Release 4 4B

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13.1.7 13.1.8 Resource Coverage - Mappings

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

Mappings:

FiveWs Pattern Mapping

Workflow Pattern

HL7 v2 Mapping

RIM Mapping

Canadian Dental Association eclaims standard

Canadian Pharmacy Associaiton eclaims standard

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

13.1.7.1 13.1.8.1 FiveWs Pattern Mapping ( http://hl7.org/fhir/fivews )

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

13.1.7.2 13.1.8.2 Workflow Pattern ( http://hl7.org/fhir/workflow )

Coverage Event
    identifier Event.identifier
    status Event.status
    beneficiary Event.subject
    period Event.occurrence[x]

13.1.7.3 13.1.8.3 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
    class
        type
        value IN1-8
        name IN1-8
    order - No exact HL7 v2 equivalent concept seems to exist;
    network
    costToBeneficiary
        type
        value[x] IN1-8
        exception
            type
            period
    subrogation
    contract IN1-16, 18, 19

13.1.7.4 13.1.8.4 RIM Mapping ( http://hl7.org/v3 )

Coverage Coverage
    identifier .id
    status Act.status
    period Act.effectiveTime
    contract n/a

13.1.7.5 13.1.8.5 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
    dependent C17
    relationship C03
    period
    payor A05
    class
        type
        value C11 (Division,Section)
        name C11 (Division,Section)
    order
    network D10
    costToBeneficiary
        type
        value[x] C11 (Division,Section)
        exception
            type
            period
    subrogation
    contract D01 through D09

13.1.7.6 13.1.8.6 Canadian Pharmacy Associaiton eclaims standard ( http://www.pharmacists.ca/ )

Coverage
    identifier C.32, C.33, C.39
    status
    type
    policyHolder C.35
    subscriber C.35
    subscriberId C.35
    beneficiary C.35
    dependent
    relationship
    period
    payor C.30
    class
        type
        value C.31
        name C.31
    order
    network
    costToBeneficiary
        type
        value[x] C.31
        exception
            type
            period
    subrogation
    contract C.35