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

Data Element

Additional Information

Coverage Type
Description
Category of health care payers. (e.g., Medicare, TRICARE, Commercial Managed Care - PPO)

Comment

Use of X12 EDI Standards

Given that the health insurance information is used specifically for filing claims or checking eligibility, consistency with the X12 EDI standards on insurance is recommended. 

Unified Comment from CDC

  • Exchange of data element: The Multiple Chronic Conditions eCare Plan project successfully tested this element at the Sep 2020 and Jan 2021 FHIR connectathons and has implemented it at the OHSU testing site.  
  • Applicable Standard:  http://hl7.org/fhir/R4/valueset-coverage-type.html  
  • Additional Use Cases: MedMorph: https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html Central Cancer Registry Reporting https://www.cdc.gov/cancer/npcr/ Health Care Surveys: https://www.cdc.gov/nchs/dhcs/nhcs_registry_landing.htm PCORnet: https://pcornet.org/ Birth Reporting: https://www.cdc.gov/nchs/nvss/births.htm Multiple Chronic Conditions eCare Pan: https://confluence.hl7.org/display/PC/Multiple+Chronic+Conditions+%28MCC%29+eCare+Plan This element is used by CMS Quality Reporting and is marked Required or MustSupport in the FHIR QI Core IG

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