Data related to an individual’s insurance coverage for health care.

Data Element

Coverage Status

Presence or absence of health care insurance.


Coverage Status for service item

This concept is better defined at the service item level or at a patient level rather than encounter or claim level for the following reasons: 

  • There could be a mix of coverages for any particular encounter or claim.
  • A claim may contain several items, some of which are covered and others not.
  • Claims can be covered by a variety of insurers.

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