Changes to Coverage Resource:

ADD:

Coverage.kind                   1..1        Code

Self-Pay, Insurance, Other

“Other” is the escape, when not self-pay or insurance. No use case for other currently

Coverage.type                  0..1         Code

Optional, but required when Kind=Insurance

Vocabulary:  remove self-pay codes  

Change:

.payor             0..1         Resource (Organization)

Require when .kind=Insurance

Change Resource list to allow only Organization (Remove person and related person)

ADD:

.paymentBy                       0..*        Reference (Patient | RelatedPerson | Organization)                          

Specify invariants (Business Rules)

1. If Coverage.kind = self-pay then .payor does not exist and .paymentBy must exist
2. If Coverage.kind = insurance then .payor must exist and .paymentBy must not exist