Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.1.8 Resource Coverage - Mappings

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

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

Coverage financial.support
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]

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

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

13.1.8.3 HL7 V2 Mapping (http://hl7.org/v2 icon)

Coverage
identifier
status
kind
paymentBy
party
responsibility
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
insurer
class
type
value IN1-2
name IN1-8
order
network
costToBeneficiary
type
category
network
unit
term
value[x] IN1-8
exception
type
period
subrogation
contract IN1-16, 18, 19
insurancePlan

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

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

13.1.8.5 Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/ icon)

Coverage
identifier C02
status
kind
paymentBy
party
responsibility
type
policyHolder D01 through D09
subscriber D01 through D09
subscriberId D01 through D09
beneficiary D01 through D09
dependent C17
relationship C03
period
insurer
class
type
value C11 (Division,Section)
name C11 (Division,Section)
order
network D10
costToBeneficiary
type
category
network
unit
term
value[x] C11 (Division,Section)
exception
type
period
subrogation
contract D01 through D09
insurancePlan

13.1.8.6 Canadian Pharmacy Association eclaims standard (http://www.pharmacists.ca/ icon)

Coverage
identifier C.32, C.33, C.39
status
kind
paymentBy
party
responsibility
type
policyHolder C.35
subscriber C.35
subscriberId C.35
beneficiary C.35
dependent
relationship
period
insurer
class
type
value C.31
name C.31
order
network
costToBeneficiary
type
category
network
unit
term
value[x] C.31
exception
type
period
subrogation
contract C.35
insurancePlan

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