Magentus Practice Management FHIR Implementation Guide - Local Development build (v1.2.35) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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• Detailed Descriptions
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Resource Profile: Genie Coverage

Genie Coverage core profile

Usage:

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

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
Coverage	C	0..*	AUBaseCoverage	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-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-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management diagnosticrequest-medicare-number-and-bulkbill: Using Bulk Billed requires a medicare number or IHI for the patient diagnosticrequest-DVA-number-and-DVA: Using DVA requires a DVA number for the patient
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 ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored 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		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type ele-1: All FHIR elements must have a @value or children
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed) 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
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. ele-1: All FHIR elements must have a @value or children 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: MC
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children 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 ele-1: All FHIR elements must have a @value or children 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) 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
type	Σ	1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required) 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 Fixed Value: http://ns.electronichealth.net.au/id/dva
value	Σ	1..1	string	DVA number ele-1: All FHIR elements must have a @value or children 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 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
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. ele-1: All FHIR elements must have a @value or children 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: MB
coding	SΣ	1..1	Coding	Member number identifier type ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Insurance member number ele-1: All FHIR elements must have a @value or children Example General: 123456
assigner	Σ	1..1	Reference(Organization)	Insurer ele-1: All FHIR elements must have a @value or children
display	SΣ	1..1	string	Name of insurer ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	active | cancelled Binding: Genie Coverage Status values (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required) ele-1: All FHIR elements must have a @value or children
text	Σ	1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident ele-1: All FHIR elements must have a @value or children
beneficiary	Σ	1..1	Reference(Genie Patient)	Patient ele-1: All FHIR elements must have a @value or children
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson) ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Patient reference when self funded ele-1: All FHIR elements must have a @value or children
type	Σ	0..1	uri	Organization | Patient | RelatedPerson Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). ele-1: All FHIR elements must have a @value or children
identifier	SΣ	0..1	Identifier	National insurer identifier 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
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. ele-1: All FHIR elements must have a @value or children 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	Σ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children Required Pattern: National Insurer identifier
system	Σ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
display	SΣ	1..1	string	Name of insurer or self funded payor ele-1: All FHIR elements must have a @value or children
class		0..1	BackboneElement	Coverage classification ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	Σ	1..1	CodeableConcept	Plan type Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children 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	SΣ	1..1	string	Class type ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.identifier:mcn.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:mcn.type	extensible	Pattern: MC http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:dva.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:dva.type	required	GSDVAEntitlement http://fhir.geniesolutions.io/ValueSet/gs-dva-entitlement from this IG
Coverage.identifier:insurancemembernumber.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:insurancemembernumber.type	extensible	Pattern: MB http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.status	required	GSCoverageStatus http://fhir.geniesolutions.io/ValueSet/gs-coverage-status from this IG
Coverage.type	required	GSCoverageType http://fhir.geniesolutions.io/ValueSet/gs-coverage-type from this IG
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.payor.identifier.type	extensible	Pattern: NII http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.class.type	extensible	Pattern: plan http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
diagnosticrequest-DVA-number-and-DVA	error	Coverage	Using DVA requires a DVA number for the patient : 'VET' in $this.type.coding.code implies $this.beneficiary.resolve().identifier.type.coding.where(code.memberOf('http://terminology.hl7.org.au/ValueSet/dva-entitlement')).exists()
diagnosticrequest-medicare-number-and-bulkbill	error	Coverage	Using Bulk Billed requires a medicare number or IHI for the patient : 'PUBLICPOL' in $this.type.coding.code implies ($this.beneficiary.resolve().identifier.type.coding.where(code = 'MC').exists() or $this.beneficiary.resolve().identifier.type.coding.where(code = 'NI').exists())
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
Coverage	C	0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement diagnosticrequest-medicare-number-and-bulkbill: Using Bulk Billed requires a medicare number or IHI for the patient diagnosticrequest-DVA-number-and-DVA: Using DVA requires a DVA number for the patient
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	Conformance	ValueSet	URI
Coverage.identifier:dva.type	required	GSDVAEntitlement http://fhir.geniesolutions.io/ValueSet/gs-dva-entitlement from this IG
Coverage.status	required	GSCoverageStatus http://fhir.geniesolutions.io/ValueSet/gs-coverage-status from this IG
Coverage.type	required	GSCoverageType http://fhir.geniesolutions.io/ValueSet/gs-coverage-type from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
diagnosticrequest-DVA-number-and-DVA	error	Coverage	Using DVA requires a DVA number for the patient : 'VET' in $this.type.coding.code implies $this.beneficiary.resolve().identifier.type.coding.where(code.memberOf('http://terminology.hl7.org.au/ValueSet/dva-entitlement')).exists()
diagnosticrequest-medicare-number-and-bulkbill	error	Coverage	Using Bulk Billed requires a medicare number or IHI for the patient : 'PUBLICPOL' in $this.type.coding.code implies ($this.beneficiary.resolve().identifier.type.coding.where(code = 'MC').exists() or $this.beneficiary.resolve().identifier.type.coding.where(code = 'NI').exists())

