STU 3 Candidate
This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R3 R2
StructureDefinition for eligibilityresponse
{
"resourceType": "StructureDefinition",
"id": "EligibilityResponse",
"meta": {
"lastUpdated": "2016-03-31T08:01:25.570+11:00"
},
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0
}
],
"url": "http://hl7.org/fhir/StructureDefinition/EligibilityResponse",
"name": "EligibilityResponse",
"status": "draft",
"publisher": "Health Level Seven International (Financial Management)",
"contact": [
{
"telecom": [
{
"system": "other",
"value": "http://hl7.org/fhir"
}
]
},
{
"telecom": [
{
"system": "other",
"value": "http://www.hl7.org/Special/committees/fm/index.cfm"
}
]
}
],
"date": "2016-03-31T08:01:25+11:00",
"description": "Base StructureDefinition for EligibilityResponse Resource",
"fhirVersion": "1.4.0",
"mapping": [
{
"identity": "w5",
"uri": "http://hl7.org/fhir/w5",
"name": "W5 Mapping"
},
{
"identity": "cdanetv4",
"uri": "http://www.cda-adc.ca/en/services/cdanet/",
"name": "Canadian Dental Association eclaims standard"
},
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM"
}
],
"kind": "resource",
"abstract": false,
"baseType": "DomainResource",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"derivation": "specialization",
"snapshot": {
"element": [
{
"path": "EligibilityResponse",
"short": "EligibilityResponse resource",
"definition": "This resource provides eligibility and plan details from the processing of an Eligibility resource.",
"min": 0,
"max": "*",
"type": [
{
"code": "DomainResource"
}
],
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "financial.support"
}
]
},
{
"path": "EligibilityResponse.id",
"short": "Logical id of this artifact",
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comments": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.id",
"min": 0,
"max": "*"
},
"type": [
{
"code": "id"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.meta",
"short": "Metadata about the resource",
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Meta"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.implicitRules",
"short": "A set of rules under which this content was created",
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
"comments": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "*"
},
"type": [
{
"code": "uri"
}
],
"isModifier": true,
"isSummary": true
},
{
"path": "EligibilityResponse.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comments": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"min": 0,
"max": "1",
"base": {
"path": "Resource.language",
"min": 0,
"max": "*"
},
"type": [
{
"code": "code"
}
],
"binding": {
"strength": "required",
"description": "A human language.",
"valueSetUri": "http://tools.ietf.org/html/bcp47"
}
},
{
"path": "EligibilityResponse.text",
"short": "Text summary of the resource, for human interpretation",
"definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comments": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"path": "EligibilityResponse.contained",
"short": "Contained, inline Resources",
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comments": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "EligibilityResponse.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "EligibilityResponse.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "EligibilityResponse.identifier",
"short": "Business Identifier",
"definition": "The Response business identifier.",
"min": 0,
"max": "*",
"type": [
{
"code": "Identifier"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.request[x]",
"short": "Claim reference",
"definition": "Original request resource reference.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/EligibilityRequest"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "cdanetv4",
"map": "A02|G01"
}
]
},
{
"path": "EligibilityResponse.outcome",
"short": "complete | error",
"definition": "Transaction status: error, complete.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "The outcome of the processing.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
}
},
{
"path": "EligibilityResponse.disposition",
"short": "Disposition Message",
"definition": "A description of the status of the adjudication.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.ruleset",
"short": "Resource version",
"definition": "The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
}
},
{
"path": "EligibilityResponse.originalRuleset",
"short": "Original version",
"definition": "The style (standard) and version of the original material which was converted into this resource.",
"requirements": "Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
}
},
{
"path": "EligibilityResponse.created",
"short": "Creation date",
"definition": "The date when the enclosed suite of services were performed or completed.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.organization[x]",
"short": "Insurer",
"definition": "The Insurer who produced this adjudicated response.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.requestProvider[x]",
"short": "Responsible practitioner",
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "cdanetv4",
"map": "B01"
}
]
},
{
"path": "EligibilityResponse.requestOrganization[x]",
"short": "Responsible organization",
"definition": "The organization which is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.inforce",
"short": "Coverage inforce",
"definition": "Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.contract",
"short": "Contract details",
"definition": "The contract resource which may provide more detailed information.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Contract"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.form",
"short": "Printed Form Identifier",
"definition": "The form to be used for printing the content.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "The forms codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/forms"
}
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefits"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "600;600"
}
],
"path": "EligibilityResponse.benefitBalance",
"short": "Benefits by Category",
"definition": "Benefits and optionally current balances by Category.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.benefitBalance.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "*"
},
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "EligibilityResponse.benefitBalance.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "EligibilityResponse.benefitBalance.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "EligibilityResponse.benefitBalance.category",
"short": "Benefit Category",
"definition": "Dental, Vision, Medical, Pharmacy, Rehab etc.",
"min": 1,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Benefit categories such as: oral, medical, vision etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-category"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.subCategory",
"short": "Benefit SubCategory",
"definition": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.network",
"short": "In or out of network",
"definition": "Network designation.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Code to classify in or out of network services",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-network"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.unit",
"short": "Individual or family",
"definition": "Unit designation: individual or family.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Unit covered/serviced - individual or family",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-unit"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.term",
"short": "Annual or lifetime",
"definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Coverage unit - annual, lifetime",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-term"
}
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefit"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "600;750"
}
],
"path": "EligibilityResponse.benefitBalance.financial",
"short": "Benefit Summary",
"definition": "Benefits Used to date.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.benefitBalance.financial.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "*"
},
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "EligibilityResponse.benefitBalance.financial.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "EligibilityResponse.benefitBalance.financial.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "EligibilityResponse.benefitBalance.financial.type",
