R4 Ballot #2 (Mixed Normative/Trial use)
This page is part of the FHIR Specification (v3.5.0: R4 Ballot #2). 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: R5 R4B R4
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Patient, Practitioner |
This is a representation of the json schema for CoverageEligibilityRequest, which is just a part of the full JSON Schema.
Financial
{
"$schema": "http://json-schema.org/draft-06/schema#",
"id": "http://hl7.org/fhir/json-schema/CoverageEligibilityRequest",
"$ref": "#/definitions/CoverageEligibilityRequest",
"description": "see http://hl7.org/fhir/json.html#schema for information about the FHIR Json Schemas",
"definitions": {
"CoverageEligibilityRequest": {
"description": "The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.",
"properties": {
"resourceType": {
"description": "This is a CoverageEligibilityRequest resource",
"const": "CoverageEligibilityRequest"
},
"id": {
"description": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"$ref": "id.schema.json#/definitions/id"
},
"meta": {
"description": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"$ref": "Meta.schema.json#/definitions/Meta"
},
"implicitRules": {
"description": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"$ref": "#/definitions/uri"
},
"_implicitRules": {
"description": "Extensions for implicitRules",
"$ref": "Element.schema.json#/definitions/Element"
},
"language": {
"description": "The base language in which the resource is written.",
"$ref": "#/definitions/code"
},
"_language": {
"description": "Extensions for language",
"$ref": "Element.schema.json#/definitions/Element"
},
"text": {
"description": "A human-readable narrative that contains a summary of the resource and can 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.",
"$ref": "Narrative.schema.json#/definitions/Narrative"
},
"contained": {
"description": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"items": {
"$ref": "ResourceList.schema.json#/definitions/ResourceList"
},
"type": "array"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"identifier": {
"description": "The Response business identifier.",
"items": {
"$ref": "Identifier.schema.json#/definitions/Identifier"
},
"type": "array"
},
"status": {
"description": "The status of the resource instance.",
"$ref": "#/definitions/code"
},
"_status": {
"description": "Extensions for status",
"$ref": "Element.schema.json#/definitions/Element"
},
"priority": {
"description": "Immediate (STAT), best effort (NORMAL), deferred (DEFER).",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"purpose": {
"description": "Specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for th patient; and/or validation that the specified coverage is in-force at the date/period specified or \u0027now\u0027 if not specified.",
"items": {
"enum": [
"auth-requirements",
"benefits",
"discovery",
"validation"
]
},
"type": "array"
},
"_purpose": {
"description": "Extensions for purpose",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"patient": {
"description": "Patient Resource.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"servicedDate": {
"description": "The date or dates when the enclosed suite of services were performed or completed.",
"pattern": "^([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1]))?)?$",
"type": "string"
},
"_servicedDate": {
"description": "Extensions for servicedDate",
"$ref": "Element.schema.json#/definitions/Element"
},
"servicedPeriod": {
"description": "The date or dates when the enclosed suite of services were performed or completed.",
"$ref": "Period.schema.json#/definitions/Period"
},
"created": {
"description": "The date when this resource was created.",
"$ref": "#/definitions/dateTime"
},
"_created": {
"description": "Extensions for created",
"$ref": "Element.schema.json#/definitions/Element"
},
"enterer": {
"description": "Person who created the invoice/claim/pre-determination or pre-authorization.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"provider": {
"description": "The provider who is responsible for the services rendered to the patient.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"insurer": {
"description": "The Insurer who is target of the request.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"facility": {
"description": "Facility where the services were provided.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"supportingInformation": {
"description": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.",
"items": {
"$ref": "#/definitions/CoverageEligibilityRequest_SupportingInformation"
},
"type": "array"
},
"insurance": {
"description": "Insurance policies which the patient has advised may be applicable for paying for health services.",
"items": {
"$ref": "#/definitions/CoverageEligibilityRequest_Insurance"
},
"type": "array"
},
"item": {
"description": "A list of service types or billable services for which bebefit details and/or an authorization prior to service delivery may be required by the payor.",
"items": {
"$ref": "#/definitions/CoverageEligibilityRequest_Item"
},
"type": "array"
}
},
"additionalProperties": false,
"required": [
"resourceType"
]
},
"CoverageEligibilityRequest_SupportingInformation": {
"description": "The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "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 in which it is contained. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "Sequence of the information element which serves to provide a link.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"information": {
"description": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"appliesToAll": {
"description": "The supporting materials are applicable for all detail intens, product/servce categories and specific billing codes.",
"$ref": "#/definitions/boolean"
},
"_appliesToAll": {
"description": "Extensions for appliesToAll",
"$ref": "Element.schema.json#/definitions/Element"
}
},
"additionalProperties": false,
"required": [
"information"
]
},
"CoverageEligibilityRequest_Insurance": {
"description": "The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "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 in which it is contained. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"focal": {
"description": "A flag to indicate that this Coverage is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"$ref": "#/definitions/boolean"
},
"_focal": {
"description": "Extensions for focal",
"$ref": "Element.schema.json#/definitions/Element"
},
"coverage": {
"description": "Financial instrument by which payment information for health care.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"businessArrangement": {
"description": "The contract number of a business agreement which describes the terms and conditions.",
"$ref": "#/definitions/string"
},
"_businessArrangement": {
"description": "Extensions for businessArrangement",
"$ref": "Element.schema.json#/definitions/Element"
}
},
"additionalProperties": false,
"required": [
"coverage"
]
},
"CoverageEligibilityRequest_Item": {
"description": "The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "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 in which it is contained. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"supportingInformationSequence": {
"description": "Exceptions, special conditions and supporting information pplicable for this service or product line.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_supportingInformationSequence": {
"description": "Extensions for supportingInformationSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"category": {
"description": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"billcode": {
"description": "A code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"provider": {
"description": "The practitioner who is responsible for the services rendered to the patient.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "The fee for an additional service or product or charge.",
"$ref": "Money.schema.json#/definitions/Money"
},
"facility": {
"description": "Facility where the services were provided.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"diagnosis": {
"description": "List of patient diagnosis for which care is sought.",
"items": {
"$ref": "#/definitions/CoverageEligibilityRequest_Diagnosis"
},
"type": "array"
},
"detail": {
"description": "The plan/proposal/order describing the proposed service in detail.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
}
},
"additionalProperties": false
},
"CoverageEligibilityRequest_Diagnosis": {
"description": "The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "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 in which it is contained. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"diagnosisCodeableConcept": {
"description": "The diagnosis.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"diagnosisReference": {
"description": "The diagnosis.",
"$ref": "Reference.schema.json#/definitions/Reference"
}
},
"additionalProperties": false
}
}
}
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot #2 (v3.5.0-14907) generated on Sun, Aug 19, 2018 21:53+1000. QA Page
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