Implementation Guide
23.1.0 - R4 APIs

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Resource Profile: Profile - Athena Coverage

Official URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile Version: 23.1.0
Active as of 2022-03-01 Computable Name: ATHENACoverage

Defines constraints and extensions on the condition resource as supported by Athena Products.

This Coverage profile is part of the set of resource profiles supported by the API Server used with the athenaPractice and athenaFlow products. It further describes read and search capabilities of these products. Note: The create and update operations are NOT supported for this resource.

Overview

The Coverage resource provides the financial instrument that may be used to pay for or reimburse health care products and services.

Scope and Usage

This profile is used to define the content that will be returned by the API Server in response to requests to access Coverage resources. All elements listed in the differential profile view are Supported,which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

The profile also defines the content that must be supplied to the API Server in response to requests to populate Coverage resources. Fields which are marked as Mandatory in this profile are those that must be supplied to the API Server in content used to populate a resource.

Source

The Coverage resource is used to information about the patient's insurance coverage. Content of the resource derives from the PatientInsurance table in athenaPractice and the INSURANC table in athenaFlow. Specific detail can be found in the Mappings tab in the profile detail page.

Usage:

Formal Views of Profile Content

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

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
.... versionId 0..1 id Version specific identifier
.... lastUpdated 0..1 instant When the resource version last changed
.... Slices for profile Content/Rules for all slices
..... profile:ATHENA Coverage Profile 1..1 canonical() Profiles this resource claims to conform to
Fixed Value: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile
.... security 0..1 Coding Security Labels applied to this resource
... Slices for extension Content/Rules for all slices
.... coverage-type 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type"
..... value[x] 1..1 string Value of extension
.... subscriber-name 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name"
..... value[x] 1..1 HumanName Value of extension
... status S 1..1 code active | cancelled | draft | entered-in-error
... type 0..1 CodeableConcept Coverage category such as medical or accident
... policyHolder 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber 0..1 Reference(Patient) Subscriber to the policy
... subscriberId 0..1 string ID assigned to the subscriber
... beneficiary S 1..1 Reference(Patient) Plan beneficiary
... period 0..1 Period Coverage start and end dates
... payor S 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... type S 1..1 CodeableConcept Type of class such as 'group' or 'plan'
.... value S 1..1 string Value associated with the type

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... Slices for profile Content/Rules for all slices
..... profile:ATHENA Coverage Profile Σ 1..1 canonical() Profiles this resource claims to conform to

Fixed Value: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile
.... security Σ 0..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
.... coverage-type 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type"
..... value[x] 1..1 string Value of extension
.... subscriber-name 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name"
..... value[x] 1..1 HumanName Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(Patient) Plan beneficiary
... period Σ 0..1 Period Coverage start and end dates
... payor SΣ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value SΣ 1..1 string Value associated with the type

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... Slices for profile Content/Rules for all slices
..... profile:ATHENA Coverage Profile Σ 1..1 canonical() Profiles this resource claims to conform to

Fixed Value: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile
.... security Σ 0..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... coverage-type 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type"
..... value[x] 1..1 string Value of extension
.... subscriber-name 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name"
..... value[x] 1..1 HumanName Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(Patient) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ 0..1 Period Coverage start and end dates
... payor SΣ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value SΣ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Coverage.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

This structure is derived from Coverage

Summary

Mandatory: 4 elements(7 nested mandatory elements)
Must-Support: 6 elements
Fixed: 3 elements

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id S 1..1 id Logical id of this artifact
... meta 0..1 Meta Metadata about the resource
.... versionId 0..1 id Version specific identifier
.... lastUpdated 0..1 instant When the resource version last changed
.... Slices for profile Content/Rules for all slices
..... profile:ATHENA Coverage Profile 1..1 canonical() Profiles this resource claims to conform to
Fixed Value: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile
.... security 0..1 Coding Security Labels applied to this resource
... Slices for extension Content/Rules for all slices
.... coverage-type 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type"
..... value[x] 1..1 string Value of extension
.... subscriber-name 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name"
..... value[x] 1..1 HumanName Value of extension
... status S 1..1 code active | cancelled | draft | entered-in-error
... type 0..1 CodeableConcept Coverage category such as medical or accident
... policyHolder 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber 0..1 Reference(Patient) Subscriber to the policy
... subscriberId 0..1 string ID assigned to the subscriber
... beneficiary S 1..1 Reference(Patient) Plan beneficiary
... period 0..1 Period Coverage start and end dates
... payor S 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... type S 1..1 CodeableConcept Type of class such as 'group' or 'plan'
.... value S 1..1 string Value associated with the type

