HL7 Europe Laboratory Report
0.1.1 - trial-use 150

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## : A.1.3 - Health insurance and payment information model to this guide - JSON Representation

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    {
      "resourceType" : "ConceptMap",
      "id" : "payer2FHIR-eu-lab",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ConceptMap payer2FHIR-eu-lab</b></p><a name=\"payer2FHIR-eu-lab\"> </a><a name=\"hcpayer2FHIR-eu-lab\"> </a><a name=\"payer2FHIR-eu-lab-en-US\"> </a><p>Mapping from (not specified) to (not specified)</p><br/><p><b>Group 1 </b>Mapping from <a href=\"StructureDefinition-Payer.html\">A.1.3 - Health insurance and payment information</a> to <a href=\"StructureDefinition-ServiceRequest-eu-lab.html\">ServiceRequest: Laboratory Order</a></p><table class=\"grid\"><tr><td><b>Source Code</b></td><td><b>Relationship</b></td><td><b>Target Code</b></td><td><b>Comment</b></td></tr><tr><td>Payer.insurance (A.1.3.1 Health insurance information)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#relatedto\" title=\"relatedto\">is related to</a></td><td>ServiceRequest.insurance</td><td>insurance.ofType(Coverage)</td></tr><tr><td>Payer.insurance.identifier (A.1.3.1.1 Health insurance code)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#relatedto\" title=\"relatedto\">is related to</a></td><td>ServiceRequest.insurance</td><td>details in Group 2</td></tr><tr><td>Payer.insurance.name (A.1.3.1.2 Health insurance name)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#relatedto\" title=\"relatedto\">is related to</a></td><td>ServiceRequest.insurance</td><td>details in Group 2</td></tr><tr><td>Payer.insurance.subjectIdentifier (A.1.3.1.3 Health insurance number)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#relatedto\" title=\"relatedto\">is related to</a></td><td>ServiceRequest.insurance</td><td>details in Group 2</td></tr></table><hr/><p><b>Group 2 </b>Mapping from <a href=\"StructureDefinition-Payer.html\">A.1.3 - Health insurance and payment information</a> to <a href=\"http://hl7.org/fhir/R4/coverage.html\">Coverage</a></p><table class=\"grid\"><tr><td><b>Source Code</b></td><td><b>Relationship</b></td><td><b>Target Code</b></td><td><b>Comment</b></td></tr><tr><td>Payer.insurance (A.1.3.1 Health insurance information)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#relatedto\" title=\"relatedto\">is related to</a></td><td>Coverage</td><td/></tr><tr><td>Payer.insurance.identifier (A.1.3.1.1 Health insurance code)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#equivalent\" title=\"equivalent\">is equivalent to</a></td><td>Coverage.payor.identifier</td><td>payor.ofType(Organization)</td></tr><tr><td>Payer.insurance.name (A.1.3.1.2 Health insurance name)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#equivalent\" title=\"equivalent\">is equivalent to</a></td><td>Coverage.payor.name</td><td>payor.ofType(Organization)</td></tr><tr><td>Payer.insurance.subjectIdentifier (A.1.3.1.3 Health insurance number)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#equivalent\" title=\"equivalent\">is equivalent to</a></td><td>Coverage.policyHolder.identifier</td><td>If it refers to the owner of the policy</td></tr><tr><td>Payer.insurance.subjectIdentifier (A.1.3.1.3 Health insurance number)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#equivalent\" title=\"equivalent\">is equivalent to</a></td><td>Coverage.beneficiary.identifier</td><td>If it refers to the plan beneficiary</td></tr><tr><td>Payer.insurance.subjectIdentifier (A.1.3.1.3 Health insurance number)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#equivalent\" title=\"equivalent\">is equivalent to</a></td><td>Coverage.subscriberId</td><td>If it is the ID assigned to the subscriber</td></tr><tr><td>Payer.insurance.subjectIdentifier (A.1.3.1.3 Health insurance number)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#equivalent\" title=\"equivalent\">is equivalent to</a></td><td>Coverage.subscriber.identifier</td><td>If it refers to the subscriber to the policy and the Subscriber is of type Patient</td></tr></table><hr/><p><b>Group 3 </b>Mapping from <a href=\"StructureDefinition-Payer.html\">A.1.3 - Health