FHIR Implementation Guide for NJSAMS

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-6: A resource should have narrative for robust management dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
identifier:sbi	Σ	0..1	Identifier	SBI Number ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi
value	Σ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:CSCInitiativeID	Σ	0..1	Identifier	CSCInitiativeID ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID
value	Σ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
beneficiary	ΣC	1..1	Reference(Patient)	Plan beneficiary ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
payor	ΣC	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.identifier:sbi.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:CSCInitiativeID.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** elements	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ref-1	error	Coverage.beneficiary, Coverage.payor	SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Slices for identifier	S	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:sbi		0..1	Identifier	SBI Number
system		1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi
value		0..1	string	The value that is unique
identifier:CSCInitiativeID		0..1	Identifier	CSCInitiativeID
system		1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID
value		0..1	string	The value that is unique
status		1..1	code	active | cancelled | draft | entered-in-error
beneficiary		1..1	Reference(Patient)	Plan beneficiary
payor		1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:sbi	Σ	0..1	Identifier	SBI Number
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi
value	Σ	0..1	string	The value that is unique Example General: 123456
period	ΣC	0..1	Period	Time period when id is/was valid for use per-1: If present, start SHALL have a lower value than end
assigner	ΣC	0..1	Reference(Organization)	Organization that issued id (may be just text) ref-1: SHALL have a contained resource if a local reference is provided
identifier:CSCInitiativeID	Σ	0..1	Identifier	CSCInitiativeID
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID
value	Σ	0..1	string	The value that is unique Example General: 123456
period	ΣC	0..1	Period	Time period when id is/was valid for use per-1: If present, start SHALL have a lower value than end
assigner	ΣC	0..1	Reference(Organization)	Organization that issued id (may be just text) ref-1: SHALL have a contained resource if a local reference is provided
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	ΣC	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy ref-1: SHALL have a contained resource if a local reference is provided
subscriber	ΣC	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy ref-1: SHALL have a contained resource if a local reference is provided
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	ΣC	1..1	Reference(Patient)	Plan beneficiary ref-1: SHALL have a contained resource if a local reference is provided
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	ΣC	0..1	Period	Coverage start and end dates per-1: If present, start SHALL have a lower value than end
payor	ΣC	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy ref-1: SHALL have a contained resource if a local reference is provided
class		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	ΣC	0..1	Period	The effective period of the exception per-1: If present, start SHALL have a lower value than end
subrogation		0..1	boolean	Reimbursement to insurer
contract	C	0..*	Reference(Contract)	Contract details ref-1: SHALL have a contained resource if a local reference is provided
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:sbi.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:sbi.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:CSCInitiativeID.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:CSCInitiativeID.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** elements	Must have either extensions or value[x], not both : extension.exists() != value.exists()
per-1	error	Coverage.identifier:sbi.period, Coverage.identifier:CSCInitiativeID.period, Coverage.period, Coverage.costToBeneficiary.exception.period	If present, start SHALL have a lower value than end : start.hasValue().not() or end.hasValue().not() or (start <= end)
ref-1	error	Coverage.identifier:sbi.assigner, Coverage.identifier:CSCInitiativeID.assigner, Coverage.policyHolder, Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract	SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Summary

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 1 element

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.identifier

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-6: A resource should have narrative for robust management dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
identifier:sbi	Σ	0..1	Identifier	SBI Number ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi
value	Σ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:CSCInitiativeID	Σ	0..1	Identifier	CSCInitiativeID ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID
value	Σ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
beneficiary	ΣC	1..1	Reference(Patient)	Plan beneficiary ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
payor	ΣC	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.identifier:sbi.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:CSCInitiativeID.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** elements	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ref-1	error	Coverage.beneficiary, Coverage.payor	SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Slices for identifier	S	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:sbi		0..1	Identifier	SBI Number
system		1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi
value		0..1	string	The value that is unique
identifier:CSCInitiativeID		0..1	Identifier	CSCInitiativeID
system		1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID
value		0..1	string	The value that is unique
status		1..1	code	active | cancelled | draft | entered-in-error
beneficiary		1..1	Reference(Patient)	Plan beneficiary
payor		1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier	SΣ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:sbi	Σ	0..1	Identifier	SBI Number
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi
value	Σ	0..1	string	The value that is unique Example General: 123456
period	ΣC	0..1	Period	Time period when id is/was valid for use per-1: If present, start SHALL have a lower value than end
assigner	ΣC	0..1	Reference(Organization)	Organization that issued id (may be just text) ref-1: SHALL have a contained resource if a local reference is provided
identifier:CSCInitiativeID	Σ	0..1	Identifier	CSCInitiativeID
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID
value	Σ	0..1	string	The value that is unique Example General: 123456
period	ΣC	0..1	Period	Time period when id is/was valid for use per-1: If present, start SHALL have a lower value than end
assigner	ΣC	0..1	Reference(Organization)	Organization that issued id (may be just text) ref-1: SHALL have a contained resource if a local reference is provided
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	ΣC	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy ref-1: SHALL have a contained resource if a local reference is provided
subscriber	ΣC	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy ref-1: SHALL have a contained resource if a local reference is provided
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	ΣC	1..1	Reference(Patient)	Plan beneficiary ref-1: SHALL have a contained resource if a local reference is provided
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	ΣC	0..1	Period	Coverage start and end dates per-1: If present, start SHALL have a lower value than end
payor	ΣC	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy ref-1: SHALL have a contained resource if a local reference is provided
class		0..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	ΣC	0..1	Period	The effective period of the exception per-1: If present, start SHALL have a lower value than end
subrogation		0..1	boolean	Reimbursement to insurer
contract	C	0..*	Reference(Contract)	Contract details ref-1: SHALL have a contained resource if a local reference is provided
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:sbi.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:sbi.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:CSCInitiativeID.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:CSCInitiativeID.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** elements	Must have either extensions or value[x], not both : extension.exists() != value.exists()
per-1	error	Coverage.identifier:sbi.period, Coverage.identifier:CSCInitiativeID.period, Coverage.period, Coverage.costToBeneficiary.exception.period	If present, start SHALL have a lower value than end : start.hasValue().not() or end.hasValue().not() or (start <= end)
ref-1	error	Coverage.identifier:sbi.assigner, Coverage.identifier:CSCInitiativeID.assigner, Coverage.policyHolder, Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract	SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Summary

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 1 element

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.identifier