Magentus Practice Management FHIR Implementation Guide - Local Development build (v1.2.60) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
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• JSON

Resource Profile: Genie Coverage

Genie Coverage core profile

Usages:

• Derived from this Profile: EOrders Coverage
• Use this Profile: EBookings ServiceRequest and EBookings Theatre List
• Refer to this Profile: EBookings ServiceRequest and Referral Request
• Examples for this Profile: Coverage/71272b8c-3061-48c3-aec6-812e1bf0eb39

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
id	SΣ	1..1	id	Unique resource identifier generated from genie bookings service or contained resource access number, e.g. 1
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed)
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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MC
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/medicare-number
value	Σ	1..1	string	Minimum length 10 digits, maximum length 11 digits with IRN Example General: 123456 Example Medicare card number: 32788511952 Max Length:11
identifier:dva	S	0..1	AUDVANumber	DVA number should be provided when Coverage type is VET (DVA)
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	1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required)
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/dva
value	Σ	1..1	string	DVA number Example General: 123456 Example DVA number: NBUR9080 Max Length:9
identifier:insurancemembernumber	S	0..1	AUInsuranceMemberNumber	Private insurance member number should be provided when Coverage type is HIP
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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
text		0..1	string	Plain text representation of the concept
coding	SΣ	1..1	Coding	Member number identifier type Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Insurance member number Example General: 123456
assigner	Σ	1..1	Reference(Organization)	Insurer
display	SΣ	1..1	string	Name of insurer
status	?!SΣ	1..1	code	active | cancelled Binding: Genie Coverage Status values (required)
type	SΣ	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required)
text	Σ	1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident
beneficiary	Σ	1..1	Reference(Genie Patient)	Patient
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson)
reference	SΣC	0..1	string	Patient reference when self funded
type	Σ	0..1	uri	Organization | Patient | RelatedPerson Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	National insurer identifier
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NII
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept Required Pattern: National Insurer identifier
system	Σ	0..1	uri	The namespace for the identifier value Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value	Σ	1..1	string	The value that is unique Example General: 123456
display	SΣ	1..1	string	Name of insurer or self funded payor
class		0..1	BackboneElement	Coverage classification
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Plan type Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Class type
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier:mcn.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:mcn.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.identifier:dva.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:dva.​type	Base	required	Genie DVA Entitlement ValueSet	📦1.2.60	This IG
Coverage.identifier:insurancemembernumber.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:insurancemembernumber.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.status	Base	required	Genie Coverage Status values	📦1.2.60	This IG
Coverage.type	Base	required	Genie Coverage Type and Self Pay codes	📦1.2.60	This IG
Coverage.payor.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from AUBaseCoverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage			AUBaseCoverage
id	S	1..1	id	Unique resource identifier generated from genie bookings service or contained resource access number, e.g. 1
Slices for identifier		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed)
value		1..1	string	Minimum length 10 digits, maximum length 11 digits with IRN
identifier:dva	S	0..1	AUDVANumber	DVA number should be provided when Coverage type is VET (DVA)
type		1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required)
identifier:insurancemembernumber	S	0..1	AUInsuranceMemberNumber	Private insurance member number should be provided when Coverage type is HIP
type
coding	S	1..1	Coding	Member number identifier type
system	S	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number
value	S	1..1	string	Insurance member number
assigner
display	S	1..1	string	Name of insurer
status	S	1..1	code	active | cancelled Binding: Genie Coverage Status values (required)
type	S	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required)
coding
code		0..1	code	pay | PUBLICPOL | payconc | WCBPOL | HIP | VET | AUTOPOL
display		0..1	string	Pay | public healthcare | Concession | workers compensation | health insurance plan policy | veteran health program | automobile
text		1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident
beneficiary		1..1	Reference(Genie Patient)	Patient
reference	S	1..1	string	Literal reference, Relative, internal or absolute URL
payor		1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson)
reference	S	0..1	string	Patient reference when self funded
type		0..1	uri	Organization | Patient | RelatedPerson
identifier	S	0..1	Identifier	National insurer identifier