insurance and payment information</a> to <a href=\"StructureDefinition-Patient-eu-lab.html\">Patient: Person</a></p><table class=\"grid\"><tr><td><b>Source Code</b></td><td><b>Relationship</b></td><td><b>Target Code</b></td><td><b>Comment</b></td></tr><tr><td>Payer.insurance (A.1.3.1 Health insurance information)</td><td colspan=\"3\" style=\"background-color: #efefef\">(not mapped)</td></tr><tr><td>Payer.insurance.identifier (A.1.3.1.1 Health insurance code)</td><td colspan=\"3\" style=\"background-color: #efefef\">(not mapped)</td></tr><tr><td>Payer.insurance.name (A.1.3.1.2 Health insurance name)</td><td colspan=\"3\" style=\"background-color: #efefef\">(not mapped)</td></tr><tr><td>Payer.insurance.subjectIdentifier (A.1.3.1.3 Health insurance number)</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-concept-map-relationship.html#relatedto\" title=\"relatedto\">is related to</a></td><td>Patient.identifier</td><td>Sometimes the identifier assigned by the payor (e.g. the SSN) is used as one of the Patient Identifiers</td></tr></table></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 2
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "informative"
        }
      ],
      "url" : "http://hl7.eu/fhir/laboratory/ConceptMap/payer2FHIR-eu-lab",
      "identifier" : {
        "system" : "urn:ietf:rfc:3986",
        "value" : "urn:oid:2.16.840.1.113883.2.51.22.1.18.6"
      },
      "version" : "0.1.1",
      "name" : "Payer2Fhir",
      "title" : "eHN Payer to this guide Map",
      "status" : "draft",
      "experimental" : true,
      "date" : "2025-03-25T12:23:34+01:00",
      "publisher" : "HL7 Europe",
      "contact" : [
        {
          "name" : "HL7 Europe",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://hl7.eu"
            }
          ]
        }
      ],
      "description" : "eHN Payer Model to this guide Map",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
              "code" : "150",
              "display" : "Europe"
            }
          ]
        }
      ],
      "purpose" : "It shows how the Laboratory Report Payer data set defined by the EU eHN guidelines is mapped into this guide",
      "copyright" : "Used by permission of HL7 Europe, all rights reserved Creative Commons License",
      "group" : [
        {
          "source" : "http://hl7.eu/fhir/laboratory/StructureDefinition/Payer",
          "target" : "http://hl7.eu/fhir/laboratory/StructureDefinition/ServiceRequest-eu-lab",
          "element" : [
            {
              "code" : "Payer.insurance",
              "display" : "A.1.3.1 Health insurance information",
              "target" : [
                {
                  "code" : "ServiceRequest.insurance",
                  "equivalence" : "relatedto",
                  "comment" : "insurance.ofType(Coverage)"
                }
              ]
            },
            {
              "code" : "Payer.insurance.identifier",
              "display" : "A.1.3.1.1 Health insurance code",
              "target" : [
                {
                  "code" : "ServiceRequest.insurance",
                  "equivalence" : "relatedto",
                  "comment" : "details in Group 2"
                }
              ]
            },
            {
              "code" : "Payer.insurance.name",
              "display" : "A.1.3.1.2 Health insurance name",
              "target" : [
                {
                  "code" : "ServiceRequest.insurance",
                  "equivalence" : "relatedto",
                  "comment" : "details in Group 2"
                }
              ]
            },
            {
              "code" : "Payer.insurance.subjectIdentifier",
              "display" : "A.1.3.1.3 Health insurance number",
              "target" : [
                {
                  "code" : "ServiceRequest.insurance",
                  "equivalence" : "relatedto",
                  "comment" : "details in Group 2"
                }
              ]
            }
          ]
        },
        {
          "source" : "http://hl7.eu/fhir/laboratory/StructureDefinition/Payer",
          "target" : "http://hl7.org/fhir/StructureDefinition/Coverage",
          "element" : [
            {
