Implementation Guide
25.0.0 - R4 APIs

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Resource Profile: ATHENACoverage - Mappings

Active as of 2022-03-01

Mappings for the athena-coverage-profile resource profile.

Mappings to Structures in this Implementation Guide

No Mappings Found

Mappings to other Structures

No Mappings Found

Other Mappings

NameathenaFlowathenaPracticeWorkflow PatternRIM MappingFiveWs Pattern MappingCanadian Dental Association eclaims standardHL7 v2 MappingCanadian Pharmacy Associaiton eclaims standarddoco
.. Coverage
FHIRR4_COVERAGEVIEW
FHIRR4_COVERAGEVIEW
Event
Coverage
... id
MakeId(%INSID%)
MakeId(%PATIENTINSURANCEID%)
... meta
.... id
n/a
.... extension
n/a
.... versionId
.... lastUpdated
%DB_UPDATED_DATE%
%LASTMODIFIED%
.... source
.... Slices for profile
..... profile:ATHENA Coverage Profile
.... security
CheckSensitive(%SENSITIVECHART%)
CheckSensitive(%SENSITIVECHART%)
.... tag
... implicitRules
... text
Act.text?
... contained
N/A
... Slices for extension
.... extension:coverage-type
..... id
n/a
..... extension
n/a
..... url
N/A
..... value[x]
%TYPE%
%TYPE%
N/A
.... extension:subscriber-name
..... id
n/a
..... extension
n/a
..... url
N/A
..... value[x]
  • MakeSearchName(%PATIENTPREFIX%
  • %PATIENTFIRST%
  • %PATIENTMI%
  • %PATIENTLAST%
  • %PATIENTSUFFIX%)
  • MakeSearchName(%PATIENTPREFIX%
  • %PATIENTFIRST%
  • %PATIENTMI%
  • %PATIENTLAST%
  • %PATIENTSUFFIX%)
N/A
... modifierExtension
N/A
... identifier
  • MakeIdentifier("MB"
  • null
  • %IDNO%)
  • MakeIdentifier("MB"
  • null
  • %INSUREDID%)
Event.identifier
.id
FiveWs.identifier
C02
IN1-2
  • C.32
  • C.33
  • C.39
... status
  • IsIntentCode("active"
  • %STATUS%)
  • IsIntentCode("active"
  • %STATUS%)
Event.status
Act.status
FiveWs.status
... type
  • MakeConcept(%CODE%
  • getSiteIdSystem("InsuranceCarrierType")
  • %DESCRIPTION%)
  • MakeConcept(%SOPCODE%
  • getSiteIdSystem("InsuranceCarrierType")
  • %SOPDESCRIPTION%)
FiveWs.class
IN1-15
... policyHolder
  • MakeReference("PATIENT"
  • %PID%
  • "Patient")
  • MakeReference("PATIENT"
  • %PID%
  • "Patient")
FiveWs.subject
D01 through D09
  • IN1-16
  • 18
  • 19-name of insured
  • address
  • date of birth
C.35
... subscriber
  • MakeReference("PATIENT"
  • %PID%
  • "Patient")
  • MakeReference("PATIENT"
  • %PID%
  • "Patient")
FiveWs.subject
D01 through D09
  • IN1-16
  • 18
  • 19-name of insured
  • address
  • date of birth
C.35
... subscriberId
%IDNO%
%INSUREDID%
FiveWs.subject
D01 through D09
  • IN1-16
  • 18
  • 19-name of insured
  • address
  • date of birth
C.35
... beneficiary
  • MakeReference("PATIENT"
  • %PID%
  • "Patient")
  • MakeReference("PATIENT"
  • %PID%
  • "Patient")
Event.subject
FiveWs.subject
D01 through D09
  • IN1-16
  • 18
  • 19-name of insured
  • address
  • date of birth
C.35
... dependent
C17
- No exact HL7 v2 equivalent concept seems to exist;
... relationship
  • MakeConcept(%RELATIONSHIPCODE%
  • //hl7.org/fhir/R4/valueset-subscriber-relationship"
  • %RELATIONSHIPDESCRIPTION%)
  • MakeConcept(%RELATIONSHIPCODE%
  • //hl7.org/fhir/R4/valueset-subscriber-relationship"
  • %RELATIONSHIPDESCRIPTION%)
C03
... period
  • MakePeriod(%EFFECTIVEDATE%
  • %EXPIREDDATE%)
  • MakePeriod(%INSCARDEFFECTIVEDATE%
  • %INSCARDTERMINATIONDATE%)
Event.occurrence[x]
Act.effectiveTime
FiveWs.done[x]
IN1-12 / IN1-13
... payor
  • MakeReference("INSCARRIER"
  • %BUSID%
  • "Organization"
  • %NAME% )
  • MakeReference("INSCARRIER"
  • %INSURANCECARRIERSID%
  • "Organization"
  • %INSURANCECARRIERNAME%)
FiveWs.author
A05
IN1-3
C.30
... Slices for class
.... class:All Slices
..... id
n/a
..... extension
n/a
..... modifierExtension
N/A
..... type
..... value
  • C11 (Division
  • Section)
IN1-8
C.31
..... name
  • C11 (Division
  • Section)
IN1-8
C.31
.... class:Group
..... id
n/a
..... extension
n/a
..... modifierExtension
N/A
..... type
  • MakeConcept(%CLASSTYPECODE%
  • //terminology.hl7.org/CodeSystem/coverage-class")
  • MakeConcept(%CLASSTYPECODE%
  • //terminology.hl7.org/CodeSystem/coverage-class")
..... value
%GRPNO%
%GROUPID%
  • C11 (Division
  • Section)
IN1-8
C.31
..... name
%GROUPNAME%
%GROUPNAME%
  • C11 (Division
  • Section)
IN1-8
C.31
.... class:Plan
..... id
n/a
..... extension
n/a
..... modifierExtension
N/A
..... type
  • MakeConcept(%CLASSTYPECODEFORPLAN%
  • //terminology.hl7.org/CodeSystem/coverage-class"
  • %CLASSTYPECODEFORPLAN%)
  • MakeConcept(%CLASSTYPECODEFORPLAN%
  • //terminology.hl7.org/CodeSystem/coverage-class"
  • %CLASSTYPECODEFORPLAN%)
..... value
%PLANID%
%PLANID%
  • C11 (Division
  • Section)
IN1-8
C.31
..... name
%PLANNAME%
%PLANNAME%
  • C11 (Division
  • Section)
IN1-8
C.31
... order
- No exact HL7 v2 equivalent concept seems to exist;
... network
D10
... costToBeneficiary
.... id
n/a
.... extension
n/a
.... modifierExtension
N/A
.... type
.... value[x]
  • C11 (Division
  • Section)
IN1-8
C.31
.... exception
..... id
n/a
..... extension
n/a
..... modifierExtension
N/A
..... type
..... period
... subrogation
... contract
n/a
D01 through D09
  • IN1-16
  • 18
  • 19
C.35

doco Documentation for this format