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Source1
{
"resourceType": "StructureDefinition",
"id": "KBV-PR-FOR-Coverage",
"url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage",
"version": "1.2.1",
"name": "KBV_PR_FOR_Coverage",
"status": "active",
"date": "2025-11-20",
"publisher": "Kassenärztliche Bundesvereinigung (KBV)",
"fhirVersion": "4.0.1",
"kind": "resource",
"abstract": false,
"type": "Coverage",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage",
"derivation": "constraint",
"differential": {
"element": [
{
"id": "Coverage",
"path": "Coverage",
"definition": "Das Versicherungsverhältnis, welches genutzt werden kann, die Behandlungskosten zu tragen.",
"constraint": [
{
"key": "-for-angabeIKzustaendigeKrankenkasseEGKPflicht",
"severity": "error",
"human": "Das IK der zustaendigen Krankenkasse ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
"expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies payor.identifier.exists()"
},
{
"key": "-for-angabeVersichertenartPflicht",
"severity": "error",
"human": "Die Versichertenart ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
"expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/versichertenart').exists()"
},
{
"key": "-for-angabeBesonderePersonengruppePflicht",
"severity": "error",
"human": "Die Besondere Personengruppe ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
"expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/besondere-personengruppe').exists()"
},
{
"key": "-for-angabeIKKostentraegerVerbot",
"severity": "error",
"human": "Nur wenn der Kostentraeger vom Typ BG oder UK ist, dann kann das IK des Kostentraegers uebertragen werden",
"expression": "(type.coding.code='GKV' or type.coding.code='SKT' or type.coding.code='SEL' or type.coding.code='PKV') implies payor.identifier.extension('https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK').exists().not()"
},
{
"key": "-for-angabeDMPPflicht",
"severity": "error",
"human": "Das DMP-Kennzeichen ist nicht vorhanden, dieses ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement.",
"expression": "(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen').exists()"
}
]
},
{
"id": "Coverage.id",
"path": "Coverage.id",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.meta",
"path": "Coverage.meta",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.meta.versionId",
"path": "Coverage.meta.versionId",
"max": "0"
},
{
"id": "Coverage.meta.lastUpdated",
"path": "Coverage.meta.lastUpdated",
"max": "0"
},
{
"id": "Coverage.meta.source",
"path": "Coverage.meta.source",
"max": "0"
},
{
"id": "Coverage.meta.profile",
"path": "Coverage.meta.profile",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "$this"
}
],
"rules": "open"
},
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.meta.profile:forProfile",
"path": "Coverage.meta.profile",
"sliceName": "forProfile",
"min": 1,
"max": "1",
"fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage|1.2",
"mustSupport": true
},
{
"id": "Coverage.meta.security",
"path": "Coverage.meta.security",
"max": "0"
},
{
"id": "Coverage.meta.tag",
"path": "Coverage.meta.tag",
"max": "0"
},
{
"id": "Coverage.implicitRules",
"path": "Coverage.implicitRules",
"max": "0"
},
{
"id": "Coverage.language",
"path": "Coverage.language",
"max": "0"
},
{
"id": "Coverage.text",
"path": "Coverage.text",
"max": "0"
},
{
"id": "Coverage.contained",
"path": "Coverage.contained",
"max": "0"
},
{
"id": "Coverage.extension",
"path": "Coverage.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"rules": "closed"
},
"max": "4",
"mustSupport": true
},
{
"id": "Coverage.extension:BesonderePersonengruppe",
"path": "Coverage.extension",
"sliceName": "BesonderePersonengruppe",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/besondere-personengruppe"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.extension:BesonderePersonengruppe.value[x]",
"path": "Coverage.extension.value[x]",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.extension:BesonderePersonengruppe.value[x].system",
"path": "Coverage.extension.value[x].system",
"mustSupport": true
},
{
"id": "Coverage.extension:BesonderePersonengruppe.value[x].version",
"path": "Coverage.extension.value[x].version",
"max": "0"
},
{
"id": "Coverage.extension:BesonderePersonengruppe.value[x].code",
"path": "Coverage.extension.value[x].code",
"mustSupport": true
},
{
"id": "Coverage.extension:BesonderePersonengruppe.value[x].display",
"path": "Coverage.extension.value[x].display",
"max": "0"
},
{
"id": "Coverage.extension:BesonderePersonengruppe.value[x].userSelected",
"path": "Coverage.extension.value[x].userSelected",
"max": "0"
},
{
"id": "Coverage.extension:DMPKennzeichen",
"path": "Coverage.extension",
