ISiKVersicherungsverhaeltnisSelbstzahler - ISiK Basis Implementierungsleitfaden v6.0.0-rc

A set of rules under which this content was created

language

0..1

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

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

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!

0..*

Extensions that cannot be ignored
Slice: Unordered, Open by value:url

Slices for identifier

Σ

0..*

IdentifierPkv(1.6.0-ballot)

Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this

identifier:pkv

Σ

0..1

An identifier intended for computation

Required Pattern: At least the following

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

use

0..1

usual | official | temp | secondary | old (If known)

1..1

Description of identifier
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

coding

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: PKV

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

0..1

The namespace for the identifier value

0..1

The value that is unique

0..1

Time period when id is/was valid for use

assigner

0..1

Reference(Organization)

Organization that issued id (may be just text)

status

?!Σ

1..1

Status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

Σ

1..1

Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

Slices for coding

Σ

1..*

coding:VersicherungsArtDeBasis

Code defined by a terminology system
Slice: Unordered, Open by pattern:$this

Σ

1..1

Codierte Darstellung der Versicherungsart

Required Pattern: At least the following

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

Σ

0..1

Codier-Schema
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis

Σ

0..1

Version of the system - if relevant

Σ

0..1

Code
Fixed Value: SEL

Σ

0..1

Representation defined by the system

Σ

0..1

If this coding was chosen directly by the user

Σ

0..1

Plain text representation of the concept

subscriber

ΣC

0..1

Reference(Patient | RelatedPerson)

Unterzeichner der Kostenübernahme
Constraints: ref-1

beneficiary

ΣC

1..1

Reference(Patient)

Begünstigte Person
Constraints: ref-1

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

ΣC

0..1

Patienten-Link

Σ

0..1

Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Σ

0..1

Logical reference, when literal reference is not known

Σ

0..1

Text alternative for the resource

dependent

Σ

0..1

Dependent number

relationship

0..1

Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

ΣC

0..1

Coverage start and end dates
Constraints: per-1

payor

ΣC

1..*

Reference(Patient | RelatedPerson | Organization)

Kostenträger
Constraints: ref-1

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

ΣC

0..1

Personen-Link

Σ

0..1

Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Σ

0..1

Logical reference, when literal reference is not known

Σ

0..1

Organisations-Bezeichnung

class

0..*

Additional coverage classifications

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

Σ

1..1

Value associated with the type

name

Σ

0..1

Human readable description of the type and value

costToBeneficiary

0..*

Patient payments for services/products

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

0..1

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..*

Exceptions for patient payments

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

ΣC

0..1

The effective period of the exception
Constraints: per-1

subrogation

0..1

Documentation for this format

Reimbursement to insurer

contract

C

0..*

Reference(Contract)

Contract details
Constraints: ref-1

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📦4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	required	VersicherungsartDeBasisVS	📦1.6.0-ballot	de.basisprofil.r4 v1.6
Coverage.beneficiary.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📦4.0.1	FHIR Std.
Coverage.payor.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.type	Base	extensible	Coverage Copay Type Codes	📦4.0.1	FHIR Std.
Coverage.costToBeneficiary.exception.type	Base	example	Example Coverage Financial Exception Codes	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources	`contained.contained.empty()`
dom-3	error	Coverage	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	`contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label	`contained.meta.security.empty()`
dom-6	best practice	Coverage	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children	`hasValue() or (children().count() > id.count())`
ext-1	error	ALL extensions	Must have either extensions or value[x], not both	`extension.exists() != value.exists()`
per-1	error	Coverage.period, Coverage.costToBeneficiary.exception.period	If present, start SHALL have a lower value than end	`start.hasValue().not() or end.hasValue().not() or (start <= end)`
ref-1	error	Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract	SHALL have a contained resource if a local reference is provided	`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`

This structure is derived from CoverageDeSel

Summary

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Coverage		0..*	CoverageDeSel(1.6.0-ballot)	Versicherungsdaten
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier	Σ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by pattern:$this
identifier:pkv	Σ	0..1	IdentifierPkv(1.6.0-ballot)	An identifier intended for computation Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
use		0..1	code	usual \| official \| temp \| secondary \| old (If known)
type		1..1	CodeableConcept	Description of identifier Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PKV
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system		0..1	uri	The namespace for the identifier value
value		0..1	string	The value that is unique
period		0..1	Period	Time period when id is/was valid for use
assigner		0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	Status Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Versicherungsart Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:VersicherungsArtDeBasis	Σ	1..1	Coding	Codierte Darstellung der Versicherungsart Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
version		0..1	string	Version of the system - if relevant
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	Σ	0..1	uri	Codier-Schema Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis
code	Σ	0..1	code	Code Fixed Value: SEL
beneficiary	ΣC	1..1	Reference(Patient)	Begünstigte Person Constraints: ref-1
reference	ΣC	0..1	string	Patienten-Link
payor	ΣC	1..*	Reference(Patient \| RelatedPerson \| Organization)	Kostenträger Constraints: ref-1
reference	ΣC	0..1	string	Personen-Link
display	Σ	0..1	string	Organisations-Bezeichnung
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	required	VersicherungsartDeBasisVS	📦1.6.0-ballot	de.basisprofil.r4 v1.6