"short": "Deductable, visits, benefit amount",
"definition": "Deductable, visits, benefit amount.",
"min": 1,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Deductable, visits, co-pay, etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-type"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.financial.benefit[x]",
"short": "Benefits allowed",
"definition": "Benefits allowed.",
"min": 0,
"max": "1",
"type": [
{
"code": "unsignedInt"
},
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Money"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.benefitBalance.financial.benefitUsed[x]",
"short": "Benefits used",
"definition": "Benefits used.",
"min": 0,
"max": "1",
"type": [
{
"code": "unsignedInt"
},
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Money"
]
}
],
"isSummary": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Errors"
}
],
"path": "EligibilityResponse.error",
"short": "Processing errors",
"definition": "Mutually exclusive with Services Provided (Item).",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.error.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "*"
},
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "EligibilityResponse.error.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "EligibilityResponse.error.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "EligibilityResponse.error.code",
"short": "Error code detailing processing issues",
"definition": "An error code,from a specified code system, which details why the eligibility check could not be performed.",
"min": 1,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "The error codes for adjudication processing.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-error"
}
}
}
]
},
"differential": {
"element": [
{
"path": "EligibilityResponse",
"short": "EligibilityResponse resource",
"definition": "This resource provides eligibility and plan details from the processing of an Eligibility resource.",
"min": 0,
"max": "*",
"type": [
{
"code": "DomainResource"
}
],
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "financial.support"
}
]
},
{
"path": "EligibilityResponse.identifier",
"short": "Business Identifier",
"definition": "The Response business identifier.",
"min": 0,
"max": "*",
"type": [
{
"code": "Identifier"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.request[x]",
"short": "Claim reference",
"definition": "Original request resource reference.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/EligibilityRequest"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "cdanetv4",
"map": "A02|G01"
}
]
},
{
"path": "EligibilityResponse.outcome",
"short": "complete | error",
"definition": "Transaction status: error, complete.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "The outcome of the processing.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
}
},
{
"path": "EligibilityResponse.disposition",
"short": "Disposition Message",
"definition": "A description of the status of the adjudication.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.ruleset",
"short": "Resource version",
"definition": "The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
}
},
{
"path": "EligibilityResponse.originalRuleset",
"short": "Original version",
"definition": "The style (standard) and version of the original material which was converted into this resource.",
"requirements": "Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
}
},
{
"path": "EligibilityResponse.created",
"short": "Creation date",
"definition": "The date when the enclosed suite of services were performed or completed.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.organization[x]",
"short": "Insurer",
"definition": "The Insurer who produced this adjudicated response.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.requestProvider[x]",
"short": "Responsible practitioner",
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "cdanetv4",
"map": "B01"
}
]
},
{
"path": "EligibilityResponse.requestOrganization[x]",
"short": "Responsible organization",
"definition": "The organization which is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
},
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.inforce",
"short": "Coverage inforce",
"definition": "Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.contract",
"short": "Contract details",
"definition": "The contract resource which may provide more detailed information.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Contract"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.form",
"short": "Printed Form Identifier",
"definition": "The form to be used for printing the content.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "The forms codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/forms"
}
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefits"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "600;600"
}
],
"path": "EligibilityResponse.benefitBalance",
"short": "Benefits by Category",
"definition": "Benefits and optionally current balances by Category.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.benefitBalance.category",
"short": "Benefit Category",
"definition": "Dental, Vision, Medical, Pharmacy, Rehab etc.",
"min": 1,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Benefit categories such as: oral, medical, vision etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-category"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.subCategory",
"short": "Benefit SubCategory",
"definition": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.network",
"short": "In or out of network",
"definition": "Network designation.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Code to classify in or out of network services",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-network"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.unit",
"short": "Individual or family",
"definition": "Unit designation: individual or family.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Unit covered/serviced - individual or family",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-unit"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.term",
"short": "Annual or lifetime",
"definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Coverage unit - annual, lifetime",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-term"
}
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefit"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "600;750"
}
],
"path": "EligibilityResponse.benefitBalance.financial",
"short": "Benefit Summary",
"definition": "Benefits Used to date.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.benefitBalance.financial.type",
"short": "Deductable, visits, benefit amount",
"definition": "Deductable, visits, benefit amount.",
"min": 1,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "example",
"description": "Deductable, visits, co-pay, etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-type"
}
}
},
{
"path": "EligibilityResponse.benefitBalance.financial.benefit[x]",
"short": "Benefits allowed",
"definition": "Benefits allowed.",
"min": 0,
"max": "1",
"type": [
{
"code": "unsignedInt"
},
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Money"
]
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.benefitBalance.financial.benefitUsed[x]",
"short": "Benefits used",
"definition": "Benefits used.",
"min": 0,
"max": "1",
"type": [
{
"code": "unsignedInt"
},
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Money"
]
}
],
"isSummary": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Errors"
}
],
"path": "EligibilityResponse.error",
"short": "Processing errors",
"definition": "Mutually exclusive with Services Provided (Item).",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"isSummary": true
},
{
"path": "EligibilityResponse.error.code",
"short": "Error code detailing processing issues",
"definition": "An error code,from a specified code system, which details why the eligibility check could not be performed.",
"min": 1,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "The error codes for adjudication processing.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-error"
}
}
}
]
}
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR STU3 Candidate (v1.4.0-8139) generated on Thu, Mar 31, 2016 08:08+1100. QA Page
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