Patient Insurance
Patient-Insurance
Source Object: Patient-Insurance
The Patient-Insurance source object captures vital data related to a patient's insurance coverage. This information is crucial for billing, claims processing, and managing the financial aspects of healthcare services.
Overview
The Patient-Insurance source object contains a comprehensive set of data concerning a patient's insurance coverage. This data includes details on both current insurances and deleted insurances. Key information includes insurance carriers, copay amounts, deductibles, group IDs, insurance plan details, member IDs, and payment programs. It also includes data about the insured person, such as their name, date of birth (DOB), gender, Social Security Number (SSN), and address.
Usage
The Patient-Insurance source object is used for the following purposes:
- Insurance Information: It stores information about the patient's current and deleted insurance coverage, such as the insurance carrier, plan details, and financial terms like copays and deductibles.
- Insured Person Data: Information about the person insured under the policy is captured, including their name, date of birth, gender, SSN, and address. This is valuable for verifying the identity of the insured.
- Billing and Claims Processing: Insurance data is used for billing and claims submission, ensuring that medical services are covered and appropriately reimbursed.
- Payment Programs: Details of payment programs associated with insurance plans are recorded, helping to manage payment arrangements.
- Group IDs and Member IDs: Group IDs and member IDs facilitate the identification of the patient within the insurance plan.
The Patient-Insurance source object is essential for the financial management of healthcare services and ensuring that patients receive the appropriate insurance benefits.
Mapping Table
| Data Field | Source Field Data Type | Resource Mapping Context | Source Data Field Cardinality | Source Data Field Description | Example Value | Source Data Field Validation Rule | Mapped FHIR Resource | Mapped FHIR Data Field | Augmented Mapping | Associated Coding System | Associated FHIR Data Field Extension | Mapped FHIR Data Field Type |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| deleted_insurances | Object | Top Level | 0..* | - | - | max 5 deleted insurances | Coverage | - | - | NA | - | TBD |
| deleted_insurances.carrier | String | Top Level | 0..1 | - | Blue Cross | string(200) | Coverage | network | - | NA | - | TBD |
| deleted_insurances.copay | Decimal | Top Level | 0..1 | - | null | - | Coverage | costToBeneficiary[*].valueMoney.value | - | NA | - | TBD |
| deleted_insurances.created_date | DateTime | Top Level | 0..1 | read-only | 2020-05-12T22:52:25Z | datetime(iso8601) | Coverage | extension[*].valueDateTime | - | NA | creted-date | TBD |
| deleted_insurances.deductible | Decimal | Top Level | 0..1 | - | null | - | Coverage | costToBeneficiary[*].valueMoney.value | - | NA | - | TBD |
| deleted_insurances.deleted_date | DateTime | Top Level | 0..1 | read-only | 2021-04-28T10:50:22Z | datetime(iso8601) | Coverage | extension[*].valueDateTime | - | NA | deleted-date | TBD |
| deleted_insurances.group_id | String | Top Level | 0..1 | - | test_group_id | string(50) | Coverage | class[*].name | - | NA | - | TBD |
| deleted_insurances.id | Id | Top Level | 0..1 | - | 140745403531347 | - | Coverage | id | - | NA | - | TBD |
| deleted_insurances.insurance_plan | Id | Top Level | 0..1 | from Insurance Plan resource | 70971687279 | - | Coverage | class[*].id | - | NA | - | TBD |
| deleted_insurances.member_id | String | Top Level | 1..1 | - | test_member_id | string(50) | Coverage | class[*].id | - | NA | - | TBD |
| deleted_insurances.payment_program | ValueSet | Top Level | 0..1 | - | Commercial - Other | "Medicare Part B", "Medicare Advantage", "Medicaid", "Commercial - HMSA", "Commercial - SFHP", "Commercial - Other", "Worker's Compensation" | Coverage | type.coding[1].display | - | NA | - | TBD |
| deleted_insurances.plan | String | Top Level | 0..1 | - | Blue Cross Blue Shield | string(200) | Coverage | class[*].name | - | NA | - | TBD |