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()`
ref-1	error	Coverage.beneficiary, Coverage.payor	SHALL have a contained resource if a local reference is provided	`reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`

Differential View

This structure is derived from CoverageDeSel

Name	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Coverage	0..*	CoverageDeSel(1.6.0-ballot)	Versicherungsdaten
status	1..1	code	Status
type	1..1	CodeableConcept	Versicherungsart
Slices for coding			Content/Rules for all slices
coding:VersicherungsArtDeBasis	1..1	Coding	Codierte Darstellung der Versicherungsart
system	0..1	uri	Codier-Schema
code	0..1	code	Code
beneficiary	1..1	Reference(Patient)	Begünstigte Person
reference	0..1	string	Patienten-Link
payor	1..*	Reference(Patient \| RelatedPerson \| Organization)	Kostenträger
reference	0..1	string	Personen-Link
display	0..1	string	Organisations-Bezeichnung
Documentation for this format

Snapshot View

Description & Constraints Filter: Filters

Coverage

0..*

CoverageDeSel(1.6.0-ballot)

Versicherungsdaten

id

Σ

0..1

id

Logical id of this artifact

Meta

Metadata about the resource

implicitRules

?!Σ

0..1

A set of rules under which this content was created

language

0..1

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

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

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!

0..*

Extensions that cannot be ignored
Slice: Unordered, Open by value:url

Slices for identifier

Σ

0..*

IdentifierPkv(1.6.0-ballot)

Business Identifier for the coverage
Slice: Unordered, Open by pattern:$this

identifier:pkv

Σ

0..1

An identifier intended for computation

Required Pattern: At least the following

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

use

0..1

usual | official | temp | secondary | old (If known)

1..1

Description of identifier
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

coding

1..*

Code defined by a terminology system
Fixed Value: (Complex)

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations

1..1

Identity of the terminology system
Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis

0..1

Version of the system - if relevant

1..1

Symbol in syntax defined by the system
Fixed Value: PKV

0..1

Representation defined by the system

0..1

If this coding was chosen directly by the user

0..1

Plain text representation of the concept

0..1

The namespace for the identifier value

0..1

The value that is unique

0..1

Time period when id is/was valid for use

assigner

0..1

Reference(Organization)

Organization that issued id (may be just text)

status

?!Σ

1..1

Status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

Σ

1..1

Versicherungsart
Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

Slices for coding

Σ

1..*

coding:VersicherungsArtDeBasis

Code defined by a terminology system
Slice: Unordered, Open by pattern:$this

Σ

1..1

Codierte Darstellung der Versicherungsart

Required Pattern: At least the following

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

Σ

0..1

Codier-Schema
Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis

Σ

0..1

Version of the system - if relevant

Σ

0..1

Code
Fixed Value: SEL

Σ

0..1

Representation defined by the system

Σ

0..1

If this coding was chosen directly by the user

Σ

0..1

Plain text representation of the concept

subscriber

ΣC

0..1

Reference(Patient | RelatedPerson)

Unterzeichner der Kostenübernahme
Constraints: ref-1

beneficiary

ΣC

1..1

Reference(Patient)

Begünstigte Person
Constraints: ref-1

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

ΣC

0..1

Patienten-Link

Σ

0..1

Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Σ

0..1

Logical reference, when literal reference is not known

Σ

0..1

Text alternative for the resource

dependent

Σ

0..1

Dependent number

relationship

0..1

Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

ΣC

0..1

Coverage start and end dates
Constraints: per-1

payor

ΣC

1..*

Reference(Patient | RelatedPerson | Organization)

Kostenträger
Constraints: ref-1

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

ΣC

0..1

Personen-Link

Σ

0..1

Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Σ

0..1

Logical reference, when literal reference is not known

Σ

0..1

Organisations-Bezeichnung

class

0..*

Additional coverage classifications

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

Σ

1..1

Value associated with the type

name

Σ

0..1

Human readable description of the type and value

costToBeneficiary

0..*

Patient payments for services/products

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

0..1

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..*

Exceptions for patient payments

id

0..1

Unique id for inter-element referencing

0..*

Additional content defined by implementations
Slice: Unordered, Open by value:url

?!Σ

0..*

Extensions that cannot be ignored even if unrecognized

Σ

1..1

Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

ΣC

0..1

The effective period of the exception
Constraints: per-1

subrogation

0..1