FHIR Release 3 (STU) 4

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13.1.6 13.1.7 Resource Coverage - Mappings

Financial Management Work Group Maturity Level : N/A Ballot Standards Status : Informative Security Category : Patient Compartments : Patient , RelatedPerson

Mappings:

RIM FiveWs Pattern Mapping

Workflow Pattern

HL7 v2 Mapping

RIM Mapping

Canadian Dental Association eclaims standard

Canadian Pharmacy Associaiton eclaims standard

Workflow Mapping

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

13.1.6.1 13.1.7.1 Mappings for RIM FiveWs Pattern Mapping (http://hl7.org/v3) ( 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 13.1.7.2 Workflow Pattern ( http://hl7.org/fhir/workflow )         subGroupDisplay         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 13.1.7.3 Mappings for HL7 v2 Mapping (http://hl7.org/v2) ( 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         type IN1-8
        groupDisplay         value IN1-8
        subGroup         name IN1-8
        subGroupDisplay     order IN1-8 - No exact HL7 v2 equivalent concept seems to exist;
        plan     network IN1-35
        planDisplay     costToBeneficiary IN1-35
        subPlan         type IN1-10
        subPlanDisplay         value[x] IN1-10 IN1-8
        class         exception IN1-35
        classDisplay             type IN1-35
        subClass             period IN1-35
        subClassDisplay     subrogation IN1-35
    dependent     contract - No exact HL7 v2 equivalent concept seems to exist; IN1-16, 18, 19

13.1.7.4 RIM Mapping ( http://hl7.org/v3 )

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

13.1.6.3 13.1.7.5 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/) ( 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     dependent C03 C17
    period     relationship C03
    payor     period A05     grouping
        group     payor C11 (Division,Section) A05
        groupDisplay     class C11 (Division,Section)
        subGroup         type         subGroupDisplay
        plan         value C01 C11 (Division,Section)
        planDisplay         name C01 C11 (Division,Section)
        subPlan     order         subPlanDisplay
        class     network C01 D10
        classDisplay     costToBeneficiary C01
        subClass         type C01
        subClassDisplay         value[x] C01 C11 (Division,Section)
    dependent         exception C17
    sequence             type D11
    order             period
    network     subrogation D10
    contract D01 through D09

13.1.6.4 13.1.7.6 Mappings for Canadian Pharmacy Associaiton eclaims standard (http://www.pharmacists.ca/) ( http://www.pharmacists.ca/ )

Event
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     dependent C.31         subGroup
        subGroupDisplay     relationship         plan         planDisplay
        subPlan         subPlanDisplay     period         class         classDisplay
        subClass     payor         subClassDisplay     dependent C.30
    sequence     class     order     network
    contract         type C.35 13.1.6.5 Mappings for Workflow Mapping (http://hl7.org/fhir/workflow) Coverage
    identifier         value Event.identifier C.31
    status         name Event.status C.31
    type     order     policyHolder     subscriber
    subscriberId     network     beneficiary Event.subject
    relationship     costToBeneficiary     period Event.occurrence
    payor         type     grouping         group
        groupDisplay         value[x]         subGroup C.31
        subGroupDisplay         exception         plan         planDisplay
        subPlan             type         subPlanDisplay         class
        classDisplay             period         subClass         subClassDisplay
    dependent     subrogation     sequence     order
    network     contract     contract C.35