German Practice Management FHIR Profiles (R4)
0.49.0 - STU1 Germany flag

German Practice Management FHIR Profiles (R4) - Local Development build (v0.49.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: FPDE Coverage Privat

Official URL: https://fhir.cognovis.de/praxis/StructureDefinition/fpde-coverage-privat Version: 0.49.0
Active as of 2026-05-04 Computable Name: FPDECoveragePrivat
Other Identifiers: OID:2.16.840.1.113883.3.7985.42.66

Privat oder selbst zu zahlendes Versicherungsverhaeltnis. Die Coverage ist der Routing-Anker fuer optionale Fremdabrechnung via PVS/Billing Service.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* CoverageDeBasis Versicherungsdaten
Constraints: fpde-coverage-privat-type
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:billingAssignment S 0..1 Reference(Organization) Coverage-spezifische Forderungsabtretung an eine PVS
URL: https://fhir.cognovis.de/praxis/StructureDefinition/billing-assignment
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... type SΣ 1..1 CodeableConcept Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Code defined by a terminology system
...... system SΣ 0..1 uri Identity of the terminology system
Required Pattern: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 0..1 string Representation defined by the system
... subscriber SΣC 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
Constraints: ref-1
... beneficiary SΣC 1..1 Reference(Patient) Begünstigte Person
Constraints: ref-1
... payor SΣC 1..* Reference(Organization | Patient | RelatedPerson) Versicherer
Constraints: ref-1
.... display SΣ 0..1 string Text alternative for the resource

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.6.0-ballot de.basisprofil.r4 v1.6

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
fpde-coverage-privat-type error Coverage Coverage.type muss eine VersicherungsartDeBasis-Kodierung mit PKV oder SEL enthalten. type.coding.where(system = 'http://fhir.de/CodeSystem/versicherungsart-de-basis').where(code = 'PKV' or code = 'SEL').exists()
ref-1 error Coverage.subscriber, Coverage.beneficiary, Coverage.payor SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from CoverageDeBasis

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* CoverageDeBasis Versicherungsdaten
Constraints: fpde-coverage-privat-type
... Slices for extension Content/Rules for all slices
.... extension:billingAssignment S 0..1 Reference(Organization) Coverage-spezifische Forderungsabtretung an eine PVS
URL: https://fhir.cognovis.de/praxis/StructureDefinition/billing-assignment
... type S 1..1 CodeableConcept Versicherungsart
.... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis S 1..1 Coding Code defined by a terminology system
...... system S 0..1 uri Identity of the terminology system
Required Pattern: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 0..1 string Representation defined by the system
... subscriber S 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
... payor S 1..* Reference(Organization | Patient | RelatedPerson) Versicherer
.... display S 0..1 string Text alternative for the resource

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression
fpde-coverage-privat-type error Coverage Coverage.type muss eine VersicherungsartDeBasis-Kodierung mit PKV oder SEL enthalten. type.coding.where(system = 'http://fhir.de/CodeSystem/versicherungsart-de-basis').where(code = 'PKV' or code = 'SEL').exists()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* CoverageDeBasis Versicherungsdaten
Constraints: fpde-coverage-privat-type
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... extension:billingAssignment S 0..1 Reference(Organization) Coverage-spezifische Forderungsabtretung an eine PVS
URL: https://fhir.cognovis.de/praxis/StructureDefinition/billing-assignment
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 0..1 uri Identity of the terminology system
Required Pattern: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subscriber SΣC 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
Constraints: ref-1
... beneficiary SΣC 1..1 Reference(Patient) Begünstigte Person
Constraints: ref-1
... 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 ΣC 0..1 Period Coverage start and end dates
Constraints: per-1
... payor SΣC 1..* Reference(Organization | Patient | RelatedPerson) Versicherer
Constraints: ref-1
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display SΣ 0..1 string Text alternative for the resource
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... 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
Slice: Unordered, Open by value:url
.... 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
Slice: Unordered, Open by value:url
..... 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 ΣC 0..1 Period The effective period of the exception
Constraints: per-1
... subrogation 0..1 boolean Reimbursement to insurer
... contract C 0..* Reference(Contract) Contract details
Constraints: ref-1

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.6.0-ballot de.basisprofil.r4 v1.6
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.payor.type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
fpde-coverage-privat-type error Coverage Coverage.type muss eine VersicherungsartDeBasis-Kodierung mit PKV oder SEL enthalten. type.coding.where(system = 'http://fhir.de/CodeSystem/versicherungsart-de-basis').where(code = 'PKV' or code = 'SEL').exists()
per-1 error Coverage.period, Coverage.costToBeneficiary.exception.period If present, start SHALL have a lower value than end start.hasValue().not() or end.hasValue().not() or (start <= end)
ref-1 error Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from CoverageDeBasis

