HRexCoverage

HRex Member Match Coverage Profile

activeDa Vinci HRex1.2.0resource20 key elements

The HRex Coverage Profile defines the constraints for representing a member's healthcare insurance information to the Payer for member match purposes. Coverage instances complying with this profile, sometimes together with the Patient which this profile references via `beneficiary`, allows a payer to identify a member in their system. It aligns with the equivalent US Core profile, but diverges in that it does not require Patient.identifier for the beneficiary.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage
ID
hrex-coverage
Type
Base Definition
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
identifier
S
Member ID and other identifiers
:memberid0..1
S
Member ID
identifier.type
1+
Member Number identifier type
identifier.value
S1+
status
S
type
S
policyHolder
Reference
S
subscriberId
S
Subscriber ID
beneficiary
Reference
S
dependent
S
relationship
S1+
period
S
payor
Reference
S
:group0..1
S
Group
class.type
S
class.value
S
Group Number
:plan0..1
S
Plan
class.type
S
class.value
S
Plan Number
class.name
S
Plan Name