html"/> <alias value="xhtml"/> <alias value="display"/> <min value="0"/> <max value="1"/> <base> <path value="DomainResource.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Narrative"/> </type> <condition value="dom-6"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="Act.text?"/> </mapping> </element> <element id="Coverage.contained"> <path value="Coverage.contained"/> <short value="Contained, inline Resources"/> <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning."/> <comment value="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."/> <alias value="inline resources"/> <alias value="anonymous resources"/> <alias value="contained resources"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.contained"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Resource"/> </type> <condition value="dom-2"/> <condition value="dom-4"/> <condition value="dom-3"/> <condition value="dom-5"/> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.extension"> <path value="Coverage.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.modifierExtension"> <path value="Coverage.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <mustSupport value="false"/> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.identifier"> <path value="Coverage.identifier"/> <short value="Business identifier(s) for this coverage"/> <definition value="The identifier of the coverage as issued by the insurer."/> <comment value="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 that not all insurers issue unique member IDs therefore searches may result in multiple responses."/> <requirements value="Allows coverages to be distinguished and referenced."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.identifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.identifier"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.identifier"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="C02"/> </mapping> <mapping> <identity value="rim"/> <map value=".id"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.32, C.33, C.39"/> </mapping> </element> <element id="Coverage.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.status"/> <short value="active | cancelled | draft | entered-in-error"/> <definition value="The status of the resource instance."/> <comment value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid."/> <requirements value="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'."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.status"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="true"/> <isModifierReason value="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"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageStatus"/> </extension> <strength value="required"/> <description value="A code specifying the state of the resource instance."/> <valueSet value="http://hl7.org/fhir/ValueSet/fm-status|5.0.0"/> </binding> <mapping> <identity value="workflow"/> <map value="Event.status"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.status"/> </mapping> <mapping> <identity value="rim"/> <map value="Act.status"/> </mapping> </element> <element id="Coverage.kind"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.kind"/> <short value="insurance | self-pay | other"/> <definition value="The nature of the coverage be it insurance, or cash payment such as self-pay."/> <requirements value="This is used to implement conformance on other elements."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.kind"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <patternCode value="self-pay"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageKind"/> </extension> <strength value="required"/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0"/> </binding> </element> <element id="Coverage.paymentBy"> <path value="Coverage.paymentBy"/> <short value="Self-pay parties and responsibility"/> <definition value="Link to the paying party and optionally what specifically they will be responsible to pay."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.paymentBy"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.paymentBy.id"> <path value="Coverage.paymentBy.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.paymentBy.extension"> <path value="Coverage.paymentBy.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.paymentBy.modifierExtension"> <path value="Coverage.paymentBy.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.paymentBy.party"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.paymentBy.party"/> <short value="Parties performing self-payment"/> <definition value="The list of parties providing non-insurance payment for the treatment costs."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.paymentBy.party"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.paymentBy.responsibility"> <path value="Coverage.paymentBy.responsibility"/> <short value="Party's responsibility"/> <definition value=" Description of the financial responsibility."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.paymentBy.responsibility"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.type"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.type"/> <short value="Coverage category such as medical or accident"/> <definition value="The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization."/> <requirements value="The order of application of coverages is dependent on the types of coverage."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/> <code value="pay"/> </coding> </patternCodeableConcept> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageType"/> </extension> <strength value="preferred"/> <description value="The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-type|5.0.0"/> </binding> <mapping> <identity value="w5"/> <map value="FiveWs.class"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-15"/> </mapping> </element> <element id="Coverage.policyHolder"> <path value="Coverage.policyHolder"/> <short value="Owner of the policy"/> <definition value="The party who 'owns' the insurance policy."/> <comment value="For example: may be an individual, corporation or the subscriber's employer."/> <requirements value="This provides employer information in the case of Worker's Compensation and other policies."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.policyHolder"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient|5.0.0"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson|5.0.0"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.subscriber"> <path value="Coverage.subscriber"/> <short value="Subscriber to the policy"/> <definition value="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."/> <comment value="May be self or a parent in the case of dependants. A subscriber is only required on certain types of policies not all policies and that it is appropriate to have just a policyholder and a beneficiary when not other party can join that policy instance."/> <requirements value="This is the party who is entitled to the benfits under the policy."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.subscriber"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient|5.0.0"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.subscriberId"> <path value="Coverage.subscriberId"/> <short value="ID assigned to the subscriber"/> <definition value="The insurer assigned ID for the Subscriber."/> <requirements value="The insurer requires this identifier on correspondance and claims (digital and otherwise)."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.subscriberId"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.beneficiary"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source"> <valueCanonical value="https://elga.moped.at/StructureDefinition/MopedCoverageSelbstzahler|0.1.0"/> </extension> </extension> <path value="Coverage.beneficiary"/> <short value="Plan beneficiary"/> <definition value="The party who benefits from the insurance coverage; the patient when products and/or services are provided."/> <requirements value="This is the party who receives treatment for which the costs are reimbursed under the coverage."