| deleted_insurances.rank | ValueSet | Top Level | 0..1 | - | secondary | "primary", "secondary", "tertiary" | Coverage | order | - | NA | - | TBD |
| insurances | Object | Top Level | 0..* | - | - | max 2 insurances | Coverage | - | - | NA | - | TBD |
| insurances.carrier | String | Top Level | 0..1 | - | Blue Cross | string(200) | Coverage | network | - | NA | - | TBD |
| insurances.copay | Decimal | Top Level | 0..1 | - | null | - | Coverage | costToBeneficiary[*].valueMoney.value | - | NA | - | TBD |
| insurances.created_date | DateTime | Top Level | 0..1 | read-only | 2020-05-12T22:52:25Z | datetime(iso8601) | Coverage | extension[*].valueString | - | NA | created-date | TBD |
| insurances.deductible | Decimal | Top Level | 0..1 | - | null | - | Coverage | costToBeneficiary[*].valueMoney.value | - | NA | - | TBD |
| insurances.deleted_date | DateTime | Top Level | 0..1 | read-only | null | datetime(iso8601) | Coverage | extension[*].valueDateTime | - | NA | deleted-date | TBD |
| insurances.group_id | String | Top Level | 0..1 | - | test_group_id | string(50) | Coverage | class[*].name | class[].type.coding[1].code=group | NA | - | TBD |
| insurances.id | Id | Top Level | 0..1 | - | 140767609356371 | - | Coverage | id | - | NA | - | TBD |
| insurances.insurance_plan | Id | Top Level | 0..1 | from Insurance Plan resource | 70971687279 | - | Coverage | class[*].id | class[].type.coding[1].code=insurance_plan | NA | - | TBD |
| insurances.member_id | String | Top Level | 1..1 | - | test_member_id | string(50) | Coverage | class[*].id | class[].type.coding[1].code=rxid | NA | - | TBD |
| insurances.payment_program | ValueSet | Top Level | 0..1 | - | Commercial - Other | "Medicare Part B", "Medicare Advantage", "Medicaid", "Commercial - HMSA", "Commercial - SFHP", "Commercial - Other", "Worker's Compensation" | Coverage | type.coding[1].display | - | NA | - | TBD |
| insurances.plan | String | Top Level | 0..1 | - | Blue Cross Blue Shield | string(200) | Coverage | class[*].name | class[].type.coding[1].code=plan | NA | - | TBD |
| insurances.rank | ValueSet | Top Level | 0..1 | - | primary | "primary", "secondary", "tertiary" | Coverage | order | - | NA | - | TBD |
| deleted_insurances.insured_person_address | String | Contained | 0..1 | - | 550 15th St | string(200) | RelatedPerson | contained[].address[].line[0] | - | NA | - | TBD |
| deleted_insurances.insured_person_city | String | Contained | 0..1 | - | San Francisco | string(50) | RelatedPerson | contained[].address[].city | - | NA | - | TBD |
| deleted_insurances.insured_person_dob | String | Contained | 0..1 | - | 08/29/1940 | string(50) | RelatedPerson | contained[*].birthDate | - | NA | - | TBD |
| deleted_insurances.insured_person_first_name | String | Contained | 0..1 | - | Paula | string(200) | RelatedPerson | policyHolder.display | - | NA | - | TBD |
| deleted_insurances.insured_person_gender | ValueSet | Contained | 0..1 | - | F | "M", "F", "N" | RelatedPerson | contained[*].gender | - | NA | - | TBD |
| deleted_insurances.insured_person_id | String | Contained | 0..1 | - | 12345 | // string(50) | RelatedPerson | contained[*].id | - | NA | - | TBD |
| deleted_insurances.insured_person_last_name | String | Contained | 0..1 | - | Patient | string(200) | RelatedPerson | policyholder.extension[*].valueString | - | NA | person-last-name | TBD |
| deleted_insurances.insured_person_ssn | Integer | Contained | 0..1 | - | 123456789 | integer(9 digits) | RelatedPerson | contained[].identifier[].value | - | NA | - | TBD |
| deleted_insurances.insured_person_state | String | Contained | 0..1 | - | CA | string(2) | RelatedPerson | contained[].address[].state | - | NA | - | TBD |
| deleted_insurances.insured_person_zip | String | Contained | 0..1 | - | 94013 | integer(9 digits) | RelatedPerson | contained[].address[].postalCode | - | NA | - | TBD |
| deleted_insurances.relationship_to_insured | String | Contained | 0..1 | - | null | string(20) | RelatedPerson | contained[].relationship[].text | - | NA | - | TBD |
| insurances.insured_person_address | String | Contained | 0..1 | - | 550 15th St | string(200) | RelatedPerson | contained[].address[].line[0] | - | NA | - | TBD |
