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Type:
Change Request
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Resolution: Persuasive
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Priority:
Medium
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FHIR Core (FHIR)
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R4
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Financial Mgmt
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Coverage
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Jeff Brown/Andy Stechishin: 4-0-0
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Enhancement
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Compatible, substantive
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R5
Reason for change
The 'costToBeneficiary.exception' element was introduced to cover the scenarios of co-payment exceptions (see https://jira.hl7.org/browse/FHIR-18122).
For these cases is usually irrelevant, or even not applicable, the concept of a fixed/predefined "amount or percentage due from the beneficiary" in the context of the coverage resource.
Proposed Change
Change the cardinality of costToBeneficiary.value[x] from 1..1 to 0..1, adding as invariant 'or value[x] or exception or both.'