Coverage FHIR Resource Proposal
- 1 Coverage
- 1.1 Owning committee name
- 1.2 Contributing or Reviewing Work Groups
- 1.3 FHIR Resource Development Project Insight ID
- 1.4 Scope of coverage
- 1.5 RIM scope
- 1.6 Resource appropriateness
- 1.7 Expected implementations
- 1.8 Content sources
- 1.9 Examples
- 1.10 Resource Relationships
- 1.11 Timelines
- 1.12 gForge Users
Owning committee name
Contributing or Reviewing Work Groups
FHIR Resource Development Project Insight ID
Scope of coverage
Represents all types of insurance coverage for healthcare-related services. This includes purchased coverage, employer plans, government funded plans, identifiers for state-funded healthcare not modelled/identified as insurance, etc. It includes coverage for humans as well as animals. It also includes extensions and authorizations to existing coverage.
The resource is limited to plans "in effect" for particular individuals or groups of individuals and does not include plan definitions identifying types of coverage that may be available.
Contract class with classCode of COV and moodCode of EVN.
Insurance is a well-understood concept. Coverage of some sort is available for most healthcare services in most jurisdictions. Coverage instances are well identified (often by a cascading set of ids). While the payments offered by some policies may be influenced by the existence of other policies, each policy is independent and can be maintained separately. Coverage information is sometimes maintained directly on patient records, however it is really a distinct thing.
Referenced by CCDA.
- v2 IN1, IN2, IN3 segments
- v3 claims models
- Representation of healthcare card
- National coverage
- Workers compensation coverage
- Coverage extension for a particular service
Coverage is associated to Patients as covered parties and RelatedPersons as policy holders. Coverage is referenced by Invoices and other financial-related resources
Part of initial DSTU