SpecialtyRxCoverage

Specialty Rx Coverage

activeSpecialty Rx2.0.0resource14 key elements

This profile constrains the Coverage resource for carrying insurance coverage information in the specialty medication enrollment process

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/specialty-rx/StructureDefinition/specialty-rx-coverage
ID
specialty-rx-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 assigned by health plan
identifier.type
1+
Member Number identifier type
subscriberId
S
ID assigned to the subscriber by the health plan
payor
S
class0..*
S
Pharmacy coverage identifiers
:bin
S
IIN (BIN) number
class.type1..1
1+
:pcn
S
Processor Control Number (PCN)
class.type1..1
1+
:rxgroup-id
S
Pharmacy Benefit Group ID
class.type1..1
1+
:pbm-member-id
S
Member ID assigned by the pharmacy benefit manager (PBM)
class.type1..1
1+