| insurances.insured_person_city | String | Contained | 0..1 | - | San Francisco | string(50) | RelatedPerson | contained[].address[].city | - | NA | - | TBD |
| insurances.insured_person_dob | String | Contained | 0..1 | - | 08/29/1940 | string(50) | RelatedPerson | contained[*].birthDate | - | NA | - | TBD |
| insurances.insured_person_first_name | String | Contained | 0..1 | - | Paula | string(200) | RelatedPerson | policyHolder.display | resourceType == RelatedPerson | NA | - | TBD |
| insurances.insured_person_gender | ValueSet | Contained | 0..1 | - | F | "M", "F", "N" | RelatedPerson | contained[*].gender | - | NA | - | TBD |
| insurances.insured_person_id | String | Contained | 0..1 | - | 12345 | string(50) | RelatedPerson | contained[*].id | - | NA | - | TBD |
| insurances.insured_person_last_name | String | Contained | 0..1 | - | Patient | string(200) | RelatedPerson | policyholder.extension[*].valueString | - | NA | person-last-name | TBD |
| insurances.insured_person_ssn | Integer | Contained | 0..1 | - | 123456789 | integer(9 digits) | RelatedPerson | contained[].identifier[].value | - | NA | ssn | string |
| insurances.insured_person_state | String | Contained | 0..1 | - | CA | string(2) | RelatedPerson | contained[].address[].state | - | NA | - | TBD |
| insurances.insured_person_zip | String | Contained | 0..1 | - | 94013 | integer(9 digits) | RelatedPerson | contained[].address[].postalCode | - | NA | - | TBD |
| insurances.relationship_to_insured | String | Contained | 0..1 | - | null | string(20) | RelatedPerson | contained[].relationship[].text | - | NA | - | string |
| deleted_insurances.address | String | Contained | 0..1 | - | 123 medicare st | string(200) | Organization | contained[].address[].line[1] | - | NA | - | TBD |
| deleted_insurances.city | String | Contained | 0..1 | - | San Francisco | string(50) | Organization | contained[].address[].city | - | NA | - | TBD |
| deleted_insurances.extension | String | Contained | 0..1 | - | - | string(6) | Organization | contained[].extension[].valueString | - | NA | extension | TBD |
| deleted_insurances.insurance_company | Id | Contained | 0..1 | from Insurance Company resource | 70970048878 | - | Organization | contained[*].id | - | NA | - | TBD |
| deleted_insurances.phone | String | Contained | 0..1 | - | - | string(20) | Organization | contained[].telecom[].value | - | NA | - | TBD |
| deleted_insurances.state | String | Contained | 0..1 | - | CA | string(2) | Organization | contained[].address[].state | - | NA | - | TBD |
| deleted_insurances.suite | String | Contained | 0..1 | - | null | string(35) | Organization | contained[].address[].line[2] | - | NA | - | TBD |
| deleted_insurances.zip | String | Contained | 0..1 | - | 94104 | integer(9 digits) | Organization | contained[].address[].postalCode | - | NA | - | TBD |
| insurances.address | String | Contained | 0..1 | - | 123 medicare st | string(200) | Organization | contained[].address[].line[1] | resourceType = Organization | NA | - | TBD |
| insurances.city | String | Contained | 0..1 | - | San Francisco | string(50) | Organization | contained[].address[].city | resourceType = Organization | NA | - | TBD |
| insurances.extension | String | Contained | 0..1 | - | - | string(6) | Organization | contained[].extension[].valueString | resourceType = Organization | NA | extension | TBD |
| insurances.insurance_company | Id | Contained | 0..1 | from Insurance Company resource | 70970048878 | - | Organization | contained[*].id | resourceType = Organization | NA | - | TBD |
| insurances.phone | String | Contained | 0..1 | - | - | string(20) | Organization | contained[].telecom[].value | resourceType = Organization && system = phone | NA | - | TBD |
| insurances.state | String | Contained | 0..1 | - | CA | string(2) | Organization | contained[].address[].state | resourceType = Organization | NA | - | TBD |
| insurances.suite | String | Contained | 0..1 | - | null | string(35) | Organization | contained[].address[].line[2] | resourceType = Organization | NA | - | TBD |
| insurances.zip | String | Contained | 0..1 | - | 94104 | integer(9 digits) | Organization | contained[].address[].postalCode | resourceType = Organization | NA | - | TBD |