insurance

Insurance Plan Profile Mapping

Supported Implementation Guides for FHIR-R4

HL7.FHIR.US.DAVINCI-PDEX-PLAN-NET\Plan-Net InsurancePlan - FHIR v4.0.1

FHIR Elements to BSC Data Mapping

FHIR Mapping

meta.profile[0]

identifier[0].use

identifier[0].type.coding[0].system

identifier[0].type.coding[0].code

identifier[0].type.coding[0].userSelected

identifier[0].system

identifier[0].value

status

type[0].coding[0].system

type[0].coding[0].code

type[0].coding[0].display

name

alias[0]

period.start

period.end

network[*].reference

network[*].display

coverage[0].type.coding[0].display

coverage[0].benefit[0].type.text

plan[*].identifier[0].use

plan[*].identifier[0].type.coding[0].system

plan[*].identifier[0] .type.coding[0].code

plan[*].identifier[0] .type.coding[0].display

plan[*].identifier[0] .type.coding[0].userSelected

plan[*].identifier[0].type.text

plan[*].identifier[0].system

plan[*].identifier[0].value

plan[*].type.coding[0].code

plan[*].type.coding[0].display

plan[*].network[*].reference

plan[*].network[*].display

plan[*].generalCost[0].type.coding[0].system

plan[*].generalCost[0].type.coding[0].code

plan[*].generalCost[0].type.coding[0].display

plan[*].generalCost[0].cost.value

plan[*].specificCost[*].category.coding[0].display

plan[*].specificCost[*].benefit[*].type.coding[0].display

plan[*].specificCost[*].benefit[*].cost[*].type.coding[0].display

plan[*].specificCost[*].benefit[*].cost[*].applicability.coding[0].system

plan[*].specificCost[*].benefit[*].cost[*].applicability.coding[0].code

plan[*].specificCost[*].benefit[*].cost[*].applicability.coding[0].display

plan[*].specificCost[*].benefit[*].cost[*].qualifiers[0].coding[0].display

plan[*].specificCost[*].benefit[*].cost[*].value.value

ownedBy.display

administeredBy.display

coverageArea[0].display

plan[*].coverageArea

Codesets Mapping

FHIR Data Element

Valueset

Binding

status

Valueset-publication-status - FHIR v4.0.1 (hl7.org)

required

type

HL7.FHIR.US.DAVINCI-PDEX-PLAN-NET\Insurance Product Type - FHIR v4.0.1

extensible

coverage.type

(Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health)

none

plan.type

HL7.FHIR.US.DAVINCI-PDEX-PLAN-NET\Insurance Plan Type - FHIR v4.0.1

extensible

plan.specificCost.category

(Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health)

none

plan.specificCost.benefit.type

(preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care)

none

plan.specificCost.benefit.cost.type

(copay; individual cap; family cap; coinsurance; deductible)

none

plan.specificCost.benefit.cost.applicability

Valueset-insuranceplan-applicability - FHIR v4.0.1 (hl7.org)

required

plan.specificCost.benefit.cost.qualifiers

(Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA))

none