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Resource Profile: ATHENACoverage - Mappings

Active as of 2022-03-01

Mappings for the athena-coverage-profile resource profile.

Mappings for athenaFlow (http://unknown.org/athenaFlow)

ATHENACoverage
Coverage	FHIRR4_COVERAGEVIEW
id	MakeId(%INSID%)
meta
lastUpdated	%DB_UPDATED_DATE%
security	CheckSensitive(%SENSITIVECHART%)
extension
extension (coverage-type)
value[x]	%TYPE%
extension (subscriber-name)
value[x]	MakeSearchName(%PATIENTPREFIX%,%PATIENTFIRST%,%PATIENTMI%,%PATIENTLAST%,%PATIENTSUFFIX%)
identifier	MakeIdentifier("MB",null,%IDNO%)
status	IsIntentCode("active",%STATUS%)
type	MakeConcept(%CODE%,getSiteIdSystem("InsuranceCarrierType"),%DESCRIPTION%)
policyHolder	MakeReference("PATIENT",%PID%,"Patient")
subscriber	MakeReference("PATIENT",%PID%,"Patient")
subscriberId	%IDNO%
beneficiary	MakeReference("PATIENT",%PID%,"Patient")
relationship	MakeConcept(%RELATIONSHIPCODE%,"https://hl7.org/fhir/R4/valueset-subscriber-relationship",%RELATIONSHIPDESCRIPTION%)
period	MakePeriod(%EFFECTIVEDATE%,%EXPIREDDATE%)
payor	MakeReference("INSCARRIER",%BUSID%,"Organization",%NAME% )
class
class (Group)
type	MakeConcept(%CLASSTYPECODE%,"http://terminology.hl7.org/CodeSystem/coverage-class")
value	%GRPNO%
name	%GROUPNAME%
class (Plan)
type	MakeConcept(%CLASSTYPECODEFORPLAN%,"http://terminology.hl7.org/CodeSystem/coverage-class",%CLASSTYPECODEFORPLAN%)
value	%PLANID%
name	%PLANNAME%

Mappings for athenaPractice (http://unknown.org/athenaPractice)

ATHENACoverage
Coverage	FHIRR4_COVERAGEVIEW
id	MakeId(%PATIENTINSURANCEID%)
meta
lastUpdated	%LASTMODIFIED%
security	CheckSensitive(%SENSITIVECHART%)
extension
extension (coverage-type)
value[x]	%TYPE%
extension (subscriber-name)
value[x]	MakeSearchName(%PATIENTPREFIX%,%PATIENTFIRST%,%PATIENTMI%,%PATIENTLAST%,%PATIENTSUFFIX%)
identifier	MakeIdentifier("MB",null,%INSUREDID%)
status	IsIntentCode("active",%STATUS%)
type	MakeConcept(%ANSI%,getSiteIdSystem("InsuranceCarrierType"),%DESCRIPTION%)
policyHolder	MakeReference("PATIENT",%PID%,"Patient")
subscriber	MakeReference("PATIENT",%PID%,"Patient")
subscriberId	%INSUREDID%
beneficiary	MakeReference("PATIENT",%PID%,"Patient")
relationship	MakeConcept(%RELATIONSHIPCODE%,"https://hl7.org/fhir/R4/valueset-subscriber-relationship",%RELATIONSHIPDESCRIPTION%)
period	MakePeriod(%INSCARDEFFECTIVEDATE%,%INSCARDTERMINATIONDATE%)
payor	MakeReference("INSCARRIER",%INSURANCECARRIERSID%,"Organization", %INSURANCECARRIERNAME%)
class
class (Group)
type	MakeConcept(%CLASSTYPECODE%,"http://terminology.hl7.org/CodeSystem/coverage-class")
value	%GROUPID%
name	%GROUPNAME%
class (Plan)
type	MakeConcept(%CLASSTYPECODEFORPLAN%,"http://terminology.hl7.org/CodeSystem/coverage-class",%CLASSTYPECODEFORPLAN%)
value	%PLANID%
name	%PLANNAME%

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

ATHENACoverage
Coverage	Event
identifier	Event.identifier
status	Event.status
beneficiary	Event.subject
period	Event.occurrence[x]

Mappings for RIM Mapping (http://hl7.org/v3)

ATHENACoverage
Coverage	Entity. Role, or Act, Coverage
meta
id	n/a
extension	n/a
text	Act.text?
contained	N/A
extension
extension (coverage-type)
id	n/a
extension	n/a
url	N/A
value[x]	N/A
extension (subscriber-name)
id	n/a
extension	n/a
url	N/A
value[x]	N/A
modifierExtension	N/A
identifier	.id
status	Act.status
period	Act.effectiveTime
class
id	n/a
extension	n/a
modifierExtension	N/A
class (Group)
id	n/a
extension	n/a
modifierExtension	N/A
class (Plan)
id	n/a
extension	n/a
modifierExtension	N/A
costToBeneficiary
id	n/a
extension	n/a
modifierExtension	N/A
exception
id	n/a
extension	n/a
modifierExtension	N/A
contract	n/a

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

ATHENACoverage
Coverage
identifier	FiveWs.identifier
status	FiveWs.status
type	FiveWs.class
policyHolder	FiveWs.subject[x], FiveWs.subject
subscriber	FiveWs.subject[x], FiveWs.subject
subscriberId	FiveWs.subject[x], FiveWs.subject
beneficiary	FiveWs.subject[x], FiveWs.subject
period	FiveWs.done[x]
payor	FiveWs.author

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

ATHENACoverage
Coverage
identifier	C02
policyHolder	D01 through D09
subscriber	D01 through D09
subscriberId	D01 through D09
beneficiary	D01 through D09
dependent	C17
relationship	C03
payor	A05
class
value	C11 (Division,Section)
name	C11 (Division,Section)
class (Group)
value	C11 (Division,Section)
name	C11 (Division,Section)
class (Plan)
value	C11 (Division,Section)
name	C11 (Division,Section)
network	D10
costToBeneficiary
value[x]	C11 (Division,Section)
contract	D01 through D09

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

ATHENACoverage
Coverage
identifier	IN1-2
type	IN1-15
policyHolder	IN1-16, 18, 19-name of insured, address, date of birth
subscriber	IN1-16, 18, 19-name of insured, address, date of birth
subscriberId	IN1-16, 18, 19-name of insured, address, date of birth
beneficiary	IN1-16, 18, 19-name of insured, address, date of birth
dependent	- No exact HL7 v2 equivalent concept seems to exist;
period	IN1-12 / IN1-13
payor	IN1-3
class
value	IN1-8
name	IN1-8
class (Group)
value	IN1-8
name	IN1-8
class (Plan)
value	IN1-8
name	IN1-8
order	- No exact HL7 v2 equivalent concept seems to exist;
costToBeneficiary
value[x]	IN1-8
contract	IN1-16, 18, 19

Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

ATHENACoverage
Coverage
identifier	C.32, C.33, C.39
policyHolder	C.35
subscriber	C.35
subscriberId	C.35
beneficiary	C.35
payor	C.30
class
value	C.31
name	C.31
class (Group)
value	C.31
name	C.31
class (Plan)
value	C.31
name	C.31
costToBeneficiary
value[x]	C.31
contract	C.35