Schema reference / Tables / view MDX source

coverage

The US Core Coverage Profile inherits from the FHIR [Coverage](https://hl7.org/fhir/R4/coverage.html) resource; refer to it for scope and usage definitions.

The US Core Coverage Profile inherits from the FHIR Coverage resource; refer to it for scope and usage definitions. This profile meets the requirements of the US Core Data for Interoperability (USCDI) *Health Insurance Information* Data Class. It sets minimum expectations for the Coverage resource to record, search, and fetch data related to an individual's insurance coverage for health care. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Source

Model	Leg	Role
`us-core-coverage`	FHIR	defines this table

Columns

Column	Type	Null	Description	Source
`id`	`uuid primary key`	no	Coverage.id	—
`created_at`	`timestamptz`	no	Row creation timestamp.	—
`updated_at`	`timestamptz`	no	Row update timestamp; maintained by the application.	—
`created_by`	`text`	no	Actor who created the row.	—
`updated_by`	`text`	no	Actor who last updated the row.	—
`memberid`	`text`	yes	Member ID	`Coverage.identifier`
`identifier_value` `identifier_system`	text, text `text`, `text`	yes	Member ID and other identifiers	`Coverage.identifier`
`status`	`text`	yes	active \| cancelled \| draft \| entered-in-error	`Coverage.status`
`type` `type_code` `type_system` `type_valueset_id`	coded text `text`, `text`, `text`, `text`	yes	Coverage category such as medical or accident	`Coverage.type`
`subscriber_id`	`text`	yes	ID assigned to the subscriber	`Coverage.subscriberId`
`patient_id`	`uuid`	yes	Plan beneficiary	`Coverage.beneficiary`
`relationship` `relationship_code` `relationship_system` `relationship_valueset_id`	coded text `text`, `text`, `text`, `text`	yes	Beneficiary relationship to the subscriber	`Coverage.relationship`
`period_start` `period_end`	timestamptz, timestamptz `timestamptz`, `timestamptz`	yes	Coverage start and end dates	`Coverage.period`
`payor_organization_id` `payor_patient_id` `payor_related_person_id`	uuid, uuid, uuid `uuid`, `uuid`, `uuid`	yes	Issuer of the policy	`Coverage.payor`
`class_group_value`	`text`	yes	Group Identifier	`Coverage.class.value`
`class_plan_value`	`text`	yes	Plan Number	`Coverage.class.value`
`class_plan_name`	`text`	yes	Plan Name	`Coverage.class.name`

Constraints

check (identifier_system is null or identifier_value is not null)
check ((type is null and type_code is null and type_system is null and type_valueset_id is null) or (type is not null and type_code is not null and type_system is not null and type_valueset_id is not null))
check ((relationship is null and relationship_code is null and relationship_system is null and relationship_valueset_id is null) or (relationship is not null and relationship_code is not null and relationship_system is not null and relationship_valueset_id is not null))
check (period_start is null or period_end is null or period_start <= period_end)
check (num_nonnulls(payor_organization_id, payor_patient_id, payor_related_person_id) <= 1)

References

Columns	Target	On delete
`type_valueset_id, type_code, type_system, type`	`valueset_code`	restrict
`relationship_valueset_id, relationship_code, relationship_system, relationship`	`valueset_code`	restrict
`patient_id`	`patient`	no action
`payor_organization_id`	`organization`	no action
`payor_patient_id`	`patient`	no action
`payor_related_person_id`	`related_person`	no action

Referenced by

coverage_other_identifier via coverage_id

Indexes

coverage_patient_id_idx on patient_id
coverage_payor_organization_id_idx on payor_organization_id
coverage_payor_patient_id_idx on payor_patient_id
coverage_payor_related_person_id_idx on payor_related_person_id

Child tables

1 table hang off coverage, one row per repetition.

`coverage_other_identifier`

Child table — one row per repetition, deleted with its parent.

Column	Type	Null	Description	Source
`id`	`uuid primary key`	no	Primary key.	—
`coverage_id`	`uuid` → `coverage`	no	—	—
`identifier_value`	`text`	no	—	—
`identifier_system`	`text`	yes	—	—
`identifier_use`	`text`	yes	—	—
`valid_from`	`timestamptz`	yes	—	—
`valid_until`	`timestamptz`	yes	—	—

Unique

coverage_id, identifier_system, identifier_value

References

Columns	Target	On delete
`coverage_id`	`coverage`	cascade

Value sets

Value set	Codes
`http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591`	0
`http://hl7.org/fhir/ValueSet/subscriber-relationship`	0