This page is part of a downloaded copy of this specification. This page is part of the CARIN Blue Button Implementation Guide (v0.1.0: STU1 Ballot 1) based on FHIR R4. For a full list of available versions, see the Directory of published versions
Coverage mapping
[Previous Page](undefined)Slice | L0 | L1 | L2 | L3 | L4 | Flag | Cardinality | DataType / Value Set |
Description | MapID | CPCDS Data Element Name | Cardinality / DataType |
Value Set Comments | Working Note |
Coverage | TU | DomainResource | Insurance or medical plan or a payment agreement | |||||||||||
Coverage | Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |||||||||||||
Coverage | extension | medicalCOB | 1..* | CodeableConcept | Indicates whether the Plans responsibility for this member's coverage is primary or secondary. | 76 | [1..1] CHAR(1) | P - for Primary | S for Secondary | M - Secondary to Medicare | N - No Medical / Pharmacy Coverage | A - Primary Under Non-Commercial Product (Medicare Advantage or Other) | ||||||
Coverage | identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | |||||||||
Coverage | status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error | New | default: active | |||||||
Coverage | status | Financial Resource Status Codes (Required) | New | |||||||||||
Coverage | type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident | 3 | [1..*] | |||||||
Coverage | type | Coverage Type and Self-Pay Codes (Preferred) | 3 | |||||||||||
Coverage | policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | |||||||||
Coverage | subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |||||||||
Coverage | subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | |||||||||
Coverage | beneficiary--> | Σ | 1..1 | Reference(Patient) | Plan beneficiary | Ref (1) | Member id | [1..1]CHAR (22) | ||||||
Coverage | beneficiary--> | Σ | 1..1 | Reference(Patient) | Plan beneficiary | Ref (70) | Date of birth | [1..1] (TS8) | ||||||
Coverage | beneficiary--> | Σ | 1..1 | Reference(Patient) | Plan beneficiary | Ref (124) | Date of death | [1..1] (TS8) | ||||||
Coverage | beneficiary--> | Σ | 1..1 | Reference(Patient) | Plan beneficiary | Ref (71) | Gender code | [1..1] (CD-CHAR(1)) | ||||||
Coverage | dependent | Σ | 0..1 | string | Dependent number | |||||||||
Coverage | relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber | 72 | Relationship to subscriber | [1..1] (CD-CHAR(2)) | coding.system = url of code
system coding.code = the code value |
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Coverage | relationship | SubscriberPolicyholder Relationship Codes (Extensible) | 72 | Relationship to subscriber | [1..1] (CD-CHAR(2)) | |||||||||
Coverage | period | Σ | 0..1 | Period | Coverage start and end dates | 74, 75 | ||||||||
Coverage | payor--> | Σ | 1..1 | Reference(Organization) | Issuer of the policy | Ref (2) Ref (140) |
Claim Payer Identifier, Claim Primary Payer Identifier | |||||||
Coverage | class | 0..* | BackboneElement | Additional coverage classifications | ||||||||||
Coverage | class | type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' | ||||||||
Coverage | class | type | Coverage Class Codes (Extensible) | |||||||||||
Coverage | class | value | Σ | 1..1 | string | Value associated with the type | ||||||||
Coverage | class | name | Σ | 0..1 | string | Human readable description of the type and value | ||||||||
Coverage | order | Σ | 0..1 | positiveInt | Relative order of the coverage | 76 | [1..1] NUMERIC(1) | |||||||
Coverage | network | Σ | 0..1 | string | Insurer network | |||||||||
Coverage | costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | ||||||||||
Coverage | costToBeneficiary | type | Σ | 0..1 | CodeableConcept | Cost category | ||||||||
Coverage | costToBeneficiary | type | Coverage Copay Type Codes (Extensible) | |||||||||||
Coverage | costToBeneficiary | value | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||||||
Coverage | costToBeneficiary | value | valueQuantity | SimpleQuantity | ||||||||||
Coverage | costToBeneficiary | value | valueMoney | Money | ||||||||||
Coverage | costToBeneficiary | exception | 0..* | BackboneElement | Exceptions for patient payments | |||||||||
Coverage | costToBeneficiary | exception | type | Σ | 1..1 | CodeableConcept | Exception category | |||||||
Coverage | costToBeneficiary | exception | type | Example Coverage Financial Exception Codes (Example) | ||||||||||
Coverage | costToBeneficiary | exception | period | Σ | 0..1 | Period | The effective period of the exception | |||||||
Coverage | subrogation | 0..1 | boolean | Reimbursement to insurer | ||||||||||
Coverage | contract | 0..* | Reference(Contract) | Contract details |