Profil Coverage pour les couvertures sociales lors de la préadmission

Introduction

La couverture sociale est un élément clé du processus de préadmission hospitalière. Elle permet de garantir que les frais médicaux du patient seront pris en charge, soit par l’Assurance Maladie Obligatoire (AMO), soit par une Assurance Maladie Complémentaire (AMC). Dans le cadre de la préadmission, ces informations sont collectées et structurées à l’aide de la ressource FHIR Coverage, enrichie d’extensions spécifiques pour répondre aux besoins administratifs et réglementaires.

Pourquoi renseigner la couverture sociale ?

La couverture sociale joue un rôle central dans la gestion administrative d’un séjour hospitalier. Elle permet :

• D’assurer la prise en charge financière : Les informations sur l’AMO et l’AMC permettent à l’hôpital de facturer correctement les soins.
• De vérifier les droits du patient : Les données collectées garantissent que le patient est bien couvert pour les prestations médicales prévues.
• De simplifier les échanges administratifs : En structurant les informations selon les standards FHIR, les systèmes hospitaliers peuvent traiter efficacement les données.

Ressource FHIR : Coverage

La ressource Coverage est utilisée pour modéliser les informations relatives à la couverture sociale d’un patient. Elle inclut des champs essentiels tels que :

• Le type de couverture : AMO (Assurance Maladie Obligatoire) ou AMC (Assurance Maladie Complémentaire).
• Le bénéficiaire : Le patient couvert par cette assurance.
• L’assuré principal : La personne à laquelle la couverture est rattachée (si différente du bénéficiaire).
• La période de validité : Les dates de début et de fin de la couverture.
• Le lien entre l’assuré et le bénéficiaire : Par exemple, parent, conjoint ou enfant.

Extensions spécifiques

Pour répondre aux besoins spécifiques de la préadmission, des extensions enrichissent la ressource Coverage :

• FrCoverageAMCExtension : Permet de détailler les informations spécifiques à une AMC, comme le nom de l’organisme complémentaire, le numéro d’adhérent, ou encore un code de convention.

Comment renseigner une AMO ?

Pour une Assurance Maladie Obligatoire (AMO), les informations suivantes doivent être renseignées dans la ressource Coverage :

1. Type de couverture : Utilisez le code PUBLICPOL pour indiquer qu’il s’agit d’une AMO.
2. Bénéficiaire : Référencez le patient concerné via le champ beneficiary.
3. Assuré principal : Si l’assuré principal est différent du bénéficiaire, renseignez le champ subscriber avec une référence vers la ressource Patient correspondante.
4. Numéro de sécurité sociale : Renseignez le champ subscriberId avec le numéro de Sécurité Sociale de l’assuré principal.
5. Lien entre l’assuré et le bénéficiaire : Si nécessaire, utilisez le champ relationship pour indiquer le lien (ex. parent, conjoint).

Comment renseigner une AMC ?

Pour une Assurance Maladie Complémentaire (AMC), les informations suivantes doivent être renseignées :

1. Type de couverture : Utilisez le code EHCPOL pour indiquer qu’il s’agit d’une AMC.
2. Bénéficiaire : Référencez le patient concerné via le champ beneficiary.
3. Assuré principal : Si l’assuré principal est différent du bénéficiaire, renseignez le champ subscriber avec une référence vers la ressource Patient correspondante.
4. Numéro d’adhérent : Renseignez le champ subscriberId avec le numéro d’adhérent fourni par l’organisme complémentaire.
5. Détails spécifiques à l’AMC
   • Le numéro de l’AMC doit être renseigné comme identifier du payor (Organization), l’oid associé est 1.2.250.1.213.1.1.4.6.
   • Utilisez l’extension FrCoverageAMCExtension pour ajouter des informations comme :
     • Un code de convention ou un code CSR, si applicable.
     • Le contenu du Datamatrix, s’il est disponible.

Exemple d’échange de couverture sociale

Lors de la préadmission, le patient fournit ses informations de couverture sociale via un portail en ligne. Ces données sont ensuite transmises au système administratif de l’hôpital pour vérification. Voici un exemple de flux :

1. Saisie par le patient : Le patient renseigne ses informations d’AMO et/ou d’AMC sur le portail de préadmission.
2. Transmission au système administratif hospitalier : Les données sont envoyées sous forme de ressource Coverage, enrichie des extensions nécessaires.
3. Vérification par l’agent administratif : L’agent vérifie la validité des informations (dates, numéros, etc.) et fait appel aux différents téléservices.
4. Validation ou correction : Si tout est conforme, la couverture est validée. Sinon, une notification est envoyée au patient pour correction.

