Kenya eClaims FHIR Implementation Guide
0.1.0 - ci-build KE

Kenya eClaims FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Coverage Profile

Official URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-coverage Version: 0.1.0
Draft as of 2026-05-19 Computable Name: EclaimsCoverage

This profile defines constraints on the Coverage resource for use within the Kenya eClaims Implementation Guide. It represents insurance coverage for a patient under a specific insurance scheme, including SHA and specialised schemes such as POMF and POMF_TEACHERS.

Usages:

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.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
.... extension:paymentMethod S 0..1 (Complex) Paymen tMethod Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Payment Method ValueSet (required)
.... extension:memberStatus S 0..1 (Complex) Current member status Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Member Status ValueSet (required)
.... extension:planType S 0..1 (Complex) Plan Type Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Plan Type ValueSet (required)
.... extension:annualLimitsCategory S 1..1 (Complex) Annual Limits Category Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: ServiceCategory (required)
.... extension:exclusion S 0..* CodeableConcept Exclusion Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/exclusion-extension
Binding: Coverage Exclusion Reason ValueSet (required)
.... extension:preAuthExclusions S 0..* CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/pre-auth-exclusion-extension
Binding: Preauthorization Exclusion Reason ValueSet (required)
.... extension:waiverType S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/waiver-type-extension
Binding: Waiver Type ValueSet (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 1..* Identifier Business Identifier for the coverage
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... system SΣ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string The value that is unique
Example General: 123456
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... subscriber SΣ 1..1 Reference(eClaims Patient Profile) Subscriber to the policy
... beneficiary SΣ 1..1 Reference(eClaims Patient Profile) Plan beneficiary
.... reference ΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 1..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).
... relationship S 1..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... period SΣ 0..1 Period Coverage start and end dates
... payor SΣ 1..1 Reference(eClaims Organization Profile) Issuer of the policy
... class S 1..* BackboneElement Additional coverage classifications
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Class ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... value SΣ 1..1 string Value associated with the type
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception S 0..* BackboneElement Exceptions for patient payments
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.extension:paymentMethod.​value[x] Base required Payment Method ValueSet 📦0.1.0 This IG
Coverage.extension:memberStatus.​value[x] Base required Coverage Member Status ValueSet 📦0.1.0 This IG
Coverage.extension:planType.​value[x] Base required Coverage Plan Type ValueSet 📦0.1.0 This IG
Coverage.extension:annualLimitsCategory.​value[x] Base required Service category 📦4.0.1 FHIR Std.
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required Coverage Type ValueSet 📦0.1.0 This IG
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required Coverage Class ValueSet 📦0.1.0 This IG
Coverage.costToBeneficiary.​type Base required Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base required 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 Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id S 1..1 id Logical id of this artifact
... meta S 1..1 Meta Metadata about the resource
.... profile S 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:paymentMethod S 0..1 (Complex) Paymen tMethod Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Payment Method ValueSet (required)
.... extension:memberStatus S 0..1 (Complex) Current member status Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Coverage Member Status ValueSet (required)
.... extension:planType S 0..1 (Complex) Plan Type Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Coverage Plan Type ValueSet (required)
.... extension:annualLimitsCategory S 1..1 (Complex) Annual Limits Category Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: ServiceCategory (required)
.... extension:exclusion S 0..* CodeableConcept Exclusion Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/exclusion-extension
Binding: Coverage Exclusion Reason ValueSet (required)
.... extension:preAuthExclusions S 0..* CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/pre-auth-exclusion-extension
Binding: Preauthorization Exclusion Reason ValueSet (required)
.... extension:waiverType S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/waiver-type-extension
Binding: Waiver Type ValueSet (required)
.... system S 1..1 uri The namespace for the identifier value
.... value S 1..1 string The value that is unique
... status S 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type S 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... subscriber S 1..1 Reference(eClaims Patient Profile) Subscriber to the policy
... beneficiary S 1..1 Reference(eClaims Patient Profile) Plan beneficiary
.... reference 1..1 string Literal reference, Relative, internal or absolute URL
.... type 1..1 uri Type the reference refers to (e.g. "Patient")
... relationship S 1..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... period S 0..1 Period Coverage start and end dates
... payor S 1..1 Reference(eClaims Organization Profile) Issuer of the policy
... class S 1..* BackboneElement Additional coverage classifications
.... type S 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Class ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... value S 1..1 string Value associated with the type
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... type S 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... exception S 0..* BackboneElement Exceptions for patient payments
..... type S 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.extension:paymentMethod.​value[x] Base required Payment Method ValueSet 📦0.1.0 This IG
Coverage.extension:memberStatus.​value[x] Base required Coverage Member Status ValueSet 📦0.1.0 This IG
Coverage.extension:planType.​value[x] Base required Coverage Plan Type ValueSet 📦0.1.0 This IG
Coverage.extension:annualLimitsCategory.​value[x] Base required Service category 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required Coverage Type ValueSet 📦0.1.0 This IG