Summary

Mandatory: 3 elements
Must-Support: 10 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.type.coding

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* CoverageDeBasis Versicherungsdaten
Constraints: fpde-coverage-privat-type
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:billingAssignment S 0..1 Reference(Organization) Coverage-spezifische Forderungsabtretung an eine PVS
URL: https://fhir.cognovis.de/praxis/StructureDefinition/billing-assignment
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... type SΣ 1..1 CodeableConcept Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Code defined by a terminology system
...... system SΣ 0..1 uri Identity of the terminology system
Required Pattern: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 0..1 string Representation defined by the system
... subscriber SΣC 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
Constraints: ref-1
... beneficiary SΣC 1..1 Reference(Patient) Begünstigte Person
Constraints: ref-1
... payor SΣC 1..* Reference(Organization | Patient | RelatedPerson) Versicherer
Constraints: ref-1
.... display SΣ 0..1 string Text alternative for the resource

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.6.0-ballot de.basisprofil.r4 v1.6

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
fpde-coverage-privat-type error Coverage Coverage.type muss eine VersicherungsartDeBasis-Kodierung mit PKV oder SEL enthalten. type.coding.where(system = 'http://fhir.de/CodeSystem/versicherungsart-de-basis').where(code = 'PKV' or code = 'SEL').exists()
ref-1 error Coverage.subscriber, Coverage.beneficiary, Coverage.payor SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Differential View

This structure is derived from CoverageDeBasis

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* CoverageDeBasis Versicherungsdaten
Constraints: fpde-coverage-privat-type
... Slices for extension Content/Rules for all slices
.... extension:billingAssignment S 0..1 Reference(Organization) Coverage-spezifische Forderungsabtretung an eine PVS
URL: https://fhir.cognovis.de/praxis/StructureDefinition/billing-assignment
... type S 1..1 CodeableConcept Versicherungsart
.... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis S 1..1 Coding Code defined by a terminology system
...... system S 0..1 uri Identity of the terminology system
Required Pattern: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 0..1 string Representation defined by the system
... subscriber S 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
... payor S 1..* Reference(Organization | Patient | RelatedPerson) Versicherer
.... display S 0..1 string Text alternative for the resource

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression
fpde-coverage-privat-type error Coverage Coverage.type muss eine VersicherungsartDeBasis-Kodierung mit PKV oder SEL enthalten. type.coding.where(system = 'http://fhir.de/CodeSystem/versicherungsart-de-basis').where(code = 'PKV' or code = 'SEL').exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* CoverageDeBasis Versicherungsdaten
Constraints: fpde-coverage-privat-type
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... extension:billingAssignment S 0..1 Reference(Organization) Coverage-spezifische Forderungsabtretung an eine PVS
URL: https://fhir.cognovis.de/praxis/StructureDefinition/billing-assignment
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:$this
..... coding:VersicherungsArtDeBasis SΣ 1..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 0..1 uri Identity of the terminology system
Required Pattern: http://fhir.de/CodeSystem/versicherungsart-de-basis
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subscriber SΣC 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
Constraints: ref-1
... beneficiary SΣC 1..1 Reference(Patient) Begünstigte Person
Constraints: ref-1
... 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 ΣC 0..1 Period Coverage start and end dates
Constraints: per-1
... payor SΣC 1..* Reference(Organization | Patient | RelatedPerson) Versicherer
Constraints: ref-1
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display SΣ 0..1 string Text alternative for the resource
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... 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
Slice: Unordered, Open by value:url
.... 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
Slice: Unordered, Open by value:url
..... 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 ΣC 0..1 Period The effective period of the exception
Constraints: per-1
... subrogation 0..1 boolean Reimbursement to insurer
... contract C 0..* Reference(Contract) Contract details
Constraints: ref-1

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.6.0-ballot de.basisprofil.r4 v1.6
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.payor.type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
fpde-coverage-privat-type error Coverage Coverage.type muss eine VersicherungsartDeBasis-Kodierung mit PKV oder SEL enthalten. type.coding.where(system = 'http://fhir.de/CodeSystem/versicherungsart-de-basis').where(code = 'PKV' or code = 'SEL').exists()
per-1 error Coverage.period, Coverage.costToBeneficiary.exception.period If present, start SHALL have a lower value than end start.hasValue().not() or end.hasValue().not() or (start <= end)
ref-1 error Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

This structure is derived from CoverageDeBasis

Summary

Mandatory: 3 elements
Must-Support: 10 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.type.coding

 

Other representations of profile: CSV, Excel, Schematron