type		0..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NII
text		0..1	string	Plain text representation of the concept Required Pattern: National Insurer identifier
system		0..1	uri	The namespace for the identifier value Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value		1..1	string	The value that is unique
display	S	1..1	string	Name of insurer or self funded payor
class		0..1	BackboneElement	Coverage classification
type		1..1	CodeableConcept	Plan type Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	S	1..1	string	Class type
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier:dva.​type	Base	required	Genie DVA Entitlement ValueSet	📦1.2.60	This IG
Coverage.status	Base	required	Genie Coverage Status values	📦1.2.60	This IG
Coverage.type	Base	required	Genie Coverage Type and Self Pay codes	📦1.2.60	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
id	SΣ	1..1	id	Unique resource identifier generated from genie bookings service or contained resource access number, e.g. 1
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed)
id		0..1	string	Unique id for inter-element referencing
extension		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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MC
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/medicare-number
value	Σ	1..1	string	Minimum length 10 digits, maximum length 11 digits with IRN Example General: 123456 Example Medicare card number: 32788511952 Max Length:11
period	Σ	0..1	Period	Time period when id is/was valid for use
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	Medicare card expiry date
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:dva	S	0..1	AUDVANumber	DVA number should be provided when Coverage type is VET (DVA)
id		0..1	string	Unique id for inter-element referencing
extension		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	1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required)
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/dva
value	Σ	1..1	string	DVA number Example General: 123456 Example DVA number: NBUR9080 Max Length:9
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:insurancemembernumber	S	0..1	AUInsuranceMemberNumber	Private insurance member number should be provided when Coverage type is HIP
id		0..1	string	Unique id for inter-element referencing
extension		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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Member number identifier type Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Insurance member number Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	1..1	Reference(Organization)	Insurer
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	SΣ	1..1	string	Name of insurer
status	?!SΣ	1..1	code	active | cancelled Binding: Genie Coverage Status values (required)
type	SΣ	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	pay | PUBLICPOL | payconc | WCBPOL | HIP | VET | AUTOPOL
display	Σ	0..1	string	Pay | public healthcare | Concession | workers compensation | health insurance plan policy | veteran health program | automobile
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(Genie Patient)	Patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
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	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Patient reference when self funded
type	Σ	0..1	uri	Organization | Patient | RelatedPerson Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	National insurer identifier
id		0..1	string	Unique id for inter-element referencing
extension		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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NII
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept Required Pattern: National Insurer identifier
system	Σ	0..1	uri	The namespace for the identifier value Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	SΣ	1..1	string	Name of insurer or self funded payor
class		0..1	BackboneElement	Coverage classification
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Plan type Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Class 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		0..*	Extension	Additional content defined by implementations
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		0..*	Extension	Additional content defined by implementations
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	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
Coverage.identifier:mcn.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:mcn.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.identifier:dva.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:dva.​type	Base	required	Genie DVA Entitlement ValueSet	📦1.2.60	This IG
Coverage.identifier:insurancemembernumber.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:insurancemembernumber.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.identifier:insurancemembernumber.​assigner.type	Base	extensible	ResourceType	📦4.0.1	FHIR Std.
Coverage.status	Base	required	Genie Coverage Status values	📦1.2.60	This IG
Coverage.type	Base	required	Genie Coverage Type and Self Pay codes	📦1.2.60	This IG
Coverage.beneficiary.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📦4.0.1	FHIR Std.
Coverage.payor.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.​type	Base	extensible	Coverage Copay Type Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.​exception.type	Base	example	Example Coverage Financial Exception Codes	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from AUBaseCoverage