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.beneficiary"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.subject"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19-name of insured, address, date of birth"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.dependent"> <path value="Coverage.dependent"/> <short value="Dependent number"/> <definition value="A designator for a dependent under the coverage."/> <comment value="Sometimes the member number is constructed from the subscriberId and the dependant number."/> <requirements value="For some coverages a single identifier is issued to the Subscriber and then an additional dependent number is issued to each beneficiary."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.dependent"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C17"/> </mapping> <mapping> <identity value="v2"/> <map value="- No exact HL7 V2 equivalent concept seems to exist;"/> </mapping> </element> <element id="Coverage.relationship"> <path value="Coverage.relationship"/> <short value="Beneficiary relationship to the subscriber"/> <definition value="The relationship of beneficiary (patient) to the subscriber."/> <comment value="Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others."/> <requirements value="The relationship between the patient and the subscriber to determine coordination of benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.relationship"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Relationship"/> </extension> <strength value="extensible"/> <description value="The relationship between the Subscriber and the Beneficiary (insured/covered party/patient)."/> <valueSet value="http://hl7.org/fhir/ValueSet/subscriber-relationship|5.0.0"/> </binding> <mapping> <identity value="cdanetv4"/> <map value="C03"/> </mapping> </element> <element id="Coverage.period"> <path value="Coverage.period"/> <short value="Coverage start and end dates"/> <definition value="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."/> <requirements value="Some insurers require the submission of the coverage term."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.period"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.occurrence[x]"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.done[x]"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-12 / IN1-13"/> </mapping> <mapping> <identity value="rim"/> <map value="Act.effectiveTime"/> </mapping> </element> <element id="Coverage.insurer"> <path value="Coverage.insurer"/> <short value="Issuer of the policy"/> <definition value="The program or plan underwriter, payor, insurance company."/> <comment value="May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)."/> <requirements value="Need to identify the issuer to target for claim processing and for coordination of benefit processing."/> <min value="0"/> <max value="0"/> <base> <path value="Coverage.insurer"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.class"> <path value="Coverage.class"/> <short value="Additional coverage classifications"/> <definition value="A suite of underwriter specific classifiers."/> <comment value="For example, class may be used to identify a class of coverage or employer group, policy, or plan."/> <requirements value="The codes provided on the health card which identify or confirm the specific policy for the insurer."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.class"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.class.id"> <path value="Coverage.class.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.class.extension"> <path value="Coverage.class.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.class.modifierExtension"> <path value="Coverage.class.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.class.type"> <path value="Coverage.class.type"/> <short value="Type of class such as 'group' or 'plan'"/> <definition value="The type of classification for which an insurer-specific class label or number and optional name is provided. For example, type may be used to identify a class of coverage or employer group, policy, or plan."/> <requirements value="The insurer issued label for a specific health card value."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.class.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageClass"/> </extension> <strength value="extensible"/> <description value="The policy classifications, e.g. Group, Plan, Class, etc."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-class|5.0.0"/> </binding> </element> <element id="Coverage.class.value"> <path value="Coverage.class.value"/> <short value="Value associated with the type"/> <definition value="The alphanumeric identifier associated with the insurer issued label."/> <comment value="For example, the Group or Plan number."/> <requirements value="The insurer issued label and identifier are necessary to identify the specific policy, group, etc.."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.class.value"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-2"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.class.name"> <path value="Coverage.class.name"/> <short value="Human readable description of the type and value"/> <definition value="A short description for the class."/> <requirements value="Used to provide a meaningful description in correspondence to the patient."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.class.name"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.order"> <path value="Coverage.order"/> <short value="Relative order of the coverage"/> <definition value="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. For example; a patient might have (0) auto insurance (1) their own health insurance and (2) spouse's health insurance. When claiming for treatments which were not the result of an auto accident then only coverages (1) and (2) above would be applicatble and would apply in the order specified in parenthesis."/> <requirements value="Used in managing the coordination of benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.order"/> <min value="0"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.network"> <path value="Coverage.network"/> <short value="Insurer network"/> <definition value="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."/> <requirements value="Used in referral for treatment and in claims processing."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.network"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="D10"/> </mapping> </element> <element id="Coverage.costToBeneficiary"> <path value="Coverage.costToBeneficiary"/> <short value="Patient payments for services/products"/> <definition value="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."/> <comment value="For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment."/> <requirements value="Required by providers to manage financial transaction with the patient."/> <alias value="CoPay"/> <alias value="Deductible"/> <alias value="Exceptions"/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.costToBeneficiary"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.costToBeneficiary.id"> <path value="Coverage.costToBeneficiary.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.extension"> <path value="Coverage.costToBeneficiary.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.modifierExtension"> <path value="Coverage.costToBeneficiary.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.costToBeneficiary.type"> <path value="Coverage.costToBeneficiary.type"/> <short value="Cost category"/> <definition value="The category of patient centric costs associated with treatment."/> <comment value="For example visit, specialist visits, emergency, inpatient care, etc."/> <requirements value="Needed to identify the category associated with the amount for the patient."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CopayTypes"/> </extension> <strength value="extensible"/> <description value="The types of services to which patient copayments are specified."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-copay-type|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.category"> <path value="Coverage.costToBeneficiary.category"/> <short value="Benefit classification"/> <definition value="Code to identify the general type of benefits under which products and services are provided."