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required Coverage Class ValueSet 📦0.1.0 This IG
Coverage.costToBeneficiary.​type Base required Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base required Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... 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
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:paymentMethod S 0..1 (Complex) Paymen tMethod Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Payment Method ValueSet (required)
.... extension:memberStatus S 0..1 (Complex) Current member status Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Member Status ValueSet (required)
.... extension:planType S 0..1 (Complex) Plan Type Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Plan Type ValueSet (required)
.... extension:annualLimitsCategory S 1..1 (Complex) Annual Limits Category Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: ServiceCategory (required)
.... extension:exclusion S 0..* CodeableConcept Exclusion Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/exclusion-extension
Binding: Coverage Exclusion Reason ValueSet (required)
.... extension:preAuthExclusions S 0..* CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/pre-auth-exclusion-extension
Binding: Preauthorization Exclusion Reason ValueSet (required)
.... extension:waiverType S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/waiver-type-extension
Binding: Waiver Type ValueSet (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 1..* Identifier Business Identifier for the coverage
.... 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.
.... system SΣ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 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)
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type ValueSet (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber SΣ 1..1 Reference(eClaims Patient Profile) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(eClaims Patient Profile) Plan beneficiary
.... 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 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 1..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 S 1..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... period SΣ 0..1 Period Coverage start and end dates
... payor SΣ 1..1 Reference(eClaims Organization Profile) Issuer of the policy
... class S 1..* BackboneElement Additional coverage classifications
.... 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 SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Class ValueSet (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... value SΣ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary S 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 SΣ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception S 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 SΣ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.extension:paymentMethod.​value[x] Base required Payment Method ValueSet 📦0.1.0 This IG
Coverage.extension:memberStatus.​value[x] Base required Coverage Member Status ValueSet 📦0.1.0 This IG
Coverage.extension:planType.​value[x] Base required Coverage Plan Type ValueSet 📦0.1.0 This IG
Coverage.extension:annualLimitsCategory.​value[x] Base required Service category 📦4.0.1 FHIR Std.
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required Coverage Type ValueSet 📦0.1.0 This IG
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required Coverage Class ValueSet 📦0.1.0 This IG
Coverage.costToBeneficiary.​type Base required Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base required 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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
.... extension:paymentMethod S 0..1 (Complex) Paymen tMethod Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Payment Method ValueSet (required)
.... extension:memberStatus S 0..1 (Complex) Current member status Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Member Status ValueSet (required)
.... extension:planType S 0..1 (Complex) Plan Type Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Plan Type ValueSet (required)
.... extension:annualLimitsCategory S 1..1 (Complex) Annual Limits Category Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: ServiceCategory (required)
.... extension:exclusion S 0..* CodeableConcept Exclusion Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/exclusion-extension
Binding: Coverage Exclusion Reason ValueSet (required)
.... extension:preAuthExclusions S 0..* CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/pre-auth-exclusion-extension
Binding: Preauthorization Exclusion Reason ValueSet (required)
.... extension:waiverType S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/waiver-type-extension
Binding: Waiver Type ValueSet (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 1..* Identifier Business Identifier for the coverage
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... system SΣ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string The value that is unique
Example General: 123456
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... subscriber SΣ 1..1 Reference(eClaims Patient Profile) Subscriber to the policy
... beneficiary SΣ 1..1 Reference(eClaims Patient Profile) Plan beneficiary
.... reference ΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 1..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).
... relationship S 1..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... period SΣ 0..1 Period Coverage start and end dates
... payor SΣ 1..1 Reference(eClaims Organization Profile) Issuer of the policy
... class S 1..* BackboneElement Additional coverage classifications
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Class ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... value SΣ 1..1 string Value associated with the type
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type SΣ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception S 0..* BackboneElement Exceptions for patient payments
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.extension:paymentMethod.​value[x] Base required Payment Method ValueSet 📦0.1.0 This IG
Coverage.extension:memberStatus.​value[x] Base required Coverage Member Status ValueSet 📦0.1.0 This IG
Coverage.extension:planType.​value[x] Base required Coverage Plan Type ValueSet 📦0.1.0 This IG
Coverage.extension:annualLimitsCategory.​value[x] Base required Service category 📦4.0.1 FHIR Std.
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required Coverage Type ValueSet 📦0.1.0 This IG
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required Coverage Class ValueSet 📦0.1.0 This IG
Coverage.costToBeneficiary.​type Base required Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base required 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()

