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• Coverage.yml

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hl7.resource.Coverage.yml Maven / Gradle / Ivy

#
# (C) Copyright IBM Corp. 2021, 2022
#
# SPDX-License-Identifier: Apache-2.0
#
---
# Coverage required fields
#  Status
#  Beneficiary (Patient)
#  Payor

resourceType: Coverage
id:
  type: STRING
  valueOf: "UUID.randomUUID()"
  expressionType: JEXL

identifier_1:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN1.2.1
    systemCX: IN1.2.3
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "XV"
    display: "Health Plan Identifier"

identifier_2:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN1.2.4
    systemCX: IN1.2.6
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "XV"
    display: "Health Plan Identifier"

identifier_3:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN1.46
    # No systemCX set for this identifier
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "XV"
    display: "Health Plan Identifier"
    use: "old"

identifier_4:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN2.61 | IN1.36
    # No systemCX set for this identifier
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "MB"
    display: "Member Number"

identifier_5:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN2.8
    # No systemCX set for this identifier
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "MA"
    display: "Patient Medicaid number"

identifier_6:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN2.6
    # No systemCX set for this identifier
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "MC"
    display: "Patient's Medicare number"

identifier_7:
  condition: $valueIn NOT_NULL
  valueOf: datatype/Identifier_var
  generateList: true
  expressionType: resource
  vars:
    valueIn: IN1.36
    # No systemCX set for this identifier
  constants:
    system: "http://terminology.hl7.org/CodeSystem/v2-0203"
    code: "SN"
    display: "Subscriber Number"

# Status is required, but it comes from a non-table 2 char ST
# It MUST be one of: active | cancelled | draft | entered-in-error
# For now, until we get a good mapping, assume all records are active
status:
  type: STRING
  default: active
  valueOf: $active
  #   valueOf: IN1.45 value will come from IN1.45, but we don't yet have a mapping.
  expressionType: HL7Spec
  constants:
    active: "active"

payor_1:
  valueOf: resource/Organization
  expressionType: reference
  generateList: true
  vars:
    orgName: String, IN1.4.1
    orgIdValue: String, IN1.3.1
    orgIdSystem: String, IN1.3.4
    orgIdTypeCode: String, IN1.3.5
    orgIdStart: IN1.3.7
    orgIdEnd: IN1.3.8
    orgAddressXAD: IN1.5
    orgContactXCN: IN1.6
    orgContactPointXTN: IN1.7
    orgCompanyPlanCode: IN1.35

payor_2:
  valueOf: resource/Organization
  expressionType: reference
  generateList: true
  vars:
    # NOTE FHIR does not require Organization.name, but we do
    # for an unknown reason. This is documented in Issue #422
    orgName: String, IN2.25.1
    orgIdValue: String, IN2.25.1
    orgIdSystem: String, IN2.25.4
    orgIdTypeCode: String, IN2.25.5
    orgIdStart: IN2.25.7
    orgIdEnd: IN2.25.8

policyHolder:
  valueOf: resource/Organization
  expressionType: reference
  vars:
    orgName: String, IN2.69.1
    orgIdValue: String, IN2.69.10
    orgIdSystem: String, IN2.69.6
    orgIdTypeCode: String, IN2.69.7

# If the subscriber is in the list of relationship codes needing a relatedPerson, create one
subscriber_1:
  condition: $createRelatedPerson NOT_NULL && $createRelatedPerson EQUALS TRUE
  valueOf: resource/RelatedPerson
  expressionType: reference
  vars:
    createRelatedPerson: RELATED_PERSON_NEEDED, IN1.17 | IN2.72
    # Related person gets many values from scope, so they do not need to be passed in
    #  IN1 and sub-fields
    #  $Patient

# If the subscriber is SEL (self), do not create a relatedPerson, but reference the patient
# NOT_NULL check is not needed because we have positive values and condition will not fire without them
subscriber_2:
  condition: $subscriberIsSelf EQUALS TRUE
  valueOf: datatype/Reference
  expressionType: resource
  specs: $Patient
  vars:
    subscriberIsSelf: SUBSCRIBER_IS_SELF, IN1.17 | IN2.72 # subscriber relationship

subscriberId:
  type: STRING
  valueOf: IN1.36
  expressionType: HL7Spec

# Relationship may be SEL (self)
relationship:
  valueOf: datatype/CodeableConcept
  expressionType: resource
  generateList: true
  condition: $coding NOT_NULL
  vars:
    coding: SUBSCRIBER_RELATIONSHIP, IN1.17 | IN2.72
    text: String, IN1.17.2 | IN2.72.2

beneficiary:
  valueOf: datatype/Reference
  expressionType: resource
  specs: $Patient

class_1:
  valueOf: secondary/Class
  generateList: true
  expressionType: resource
  vars:
    classValue: String, IN1.8

class_2:
  valueOf: secondary/Class
  generateList: true
  expressionType: resource
  specs: IN1.9

period:
  valueOf: datatype/Period
  expressionType: resource
  vars:
    start: IN1.12
    end: IN1.13

order:
  type: INTEGER
  valueOf: IN1.22 | IN1.1
  expressionType: HL7Spec