"sliceName": "DMPKennzeichen",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.extension:DMPKennzeichen.value[x]",
"path": "Coverage.extension.value[x]",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.extension:DMPKennzeichen.value[x].system",
"path": "Coverage.extension.value[x].system",
"mustSupport": true
},
{
"id": "Coverage.extension:DMPKennzeichen.value[x].version",
"path": "Coverage.extension.value[x].version",
"max": "0"
},
{
"id": "Coverage.extension:DMPKennzeichen.value[x].code",
"path": "Coverage.extension.value[x].code",
"mustSupport": true
},
{
"id": "Coverage.extension:DMPKennzeichen.value[x].display",
"path": "Coverage.extension.value[x].display",
"max": "0"
},
{
"id": "Coverage.extension:DMPKennzeichen.value[x].userSelected",
"path": "Coverage.extension.value[x].userSelected",
"max": "0"
},
{
"id": "Coverage.extension:Versichertenart",
"path": "Coverage.extension",
"sliceName": "Versichertenart",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/versichertenart"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.extension:Versichertenart.value[x]",
"path": "Coverage.extension.value[x]",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.extension:Versichertenart.value[x].system",
"path": "Coverage.extension.value[x].system",
"mustSupport": true
},
{
"id": "Coverage.extension:Versichertenart.value[x].version",
"path": "Coverage.extension.value[x].version",
"max": "0"
},
{
"id": "Coverage.extension:Versichertenart.value[x].code",
"path": "Coverage.extension.value[x].code",
"mustSupport": true
},
{
"id": "Coverage.extension:Versichertenart.value[x].display",
"path": "Coverage.extension.value[x].display",
"max": "0"
},
{
"id": "Coverage.extension:Versichertenart.value[x].userSelected",
"path": "Coverage.extension.value[x].userSelected",
"max": "0"
},
{
"id": "Coverage.extension:WOP",
"path": "Coverage.extension",
"sliceName": "WOP",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/wop"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.extension:WOP.value[x]",
"path": "Coverage.extension.value[x]",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.extension:WOP.value[x].system",
"path": "Coverage.extension.value[x].system",
"mustSupport": true
},
{
"id": "Coverage.extension:WOP.value[x].version",
"path": "Coverage.extension.value[x].version",
"max": "0"
},
{
"id": "Coverage.extension:WOP.value[x].code",
"path": "Coverage.extension.value[x].code",
"mustSupport": true
},
{
"id": "Coverage.extension:WOP.value[x].display",
"path": "Coverage.extension.value[x].display",
"max": "0"
},
{
"id": "Coverage.extension:WOP.value[x].userSelected",
"path": "Coverage.extension.value[x].userSelected",
"max": "0"
},
{
"id": "Coverage.identifier",
"path": "Coverage.identifier",
"short": "Primaerer Identifier der Versicherung",
"definition": "Ein gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet.",
"max": "0",
"mustSupport": true
},
{
"id": "Coverage.status",
"path": "Coverage.status",
"fixedCode": "active",
"mustSupport": true
},
{
"id": "Coverage.type",
"path": "Coverage.type",
"short": "Kostenträgertyp",
"definition": "Art des Kostenträgers",
"min": 1,
"mustSupport": true,
"binding": {
"strength": "required",
"valueSet": "https://fhir.kbv.de/ValueSet/KBV_VS_FOR_Payor_type"
}
},
{
"id": "Coverage.type.coding",
"path": "Coverage.type.coding",
"min": 1,
"max": "1",
"mustSupport": true
},
{
"id": "Coverage.type.coding.system",
"path": "Coverage.type.coding.system",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.type.coding.version",
"path": "Coverage.type.coding.version",
"max": "0"
},
{
"id": "Coverage.type.coding.code",
"path": "Coverage.type.coding.code",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.type.coding.display",
"path": "Coverage.type.coding.display",
"max": "0"
},
{
"id": "Coverage.type.coding.userSelected",
"path": "Coverage.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.type.text",
"path": "Coverage.type.text",
"max": "0"
},
{
"id": "Coverage.policyHolder",
"path": "Coverage.policyHolder",
"max": "0"
},
{
"id": "Coverage.subscriber",
"path": "Coverage.subscriber",
"max": "0"
},
{
"id": "Coverage.subscriberId",
"path": "Coverage.subscriberId",
"max": "0"
},
{
"id": "Coverage.beneficiary",
"path": "Coverage.beneficiary",
"short": "Begünstigte Person",
"type": [
{
"code": "Reference",
"targetProfile": [
"https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Patient|1.2"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.beneficiary.reference",
"path": "Coverage.beneficiary.reference",
"definition": "An dieser Stelle wird die Referenz zum Patienten hinterlegt.",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.beneficiary.type",
"path": "Coverage.beneficiary.type",
"max": "0"
},
{
"id": "Coverage.beneficiary.identifier",