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... Slices for profile Content/Rules for all slices
..... profile:ATHENA Coverage Profile Σ 1..1 canonical() Profiles this resource claims to conform to

Fixed Value: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile
.... security Σ 0..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
.... coverage-type 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type"
..... value[x] 1..1 string Value of extension
.... subscriber-name 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name"
..... value[x] 1..1 HumanName Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(Patient) Plan beneficiary
... period Σ 0..1 Period Coverage start and end dates
... payor SΣ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value SΣ 1..1 string Value associated with the type

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... Slices for profile Content/Rules for all slices
..... profile:ATHENA Coverage Profile Σ 1..1 canonical() Profiles this resource claims to conform to

Fixed Value: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-profile
.... security Σ 0..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... coverage-type 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-coverage-type"
..... value[x] 1..1 string Value of extension
.... subscriber-name 0..1 (Complex) Extension
URL: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-coverage-extension-subscriber-name"
..... value[x] 1..1 HumanName Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(Patient) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ 0..1 Period Coverage start and end dates
... payor SΣ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value SΣ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Coverage.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

This structure is derived from Coverage

Summary

Mandatory: 4 elements(7 nested mandatory elements)
Must-Support: 6 elements
Fixed: 3 elements

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Supported Interactions

Interactions supported by this resource are listed below.

Search Parameters

Search parameters are executed as specified in the HL7 FHIR RESTful API implementation definition. To search for Coverage resources, an application shall perform an HTTP GET, specifying the query parameters associated with the resource.

GET [base]/fhir/Coverage?{search-parameters}{&_count=[max-results]&_format=[json|xml]&_summary=[true|text|data]}

Where:

Name Description
[base] Specifies the base URL of the FHIR Server, e.g., https://apsandbox.fhirapi.athenahealth.com/demoAPIServer
[_count] Specifies the maximum number of search results to return in a single query. Note: The count of results does not limit the number of additional resources returned via the _include parameter. No more than max-results Coverage resources which match the search criteria will be returned. The API Server has default and maximum limits for the value that can be specified for this parameter. These limits may vary depending upon the client application vendors participation level in the Athenahealth Partner program. Note: The API Server support the HL7 FHIR Paging capability.
[_format] Specifies the format of the output and may be xml or json. When present, the _format value overrides the value of the Accept header in the request.
[_summary] Filters the output to include only narrative elements (_summary=text), summary elements (_summary=true) or to omit the generated narrative (_summary=data). Note: If the generated html narrative for the resource is not going to be used by the call, using _summary=data provides improved API response times, especially when returning larger result sets.
_id (token) The ID of the resource
patient (token) The PID of the resource
_security (token)
_lastUpdated (date)
_lastUpdated-fromnow (quantity) Like _lastUpdated except expressed as a positive or negative offset from the current time in units of time, e.g. _lastUpdated-fromnow=ge7||d for more than seven days in the future or =le-2||mo for less than two months in the past. The unit must be specified.
identifier (token) Any identifier for the Coverage (not the accreditation issuer's identifier)
beneficiary (string) Covered party
payor (reference) The identity of the insurer or party paying for services
type (token) The kind of coverage (health plan, auto, Workers Compensation)
subscriber (reference) The kind of coverage (health plan, auto, Workers Compensation)
period (date) period-fromnow (quantity)
status (string) The status of the Coverage
policy-holder (reference) Reference to the policyholder
HTTP Response Codes

The following HTTP response codes are returned by this API call:

200 OK The query was performed and any results found are contained within the body of the HTTP response. Note: The search API will return 200 OK when the query itself is successful, regardless of whether or not any matching results were found.
401 Unauthorized Authorization is required for this request, and either the Authorization header is missing or the supplied user credentials in the Authorization header are not valid or have expired. The body of the HTTP response will contain an OperationOutcome resource that indicates that Authorization is required.
500 Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.