              "code" : "Payer.insurance",
              "display" : "A.1.3.1 Health insurance information",
              "target" : [
                {
                  "code" : "Coverage",
                  "equivalence" : "relatedto"
                }
              ]
            },
            {
              "code" : "Payer.insurance.identifier",
              "display" : "A.1.3.1.1 Health insurance code",
              "target" : [
                {
                  "code" : "Coverage.payor.identifier",
                  "equivalence" : "equivalent",
                  "comment" : "payor.ofType(Organization)"
                }
              ]
            },
            {
              "code" : "Payer.insurance.name",
              "display" : "A.1.3.1.2 Health insurance name",
              "target" : [
                {
                  "code" : "Coverage.payor.name",
                  "equivalence" : "equivalent",
                  "comment" : "payor.ofType(Organization)"
                }
              ]
            },
            {
              "code" : "Payer.insurance.subjectIdentifier",
              "display" : "A.1.3.1.3 Health insurance number",
              "target" : [
                {
                  "code" : "Coverage.policyHolder.identifier",
                  "equivalence" : "equivalent",
                  "comment" : "If it refers to the owner of the policy"
                }
              ]
            },
            {
              "code" : "Payer.insurance.subjectIdentifier",
              "display" : "A.1.3.1.3 Health insurance number",
              "target" : [
                {
                  "code" : "Coverage.beneficiary.identifier",
                  "equivalence" : "equivalent",
                  "comment" : "If it refers to the plan beneficiary"
                }
              ]
            },
            {
              "code" : "Payer.insurance.subjectIdentifier",
              "display" : "A.1.3.1.3 Health insurance number",
              "target" : [
                {
                  "code" : "Coverage.subscriberId",
                  "equivalence" : "equivalent",
                  "comment" : "If it is the ID assigned to the subscriber"
                }
              ]
            },
            {
              "code" : "Payer.insurance.subjectIdentifier",
              "display" : "A.1.3.1.3 Health insurance number",
              "target" : [
                {
                  "code" : "Coverage.subscriber.identifier",
                  "equivalence" : "equivalent",
                  "comment" : "If it refers to the subscriber to the policy and the Subscriber is of type Patient"
                }
              ]
            }
          ]
        },
        {
          "source" : "http://hl7.eu/fhir/laboratory/StructureDefinition/Payer",
          "target" : "http://hl7.eu/fhir/laboratory/StructureDefinition/Patient-eu-lab",
          "element" : [
            {
              "code" : "Payer.insurance",
              "display" : "A.1.3.1 Health insurance information",
              "target" : [
                {
                  "equivalence" : "unmatched"
                }
              ]
            },
            {
              "code" : "Payer.insurance.identifier",
              "display" : "A.1.3.1.1 Health insurance code",
              "target" : [
                {
                  "equivalence" : "unmatched"
                }
              ]
            },
            {
              "code" : "Payer.insurance.name",
              "display" : "A.1.3.1.2 Health insurance name",
              "target" : [
                {
                  "equivalence" : "unmatched"
                }
              ]
            },
            {
              "code" : "Payer.insurance.subjectIdentifier",
              "display" : "A.1.3.1.3 Health insurance number",
              "target" : [
                {
                  "code" : "Patient.identifier",
                  "equivalence" : "relatedto",
                  "comment" : "Sometimes the identifier assigned by the payor (e.g. the SSN) is used as one of the Patient Identifiers"
                }
              ]
            }
          ]
        }
      ]
    }