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id S 1..1 id Logical id of this artifact
... meta S 1..1 Meta Metadata about the resource
.... profile S 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:paymentMethod S 0..1 (Complex) Paymen tMethod Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Payment Method ValueSet (required)
.... extension:memberStatus S 0..1 (Complex) Current member status Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Coverage Member Status ValueSet (required)
.... extension:planType S 0..1 (Complex) Plan Type Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Coverage Plan Type ValueSet (required)
.... extension:annualLimitsCategory S 1..1 (Complex) Annual Limits Category Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension
..... value[x] 1..1 CodeableConcept Value of extension
Binding: ServiceCategory (required)
.... extension:exclusion S 0..* CodeableConcept Exclusion Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/exclusion-extension
Binding: Coverage Exclusion Reason ValueSet (required)
.... extension:preAuthExclusions S 0..* CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/pre-auth-exclusion-extension
Binding: Preauthorization Exclusion Reason ValueSet (required)
.... extension:waiverType S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/waiver-type-extension
Binding: Waiver Type ValueSet (required)
.... system S 1..1 uri The namespace for the identifier value
.... value S 1..1 string The value that is unique
... status S 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type S 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... subscriber S 1..1 Reference(eClaims Patient Profile) Subscriber to the policy
... beneficiary S 1..1 Reference(eClaims Patient Profile) Plan beneficiary
.... reference 1..1 string Literal reference, Relative, internal or absolute URL
.... type 1..1 uri Type the reference refers to (e.g. "Patient")
... relationship S 1..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... period S 0..1 Period Coverage start and end dates
... payor S 1..1 Reference(eClaims Organization Profile) Issuer of the policy
... class S 1..* BackboneElement Additional coverage classifications
.... type S 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Class ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... value S 1..1 string Value associated with the type
... costToBeneficiary S 0..* BackboneElement Patient payments for services/products
.... type S 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... exception S 0..* BackboneElement Exceptions for patient payments
..... type S 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.extension:paymentMethod.​value[x] Base required Payment Method ValueSet 📦0.1.0 This IG
Coverage.extension:memberStatus.​value[x] Base required Coverage Member Status ValueSet 📦0.1.0 This IG
Coverage.extension:planType.​value[x] Base required Coverage Plan Type ValueSet 📦0.1.0 This IG
Coverage.extension:annualLimitsCategory.​value[x] Base required Service category 📦4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required Coverage Type ValueSet 📦0.1.0 This IG
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required Coverage Class ValueSet 📦0.1.0 This IG
Coverage.costToBeneficiary.​type Base required Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base required Example Coverage Financial Exception Codes 📦4.0.1 FHIR Std.

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... 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
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:paymentMethod S 0..1 (Complex) Paymen tMethod Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/payment-method-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Payment Method ValueSet (required)
.... extension:memberStatus S 0..1 (Complex) Current member status Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/member-status-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Member Status ValueSet (required)
.... extension:planType S 0..1 (Complex) Plan Type Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/plan-type-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: Coverage Plan Type ValueSet (required)
.... extension:annualLimitsCategory S 1..1 (Complex) Annual Limits Category Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "https://fhir.dha.go.ke/eclaims/StructureDefinition/annual-limit-category-extension"
..... value[x] S 1..1 CodeableConcept Value of extension
Binding: ServiceCategory (required)
.... extension:exclusion S 0..* CodeableConcept Exclusion Extension
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/exclusion-extension
Binding: Coverage Exclusion Reason ValueSet (required)
.... extension:preAuthExclusions S 0..* CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/pre-auth-exclusion-extension
Binding: Preauthorization Exclusion Reason ValueSet (required)
.... extension:waiverType S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://fhir.dha.go.ke/eclaims/StructureDefinition/waiver-type-extension
Binding: Waiver Type ValueSet (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 1..* Identifier Business Identifier for the coverage
.... 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.
.... system SΣ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 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)
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: Coverage Type ValueSet (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber SΣ 1..1 Reference(eClaims Patient Profile) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(eClaims Patient Profile) Plan beneficiary
.... 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 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 1..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 S 1..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... period SΣ 0..1 Period Coverage start and end dates
... payor SΣ 1..1 Reference(eClaims Organization Profile) Issuer of the policy
... class S 1..* BackboneElement Additional coverage classifications
.... 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 SΣ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: Coverage Class ValueSet (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... value SΣ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary S 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 SΣ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception S 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 SΣ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (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 SΣ 1..* 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 SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Coverage.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.extension:paymentMethod.​value[x] Base required Payment Method ValueSet 📦0.1.0 This IG
Coverage.extension:memberStatus.​value[x] Base required Coverage Member Status ValueSet 📦0.1.0 This IG
Coverage.extension:planType.​value[x] Base required Coverage Plan Type ValueSet 📦0.1.0 This IG
Coverage.extension:annualLimitsCategory.​value[x] Base required Service category 📦4.0.1 FHIR Std.
Coverage.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required Coverage Type ValueSet 📦0.1.0 This IG
Coverage.beneficiary.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.relationship Base required SubscriberPolicyholder Relationship Codes 📦4.0.1 FHIR Std.
Coverage.class.type Base required Coverage Class ValueSet 📦0.1.0 This IG
Coverage.costToBeneficiary.​type Base required Coverage Copay Type Codes 📦4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base required 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()

 

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