Name	Flags	Card.	Type	Description & Constraints
Coverage	C	0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement diagnosticrequest-medicare-number-and-bulkbill: Using Bulk Billed requires a medicare number or IHI for the patient diagnosticrequest-DVA-number-and-DVA: Using DVA requires a DVA number for the patient
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
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
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: MB
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
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
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
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		0..1	string	Plain text representation of the concept
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
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	Conformance	ValueSet / Code	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:mcn.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:mcn.type	extensible	Pattern: MC http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:dva.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:dva.type	required	GSDVAEntitlement http://fhir.geniesolutions.io/ValueSet/gs-dva-entitlement from this IG
Coverage.identifier:insurancemembernumber.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:insurancemembernumber.type	extensible	Pattern: MB http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:insurancemembernumber.assigner.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.status	required	GSCoverageStatus http://fhir.geniesolutions.io/ValueSet/gs-coverage-status from this IG
Coverage.type	required	GSCoverageType http://fhir.geniesolutions.io/ValueSet/gs-coverage-type from this IG
Coverage.beneficiary.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.payor.identifier.type	extensible	Pattern: NII http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.class.type	extensible	Pattern: plan 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
diagnosticrequest-DVA-number-and-DVA	error	Coverage	Using DVA requires a DVA number for the patient : 'VET' in $this.type.coding.code implies $this.beneficiary.resolve().identifier.type.coding.where(code.memberOf('http://terminology.hl7.org.au/ValueSet/dva-entitlement')).exists()
diagnosticrequest-medicare-number-and-bulkbill	error	Coverage	Using Bulk Billed requires a medicare number or IHI for the patient : 'PUBLICPOL' in $this.type.coding.code implies ($this.beneficiary.resolve().identifier.type.coding.where(code = 'MC').exists() or $this.beneficiary.resolve().identifier.type.coding.where(code = 'NI').exists())
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
Coverage	C	0..*	AUBaseCoverage	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-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-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management diagnosticrequest-medicare-number-and-bulkbill: Using Bulk Billed requires a medicare number or IHI for the patient diagnosticrequest-DVA-number-and-DVA: Using DVA requires a DVA number for the patient
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 ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored 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		0..*	Identifier, AUMedicareCardNumber, AUDVANumber, AUInsuranceMemberNumber	An identifier intended for computation Slice: Unordered, Open by value:type ele-1: All FHIR elements must have a @value or children
identifier:mcn	S	0..1	AUMedicareCardNumber	Medicare card number should be provided when Coverage type is PUBLICPOL (Bulk Billed) 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
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. ele-1: All FHIR elements must have a @value or children 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: MC
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children 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 ele-1: All FHIR elements must have a @value or children 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) 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
type	Σ	1..1	CodeableConcept	DVAU | DVG | DVO | DVW Binding: Genie DVA Entitlement ValueSet (required) 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 Fixed Value: http://ns.electronichealth.net.au/id/dva
value	Σ	1..1	string	DVA number ele-1: All FHIR elements must have a @value or children 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 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
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. ele-1: All FHIR elements must have a @value or children 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: MB
coding	SΣ	1..1	Coding	Member number identifier type ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	System identifier namespace for the insurer that assigned the insurance member number ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Insurance member number ele-1: All FHIR elements must have a @value or children Example General: 123456
assigner	Σ	1..1	Reference(Organization)	Insurer ele-1: All FHIR elements must have a @value or children
display	SΣ	1..1	string	Name of insurer ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	active | cancelled Binding: Genie Coverage Status values (required) ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Coverage Type and Self Payment code Binding: Genie Coverage Type and Self Pay codes (required) ele-1: All FHIR elements must have a @value or children
text	Σ	1..1	string	Private (Self Funded) | Bulk Billed | Concession | Workcover | Private Insurance Plan | DVA | Motor Accident ele-1: All FHIR elements must have a @value or children
beneficiary	Σ	1..1	Reference(Genie Patient)	Patient ele-1: All FHIR elements must have a @value or children
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
payor	Σ	1..1	Reference(Organization | Patient | RelatedPerson)	Insurer of the policy (organization), or self funded payor (Patient or RelatedPerson) ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Patient reference when self funded ele-1: All FHIR elements must have a @value or children
type	Σ	0..1	uri	Organization | Patient | RelatedPerson Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). ele-1: All FHIR elements must have a @value or children
identifier	SΣ	0..1	Identifier	National insurer identifier 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
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. ele-1: All FHIR elements must have a @value or children 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	Σ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children Required Pattern: National Insurer identifier