/> <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/> <requirements value="Needed to convey the category of service or product for which eligibility is sought."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitCategory"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.network"> <path value="Coverage.costToBeneficiary.network"/> <short value="In or out of network"/> <definition value="Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers."/> <requirements value="Needed as in or out of network providers are treated differently under the coverage."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.network"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitNetwork"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-network|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.unit"> <path value="Coverage.costToBeneficiary.unit"/> <short value="Individual or family"/> <definition value="Indicates if the benefits apply to an individual or to the family."/> <requirements value="Needed for the understanding of the benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.unit"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitUnit"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-unit|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.term"> <path value="Coverage.costToBeneficiary.term"/> <short value="Annual or lifetime"/> <definition value="The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'."/> <requirements value="Needed for the understanding of the benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.term"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitTerm"/> </extension> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-term|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.value[x]"> <path value="Coverage.costToBeneficiary.value[x]"/> <short value="The amount or percentage due from the beneficiary"/> <definition value="The amount due from the patient for the cost category."/> <comment value="Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency."/> <requirements value="Needed to identify the amount for the patient associated with the category."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.value[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity|5.0.0"/> </type> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="cdanetv4"/> <map value="C11 (Division,Section)"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-8"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.31"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception"> <path value="Coverage.costToBeneficiary.exception"/> <short value="Exceptions for patient payments"/> <definition value="A suite of codes indicating exceptions or reductions to patient costs and their effective periods."/> <requirements value="Required by providers to manage financial transaction with the patient."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.costToBeneficiary.exception"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.costToBeneficiary.exception.id"> <path value="Coverage.costToBeneficiary.exception.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception.extension"> <path value="Coverage.costToBeneficiary.exception.extension"/> <short value="Additional content defined by implementations"/> <definition value="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 managable, 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."/> <comment value="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."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception.modifierExtension"> <path value="Coverage.costToBeneficiary.exception.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="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 managable, 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)."/> <comment value="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."/> <requirements value="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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Coverage.costToBeneficiary.exception.type"> <path value="Coverage.costToBeneficiary.exception.type"/> <short value="Exception category"/> <definition value="The code for the specific exception."/> <requirements value="Needed to identify the exception associated with the amount for the patient."/> <min value="1"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.exception.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CoverageFinancialException"/> </extension> <strength value="example"/> <description value="The types of exceptions from the part or full value of financial obligations such as copays."/> <valueSet value="http://hl7.org/fhir/ValueSet/coverage-financial-exception|5.0.0"/> </binding> </element> <element id="Coverage.costToBeneficiary.exception.period"> <path value="Coverage.costToBeneficiary.exception.period"/> <short value="The effective period of the exception"/> <definition value="The timeframe the exception is in force."/> <requirements value="Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.costToBeneficiary.exception.period"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="Coverage.subrogation"> <path value="Coverage.subrogation"/> <short value="Reimbursement to insurer"/> <definition value="When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs."/> <comment value="Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims."/> <requirements value="See definition for when to be used."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.subrogation"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="Coverage.contract"> <path value="Coverage.contract"/> <short value="Contract details"/> <definition value="The policy(s) which constitute this insurance coverage."/> <requirements value="To reference the legally binding contract between the policy holder and the insurer."/> <min value="0"/> <max value="*"/> <base> <path value="Coverage.contract"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Contract|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="cdanetv4"/> <map value="D01 through D09"/> </mapping> <mapping> <identity value="v2"/> <map value="IN1-16, 18, 19"/> </mapping> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> <mapping> <identity value="cpha3pharm"/> <map value="C.35"/> </mapping> </element> <element id="Coverage.insurancePlan"> <path value="Coverage.insurancePlan"/> <short value="Insurance plan details"/> <definition value="The insurance plan details, benefits and costs, which constitute this insurance coverage."/> <requirements value="To associate the plan benefits and costs with the coverage which is an instance of that plan."/> <min value="0"/> <max value="1"/> <base> <path value="Coverage.insurancePlan"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/InsurancePlan|5.0.0"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> </snapshot> <differential> <element id="Coverage.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> </extension> <path value="Coverage.status"/> </element> <element id="Coverage.kind"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> </extension> <path value="Coverage.kind"/> <patternCode value="self-pay"/> </element> <element id="Coverage.paymentBy.party"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> </extension> <path value="Coverage.paymentBy.party"/> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> </element> <element id="Coverage.type"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedKHActor"/> </extension> </extension> <path value="Coverage.type"/> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/> <code value="pay"/> </coding> </patternCodeableConcept> </element> <element id="Coverage.beneficiary"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="https://elga.moped.at/ActorDefinition/MopedDeviceActor"/> </extension> </extension> <path value="Coverage.beneficiary"/> <type> <code value="Reference"/> <targetProfile value="https://elga.moped.at/StructureDefinition/MopedPatient"/> </type> </element> <element id="Coverage.insurer"> <path value="Coverage.insurer"/> <max value="0"/> </element> </differential> </StructureDefinition>