Critère de recherche autorisé

Dans le contexte de la préadmission, la ressource Coverage ne peut être recherchée qu’à partir du patient. Cela signifie que les systèmes doivent utiliser uniquement le critère patient pour interroger les informations de couverture, conformément aux contraintes d’implémentation définies.

coverage?patient=

Conclusion

La gestion de la couverture sociale dans la préadmission est essentielle pour garantir une prise en charge fluide et efficace des patients. En utilisant la ressource FHIR Coverage et ses extensions spécifiques, les établissements de santé peuvent structurer et automatiser ce processus tout en respectant les exigences réglementaires. Que ce soit pour une AMO ou une AMC, chaque détail compte pour assurer une expérience patient optimale et une gestion administrative sans faille.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:informationsAmc	S This element must be supported.	0..1	(Complex)	Informations AMC URL: https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.identifier	S This element must be supported. Σ This element is included in summaries.	1..1	Identifier	Business Identifier for the coverage
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active (extensions allowed)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Coverage.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Binding: type-couverture-sociale-vs (required)
Coverage.subscriber	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile | RelatedPerson)	Référence vers l’assuré
Coverage.subscriberId	Σ This element is included in summaries.	1..1	string	Numéro de sécurité sociale ou numéro d'adhérent
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile)	Plan beneficiary
Coverage.relationship		0..1	CodeableConcept	Lien entre l’assuré et le bénéficiaire Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.relationship.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.payor	Σ This element is included in summaries.	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
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	preferred	Coverage Type and Self-Pay Codes	📍4.0.1	FHIR Std.
Coverage.type.coding.​code	Base	required	type-couverture-sociale-vs	📦1.0.0-ballot	This IG
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship 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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:informationsAmc	S This element must be supported.	0..1	(Complex)	Informations AMC URL: https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended
Coverage.identifier	S This element must be supported.	1..1	Identifier	Business Identifier for the coverage
Coverage.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active (extensions allowed)
Coverage.type	S This element must be supported.	1..1	CodeableConcept	Coverage category such as medical or accident
Coverage.type.coding		1..1	Coding	Code defined by a terminology system
Coverage.type.coding.code		0..1	code	Symbol in syntax defined by the system Binding: type-couverture-sociale-vs (required)
Coverage.subscriber	S This element must be supported.	1..1	Reference(FR Core Patient Profile | RelatedPerson)	Référence vers l’assuré
Coverage.subscriberId		1..1	string	Numéro de sécurité sociale ou numéro d'adhérent
Coverage.beneficiary	S This element must be supported.	1..1	Reference(FR Core Patient Profile)	Plan beneficiary
Coverage.relationship		0..1	CodeableConcept	Lien entre l’assuré et le bénéficiaire
Coverage.relationship.coding		1..1	Coding	Code defined by a terminology system
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type.coding.​code	Base	required	type-couverture-sociale-vs	📦1.0.0-ballot	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Coverage.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.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
Coverage.contained		0..*	Resource	Contained, inline Resources
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:informationsAmc	S This element must be supported.	0..1	(Complex)	Informations AMC URL: https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.identifier	S This element must be supported. Σ This element is included in summaries.	1..1	Identifier	Business Identifier for the coverage
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active (extensions allowed)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Coverage.type.id		0..1	string	Unique id for inter-element referencing
Coverage.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.type.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system
Coverage.type.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.type.coding.code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Binding: type-couverture-sociale-vs (required)
Coverage.type.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.type.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.type.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
Coverage.subscriber	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile | RelatedPerson)	Référence vers l’assuré
Coverage.subscriberId	Σ This element is included in summaries.	1..1	string	Numéro de sécurité sociale ou numéro d'adhérent
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile)	Plan beneficiary
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship		0..1	CodeableConcept	Lien entre l’assuré et le bénéficiaire Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.relationship.id		0..1	string	Unique id for inter-element referencing
Coverage.relationship.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.relationship.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.relationship.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Coverage.period	Σ This element is included in summaries.	0..1	Period	Coverage start and end dates
Coverage.payor	Σ This element is included in summaries.	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
Coverage.class		0..*	BackboneElement	Additional coverage classifications
Coverage.class.id		0..1	string	Unique id for inter-element referencing
Coverage.class.extension		0..*	Extension	Additional content defined by implementations
Coverage.class.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.class.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.class.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
Coverage.costToBeneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type	Σ This element is included in summaries.	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x]	Σ This element is included in summaries.	1..1		The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity			Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney			Money
Coverage.costToBeneficiary.exception		0..*	BackboneElement	Exceptions for patient payments
Coverage.costToBeneficiary.exception.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type	Σ This element is included in summaries.	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period	Σ This element is included in summaries.	0..1	Period	The effective period of the exception
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	preferred	Coverage Type and Self-Pay Codes	📍4.0.1	FHIR Std.
Coverage.type.coding.​code	Base	required	type-couverture-sociale-vs	📦1.0.0-ballot	This IG
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📍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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:informationsAmc	S This element must be supported.	0..1	(Complex)	Informations AMC URL: https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.identifier	S This element must be supported. Σ This element is included in summaries.	1..1	Identifier	Business Identifier for the coverage
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active (extensions allowed)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Coverage.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Binding: type-couverture-sociale-vs (required)
Coverage.subscriber	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile | RelatedPerson)	Référence vers l’assuré
Coverage.subscriberId	Σ This element is included in summaries.	1..1	string	Numéro de sécurité sociale ou numéro d'adhérent
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile)	Plan beneficiary
Coverage.relationship		0..1	CodeableConcept	Lien entre l’assuré et le bénéficiaire Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.relationship.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.payor	Σ This element is included in summaries.	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
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	preferred	Coverage Type and Self-Pay Codes	📍4.0.1	FHIR Std.
Coverage.type.coding.​code	Base	required	type-couverture-sociale-vs	📦1.0.0-ballot	This IG
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship 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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:informationsAmc	S This element must be supported.	0..1	(Complex)	Informations AMC URL: https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended
Coverage.identifier	S This element must be supported.	1..1	Identifier	Business Identifier for the coverage
Coverage.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active (extensions allowed)
Coverage.type	S This element must be supported.	1..1	CodeableConcept	Coverage category such as medical or accident
Coverage.type.coding		1..1	Coding	Code defined by a terminology system
Coverage.type.coding.code		0..1	code	Symbol in syntax defined by the system Binding: type-couverture-sociale-vs (required)
Coverage.subscriber	S This element must be supported.	1..1	Reference(FR Core Patient Profile | RelatedPerson)	Référence vers l’assuré
Coverage.subscriberId		1..1	string	Numéro de sécurité sociale ou numéro d'adhérent
Coverage.beneficiary	S This element must be supported.	1..1	Reference(FR Core Patient Profile)	Plan beneficiary
Coverage.relationship		0..1	CodeableConcept	Lien entre l’assuré et le bénéficiaire
Coverage.relationship.coding		1..1	Coding	Code defined by a terminology system
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type.coding.​code	Base	required	type-couverture-sociale-vs	📦1.0.0-ballot	This IG