Summary

Mandatory: 5 elements(2 nested mandatory elements)
Must-Support: 15 elements

Structures

This structure refers to these other structures:

• AU Medicare Card Number (http://hl7.org.au/fhir/StructureDefinition/au-medicarecardnumber)
• AU DVA Number (http://hl7.org.au/fhir/StructureDefinition/au-dvanumber)
• AU Insurance Member Number (http://hl7.org.au/fhir/StructureDefinition/au-insurancemembernumber)
• Genie Patient (http://fhir.geniesolutions.io/StructureDefinition/gs-patient)

Slices

This structure defines the following Slices:

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

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
id	SΣ	1..1	id	Unique resource identifier generated from genie bookings service or contained resource access number, e.g. 1
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed)
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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MC
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/medicare-number
value	Σ	1..1	string	Minimum length 10 digits, maximum length 11 digits with IRN Example General: 123456 Example Medicare card number: 32788511952 Max Length:11
identifier:dva	S	0..1	AUDVANumber	DVA number should be provided when Coverage type is VET (DVA)
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	1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required)
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/dva
value	Σ	1..1	string	DVA number Example General: 123456 Example DVA number: NBUR9080 Max Length:9
identifier:insurancemembernumber	S	0..1	AUInsuranceMemberNumber	Private insurance member number should be provided when Coverage type is HIP
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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
text		0..1	string	Plain text representation of the concept
coding	SΣ	1..1	Coding	Member number identifier type Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Insurance member number Example General: 123456
assigner	Σ	1..1	Reference(Organization)	Insurer
display	SΣ	1..1	string	Name of insurer
status	?!SΣ	1..1	code	active | cancelled Binding: Genie Coverage Status values (required)
type	SΣ	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required)
text	Σ	1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident
beneficiary	Σ	1..1	Reference(Genie Patient)	Patient
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson)
reference	SΣC	0..1	string	Patient reference when self funded
type	Σ	0..1	uri	Organization | Patient | RelatedPerson Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	National insurer identifier
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NII
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept Required Pattern: National Insurer identifier
system	Σ	0..1	uri	The namespace for the identifier value Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value	Σ	1..1	string	The value that is unique Example General: 123456
display	SΣ	1..1	string	Name of insurer or self funded payor
class		0..1	BackboneElement	Coverage classification
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Plan type Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Class type
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier:mcn.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:mcn.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.identifier:dva.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:dva.​type	Base	required	Genie DVA Entitlement ValueSet	📦1.2.60	This IG
Coverage.identifier:insurancemembernumber.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:insurancemembernumber.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.status	Base	required	Genie Coverage Status values	📦1.2.60	This IG
Coverage.type	Base	required	Genie Coverage Type and Self Pay codes	📦1.2.60	This IG
Coverage.payor.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from AUBaseCoverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage			AUBaseCoverage
id	S	1..1	id	Unique resource identifier generated from genie bookings service or contained resource access number, e.g. 1
Slices for identifier		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed)
value		1..1	string	Minimum length 10 digits, maximum length 11 digits with IRN
identifier:dva	S	0..1	AUDVANumber	DVA number should be provided when Coverage type is VET (DVA)
type		1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required)
identifier:insurancemembernumber	S	0..1	AUInsuranceMemberNumber	Private insurance member number should be provided when Coverage type is HIP
type
coding	S	1..1	Coding	Member number identifier type
system	S	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number
value	S	1..1	string	Insurance member number
assigner
display	S	1..1	string	Name of insurer
status	S	1..1	code	active | cancelled Binding: Genie Coverage Status values (required)
type	S	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required)
coding
code		0..1	code	pay | PUBLICPOL | payconc | WCBPOL | HIP | VET | AUTOPOL
display		0..1	string	Pay | public healthcare | Concession | workers compensation | health insurance plan policy | veteran health program | automobile
text		1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident
beneficiary		1..1	Reference(Genie Patient)	Patient
reference	S	1..1	string	Literal reference, Relative, internal or absolute URL
payor		1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson)
reference	S	0..1	string	Patient reference when self funded
type		0..1	uri	Organization | Patient | RelatedPerson
identifier	S	0..1	Identifier	National insurer identifier
type		0..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NII
text		0..1	string	Plain text representation of the concept Required Pattern: National Insurer identifier
system		0..1	uri	The namespace for the identifier value Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value		1..1	string	The value that is unique
display	S	1..1	string	Name of insurer or self funded payor
