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13.1.6 Resource Coverage - Mappings

Financial Management Work Group

Maturity Level : N/A

Ballot Status : Informative

Compartments : Patient , RelatedPerson

Mappings for the coverage resource. resource (see Mappings to Other Standards for further information & status).

13.1.6.1 Mappings for RIM Mapping (http://hl7.org/v3) FiveWs Pattern (http://hl7.org/fhir/fivews)

        groupDisplay

Coverage	Coverage
identifier	FiveWs.identifier
status	FiveWs.status
type	FiveWs.class
policyHolder	FiveWs.subject[x]
subscriber	FiveWs.subject[x]
subscriberId	FiveWs.subject[x]
beneficiary	relationship FiveWs.subject[x]
period	payor FiveWs.done[x]
grouping     payor	group FiveWs.author

        subGroup

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

planDisplay         subPlan Coverage         subPlanDisplay	class Event
classDisplay     identifier	subClass Event.identifier
subClassDisplay     status	dependent Event.status
sequence     beneficiary	order Event.subject
network     period	contract Event.occurrence[x]

13.1.6.2 13.1.6.3 Mappings for HL7 v2 Mapping (http://hl7.org/v2)

Coverage
identifier	IN1-2
status
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;
relationship
period	IN1-12 / IN1-13
payor	IN1-3
grouping     class	group IN1-8
groupDisplay         type	IN1-8
subGroup         value	IN1-8
subGroupDisplay         name	IN1-8
plan     order	IN1-35 - No exact HL7 v2 equivalent concept seems to exist;
planDisplay     network	IN1-35
subPlan     copay	IN1-10
subPlanDisplay         type	IN1-10
class         value	IN1-35 IN1-8
classDisplay     contract	IN1-35 IN1-16, 18, 19

        subClass IN1-35

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

No HL7 v2 equivalent concept seems to exist

dependent Coverage	- No exact HL7 v2 equivalent concept seems to exist; Coverage
sequence     identifier	.id
order     status	- No exact HL7 v2 equivalent concept seems to exist; Act.status
network     period	Act.effectiveTime
contract	IN1-16, 18, 19 n/a

13.1.6.3 13.1.6.5 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

Coverage
identifier	C02
status
type
policyHolder	D01 through D09
subscriber	D01 through D09
subscriberId	D01 through D09
beneficiary	D01 through D09
relationship C03     dependent	period C17
payor     relationship	A05 C03
grouping     period	group C11 (Division,Section)
groupDisplay     payor	C11 (Division,Section)         subGroup A05
subGroupDisplay     class	plan C01
planDisplay         type	C01         subPlan
subPlanDisplay         class         value	C01 C11 (Division,Section)
classDisplay         name	C01 C11 (Division,Section)
subClass     order	C01
subClassDisplay     network	C01 D10
dependent     copay	C17
sequence         type	D11     order
network         value	D10 C11 (Division,Section)
contract	D01 through D09

13.1.6.4 13.1.6.6 Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/)

13.1.6.5 Mappings for Workflow Mapping (http://hl7.org/fhir/workflow)     subscriberId

Coverage
identifier	C.32, C.33, C.39
status
type
policyHolder	C.35
subscriber	C.35
subscriberId	C.35
beneficiary	C.35
relationship     period     payor C.30     grouping         group C.31         groupDisplay C.31         subGroup         subGroupDisplay         plan         planDisplay         subPlan         subPlanDisplay         class         classDisplay         subClass         subClassDisplay     dependent	sequence     order
network     relationship	contract C.35
Coverage     period	Event     identifier Event.identifier
status     payor	Event.status C.30
type     class	policyHolder     subscriber
beneficiary         type	Event.subject     relationship
period         value	Event.occurrence C.31
payor     grouping         name	group C.31
groupDisplay     order	subGroup         subGroupDisplay
plan     network	planDisplay         subPlan
subPlanDisplay     copay	class         classDisplay
subClass         type	subClassDisplay     dependent
sequence         value	order C.31
network     contract	contract C.35