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Coverage.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.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
Coverage.contained		0..*	Resource	Contained, inline Resources
Coverage.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:informationsAmc	S This element must be supported.	0..1	(Complex)	Informations AMC URL: https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.identifier	S This element must be supported. Σ This element is included in summaries.	1..1	Identifier	Business Identifier for the coverage
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active (extensions allowed)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Coverage.type.id		0..1	string	Unique id for inter-element referencing
Coverage.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.type.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system
Coverage.type.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.type.coding.code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Binding: type-couverture-sociale-vs (required)
Coverage.type.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.type.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.type.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
Coverage.subscriber	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile | RelatedPerson)	Référence vers l’assuré
Coverage.subscriberId	Σ This element is included in summaries.	1..1	string	Numéro de sécurité sociale ou numéro d'adhérent
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(FR Core Patient Profile)	Plan beneficiary
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship		0..1	CodeableConcept	Lien entre l’assuré et le bénéficiaire Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.relationship.id		0..1	string	Unique id for inter-element referencing
Coverage.relationship.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.relationship.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.relationship.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Coverage.period	Σ This element is included in summaries.	0..1	Period	Coverage start and end dates
Coverage.payor	Σ This element is included in summaries.	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
Coverage.class		0..*	BackboneElement	Additional coverage classifications
Coverage.class.id		0..1	string	Unique id for inter-element referencing
Coverage.class.extension		0..*	Extension	Additional content defined by implementations
Coverage.class.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.class.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.class.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
Coverage.costToBeneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type	Σ This element is included in summaries.	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x]	Σ This element is included in summaries.	1..1		The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity			Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney			Money
Coverage.costToBeneficiary.exception		0..*	BackboneElement	Exceptions for patient payments
Coverage.costToBeneficiary.exception.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type	Σ This element is included in summaries.	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period	Σ This element is included in summaries.	0..1	Period	The effective period of the exception
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	preferred	Coverage Type and Self-Pay Codes	📍4.0.1	FHIR Std.
Coverage.type.coding.​code	Base	required	type-couverture-sociale-vs	📦1.0.0-ballot	This IG
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📍4.0.1	FHIR Std.
Coverage.class.type	Base	extensible	Coverage Class Codes	📍4.0.1	FHIR Std.
Coverage.costToBeneficiary.​type	Base	extensible	Coverage Copay Type Codes	📍4.0.1	FHIR Std.
Coverage.costToBeneficiary.​exception.type	Base	example	Example Coverage Financial Exception Codes	📍4.0.1	FHIR Std.

Constraints

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

This structure is derived from Coverage

Summary

Mandatory: 5 elements(1 nested mandatory element)
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• FR Core Patient Profile (https://hl7.fr/ig/fhir/core/StructureDefinition/fr-core-patient)

Extensions

This structure refers to these extensions:

• https://hl7.fr/ig/fhir/preadmission/StructureDefinition/fr-coverage-amc-extended