system	Σ	0..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Required Pattern: https://privatehealth.gov.au/dynamic/insurer
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
display	SΣ	1..1	string	Name of insurer or self funded payor ele-1: All FHIR elements must have a @value or children
class		0..1	BackboneElement	Coverage classification ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	Σ	1..1	CodeableConcept	Plan type Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. ele-1: All FHIR elements must have a @value or children 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	SΣ	1..1	string	Class type ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.identifier:mcn.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:mcn.type	extensible	Pattern: MC http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:dva.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:dva.type	required	GSDVAEntitlement http://fhir.geniesolutions.io/ValueSet/gs-dva-entitlement from this IG
Coverage.identifier:insurancemembernumber.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:insurancemembernumber.type	extensible	Pattern: MB http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.status	required	GSCoverageStatus http://fhir.geniesolutions.io/ValueSet/gs-coverage-status from this IG
Coverage.type	required	GSCoverageType http://fhir.geniesolutions.io/ValueSet/gs-coverage-type from this IG
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.payor.identifier.type	extensible	Pattern: NII http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.class.type	extensible	Pattern: plan http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
diagnosticrequest-DVA-number-and-DVA	error	Coverage	Using DVA requires a DVA number for the patient : 'VET' in $this.type.coding.code implies $this.beneficiary.resolve().identifier.type.coding.where(code.memberOf('http://terminology.hl7.org.au/ValueSet/dva-entitlement')).exists()
diagnosticrequest-medicare-number-and-bulkbill	error	Coverage	Using Bulk Billed requires a medicare number or IHI for the patient : 'PUBLICPOL' in $this.type.coding.code implies ($this.beneficiary.resolve().identifier.type.coding.where(code = 'MC').exists() or $this.beneficiary.resolve().identifier.type.coding.where(code = 'NI').exists())
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
Coverage	C	0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement diagnosticrequest-medicare-number-and-bulkbill: Using Bulk Billed requires a medicare number or IHI for the patient diagnosticrequest-DVA-number-and-DVA: Using DVA requires a DVA number for the patient
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	Conformance	ValueSet	URI
Coverage.identifier:dva.type	required	GSDVAEntitlement http://fhir.geniesolutions.io/ValueSet/gs-dva-entitlement from this IG
Coverage.status	required	GSCoverageStatus http://fhir.geniesolutions.io/ValueSet/gs-coverage-status from this IG
Coverage.type	required	GSCoverageType http://fhir.geniesolutions.io/ValueSet/gs-coverage-type from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
diagnosticrequest-DVA-number-and-DVA	error	Coverage	Using DVA requires a DVA number for the patient : 'VET' in $this.type.coding.code implies $this.beneficiary.resolve().identifier.type.coding.where(code.memberOf('http://terminology.hl7.org.au/ValueSet/dva-entitlement')).exists()
diagnosticrequest-medicare-number-and-bulkbill	error	Coverage	Using Bulk Billed requires a medicare number or IHI for the patient : 'PUBLICPOL' in $this.type.coding.code implies ($this.beneficiary.resolve().identifier.type.coding.where(code = 'MC').exists() or $this.beneficiary.resolve().identifier.type.coding.where(code = 'NI').exists())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage	C	0..*	AUBaseCoverage	Insurance or medical plan or a payment agreement diagnosticrequest-medicare-number-and-bulkbill: Using Bulk Billed requires a medicare number or IHI for the patient diagnosticrequest-DVA-number-and-DVA: Using DVA requires a DVA number for the patient
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
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
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: MB
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
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
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
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		0..1	string	Plain text representation of the concept
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
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	Conformance	ValueSet / Code	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:mcn.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:mcn.type	extensible	Pattern: MC http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:dva.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:dva.type	required	GSDVAEntitlement http://fhir.geniesolutions.io/ValueSet/gs-dva-entitlement from this IG
Coverage.identifier:insurancemembernumber.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.identifier:insurancemembernumber.type	extensible	Pattern: MB http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.identifier:insurancemembernumber.assigner.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.status	required	GSCoverageStatus http://fhir.geniesolutions.io/ValueSet/gs-coverage-status from this IG
Coverage.type	required	GSCoverageType http://fhir.geniesolutions.io/ValueSet/gs-coverage-type from this IG
Coverage.beneficiary.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Coverage.payor.identifier.type	extensible	Pattern: NII http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Coverage.class.type	extensible	Pattern: plan 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
diagnosticrequest-DVA-number-and-DVA	error	Coverage	Using DVA requires a DVA number for the patient : 'VET' in $this.type.coding.code implies $this.beneficiary.resolve().identifier.type.coding.where(code.memberOf('http://terminology.hl7.org.au/ValueSet/dva-entitlement')).exists()
diagnosticrequest-medicare-number-and-bulkbill	error	Coverage	Using Bulk Billed requires a medicare number or IHI for the patient : 'PUBLICPOL' in $this.type.coding.code implies ($this.beneficiary.resolve().identifier.type.coding.where(code = 'MC').exists() or $this.beneficiary.resolve().identifier.type.coding.where(code = 'NI').exists())
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