"path": "Coverage.beneficiary.identifier",
"max": "0"
},
{
"id": "Coverage.beneficiary.display",
"path": "Coverage.beneficiary.display",
"max": "0"
},
{
"id": "Coverage.dependent",
"path": "Coverage.dependent",
"max": "0"
},
{
"id": "Coverage.relationship",
"path": "Coverage.relationship",
"max": "0"
},
{
"id": "Coverage.period",
"path": "Coverage.period",
"constraint": [
{
"key": "-for-begrenzungDate",
"severity": "error",
"human": "Beschränkung auf die Angaben JJJJ-MM-TT",
"expression": "end.toString().length() = 10"
}
],
"mustSupport": true
},
{
"id": "Coverage.period.start",
"path": "Coverage.period.start",
"max": "0"
},
{
"id": "Coverage.period.end",
"path": "Coverage.period.end",
"short": "Versicherungsschutz Ende",
"definition": "Angabe zum Versicherungsschutz Ende",
"min": 1,
"mustSupport": true
},
{
"id": "Coverage.payor",
"path": "Coverage.payor",
"max": "1",
"mustSupport": true
},
{
"id": "Coverage.payor.reference",
"path": "Coverage.payor.reference",
"max": "0"
},
{
"id": "Coverage.payor.type",
"path": "Coverage.payor.type",
"max": "0"
},
{
"id": "Coverage.payor.identifier",
"path": "Coverage.payor.identifier",
"short": "IKs",
"type": [
{
"code": "Identifier",
"profile": [
"http://fhir.de/StructureDefinition/identifier-iknr"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension",
"path": "Coverage.payor.identifier.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"rules": "closed"
},
"max": "1"
},
{
"id": "Coverage.payor.identifier.extension:alternativeID",
"path": "Coverage.payor.identifier.extension",
"sliceName": "alternativeID",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]",
"path": "Coverage.payor.identifier.extension.value[x]",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier",
"path": "Coverage.payor.identifier.extension.value[x]",
"sliceName": "valueIdentifier",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.use",
"path": "Coverage.payor.identifier.extension.value[x].use",
"mustSupport": false
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type",
"path": "Coverage.payor.identifier.extension.value[x].type",
"mustSupport": false
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding",
"path": "Coverage.payor.identifier.extension.value[x].type.coding",
"mustSupport": false
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding.system",
"path": "Coverage.payor.identifier.extension.value[x].type.coding.system",
"mustSupport": false
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding.code",
"path": "Coverage.payor.identifier.extension.value[x].type.coding.code",
"mustSupport": false
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.system",
"path": "Coverage.payor.identifier.extension.value[x].system",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.value",
"path": "Coverage.payor.identifier.extension.value[x].value",
"constraint": [
{
"key": "-for-laengeIK",
"severity": "error",
"human": "Die IK-Nummer muss 9-stellig numerisch sein.",
"expression": "matches('^[0-9]{9}[%content%]#x27;)"
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.type.coding.version",
"path": "Coverage.payor.identifier.type.coding.version",
"max": "0"
},
{
"id": "Coverage.payor.identifier.type.coding.display",
"path": "Coverage.payor.identifier.type.coding.display",
"max": "0"
},
{
"id": "Coverage.payor.identifier.type.coding.userSelected",
"path": "Coverage.payor.identifier.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.payor.identifier.type.text",
"path": "Coverage.payor.identifier.type.text",
"max": "0"
},
{
"id": "Coverage.payor.identifier.system",
"path": "Coverage.payor.identifier.system",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.value",
"path": "Coverage.payor.identifier.value",
"constraint": [
{
"key": "-for-laengeIK",
"severity": "error",
"human": "Die IK-Nummer muss 9-stellig numerisch sein.",
"expression": "matches('^[0-9]{9}[%content%]#x27;)"
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.period",
"path": "Coverage.payor.identifier.period",
"max": "0"
},
{
"id": "Coverage.payor.identifier.assigner",
"path": "Coverage.payor.identifier.assigner",
"max": "0"
},
{
"id": "Coverage.payor.display",
"path": "Coverage.payor.display",
"short": "Kostenträgername",
"min": 1,
"maxLength": 45,
"mustSupport": true
},
{
"id": "Coverage.class",
"path": "Coverage.class",
"max": "0"
},
{
"id": "Coverage.order",
"path": "Coverage.order",
"max": "0"
},
{
"id": "Coverage.network",
"path": "Coverage.network",
"max": "0"
},
{
"id": "Coverage.costToBeneficiary",
"path": "Coverage.costToBeneficiary",
"max": "0"
},
{
"id": "Coverage.subrogation",
"path": "Coverage.subrogation",
"max": "0"
},
{
"id": "Coverage.contract",
"path": "Coverage.contract",
"max": "0"
}
]
}
}
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