class		0..1	BackboneElement	Coverage classification
type		1..1	CodeableConcept	Plan type Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
value	S	1..1	string	Class type
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier:dva.​type	Base	required	Genie DVA Entitlement ValueSet	📦1.2.60	This IG
Coverage.status	Base	required	Genie Coverage Status values	📦1.2.60	This IG
Coverage.type	Base	required	Genie Coverage Type and Self Pay codes	📦1.2.60	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement
id	SΣ	1..1	id	Unique resource identifier generated from genie bookings service or contained resource access number, e.g. 1
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed)
id		0..1	string	Unique id for inter-element referencing
extension		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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MC
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/medicare-number
value	Σ	1..1	string	Minimum length 10 digits, maximum length 11 digits with IRN Example General: 123456 Example Medicare card number: 32788511952 Max Length:11
period	Σ	0..1	Period	Time period when id is/was valid for use
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	Medicare card expiry date
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:dva	S	0..1	AUDVANumber	DVA number should be provided when Coverage type is VET (DVA)
id		0..1	string	Unique id for inter-element referencing
extension		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	1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required)
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: http://ns.electronichealth.net.au/id/dva
value	Σ	1..1	string	DVA number Example General: 123456 Example DVA number: NBUR9080 Max Length:9
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:insurancemembernumber	S	0..1	AUInsuranceMemberNumber	Private insurance member number should be provided when Coverage type is HIP
id		0..1	string	Unique id for inter-element referencing
extension		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	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Member number identifier type Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: MB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
system	SΣ	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Insurance member number Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	1..1	Reference(Organization)	Insurer
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	SΣ	1..1	string	Name of insurer
status	?!SΣ	1..1	code	active | cancelled Binding: Genie Coverage Status values (required)
type	SΣ	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	pay | PUBLICPOL | payconc | WCBPOL | HIP | VET | AUTOPOL
display	Σ	0..1	string	Pay | public healthcare | Concession | workers compensation | health insurance plan policy | veteran health program | automobile
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(Genie Patient)	Patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
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	Σ	0..1	Period	Coverage start and end dates
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Patient reference when self funded
type	Σ	0..1	uri	Organization | Patient | RelatedPerson Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	National insurer identifier
id		0..1	string	Unique id for inter-element referencing
extension		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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NII
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept Required Pattern: National Insurer identifier
system	Σ	0..1	uri	The namespace for the identifier value Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	SΣ	1..1	string	Name of insurer or self funded payor
class		0..1	BackboneElement	Coverage classification
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Plan type Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Class 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		0..*	Extension	Additional content defined by implementations
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		0..*	Extension	Additional content defined by implementations
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	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
Coverage.identifier:mcn.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:mcn.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.identifier:dva.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:dva.​type	Base	required	Genie DVA Entitlement ValueSet	📦1.2.60	This IG
Coverage.identifier:insurancemembernumber.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:insurancemembernumber.​type	Base	extensible	IdentifierType	📦4.0.1	FHIR Std.
Coverage.identifier:insurancemembernumber.​assigner.type	Base	extensible	ResourceType	📦4.0.1	FHIR Std.
Coverage.status	Base	required	Genie Coverage Status values	📦1.2.60	This IG
Coverage.type	Base	required	Genie Coverage Type and Self Pay codes	📦1.2.60	This IG
Coverage.beneficiary.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📦4.0.1	FHIR Std.
Coverage.payor.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.payor.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.​type	Base	extensible	Coverage Copay Type Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.​exception.type	Base	example	Example Coverage Financial Exception Codes	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from AUBaseCoverage

Summary

Mandatory: 5 elements(2 nested mandatory elements)
Must-Support: 15 elements

Structures

This structure refers to these other structures:

• AU Medicare Card Number (http://hl7.org.au/fhir/StructureDefinition/au-medicarecardnumber)
• AU DVA Number (http://hl7.org.au/fhir/StructureDefinition/au-dvanumber)
• AU Insurance Member Number (http://hl7.org.au/fhir/StructureDefinition/au-insurancemembernumber)
• Genie Patient (http://fhir.geniesolutions.io/StructureDefinition/gs-patient)

Slices

This structure defines the following Slices:

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