Coverageeligibilityrequest.shex

ShEx statement for coverageeligibilityrequest

PREFIX fhir: <http://hl7.org/fhir/> 
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#> 
PREFIX rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> 

IMPORT <code.shex>
IMPORT <date.shex>
IMPORT <Money.shex>
IMPORT <Period.shex>
IMPORT <string.shex>
IMPORT <Patient.shex>
IMPORT <boolean.shex>
IMPORT <dateTime.shex>
IMPORT <Location.shex>
IMPORT <Resource.shex>
IMPORT <Coverage.shex>
IMPORT <Quantity.shex>
IMPORT <Reference.shex>
IMPORT <Condition.shex>
IMPORT <Identifier.shex>
IMPORT <positiveInt.shex>
IMPORT <Practitioner.shex>
IMPORT <Organization.shex>
IMPORT <DomainResource.shex>
IMPORT <CodeableConcept.shex>
IMPORT <BackboneElement.shex>
IMPORT <PractitionerRole.shex>


start=@<CoverageEligibilityRequest> AND {fhir:nodeRole [fhir:treeRoot]}

# CoverageEligibilityRequest resource
<CoverageEligibilityRequest> EXTENDS @<DomainResource> CLOSED {   

    a [fhir:CoverageEligibilityRequest]?;
    fhir:nodeRole [fhir:treeRoot]?;

    fhir:identifier @<OneOrMore_Identifier>?;  # Business Identifier for coverage 
                                            # eligiblity request 
    fhir:status @<code> AND
    	{fhir:v @fhirvs:fm-status};  # active | cancelled | draft | 
                                            # entered-in-error 
    fhir:priority @<CodeableConcept>?;      # Desired processing priority
    fhir:purpose @<OneOrMore_code> AND
    	{fhir:v @fhirvs:eligibilityrequest-purpose};  # auth-requirements | benefits | 
                                            # discovery | validation 
    fhir:patient @<Reference> AND {fhir:link 
    			@<Patient> ? };  # Intended recipient of products and 
                                            # services 
    fhir:event @<OneOrMore_CoverageEligibilityRequest.event>?;  # Event information
    fhir:serviced @<date>  OR 
    			@<Period>  ?;  # Estimated date or dates of service
    fhir:created @<dateTime>;               # Creation date
    fhir:enterer @<Reference> AND {fhir:link 
    			@<Practitioner> OR 
    			@<PractitionerRole> ? }?;  # Author
    fhir:provider @<Reference> AND {fhir:link 
    			@<Organization> OR 
    			@<Practitioner> OR 
    			@<PractitionerRole> ? }?;  # Party responsible for the request
    fhir:insurer @<Reference> AND {fhir:link 
    			@<Organization> ? };  # Coverage issuer
    fhir:facility @<Reference> AND {fhir:link 
    			@<Location> ? }?;  # Servicing facility
    fhir:supportingInfo @<OneOrMore_CoverageEligibilityRequest.supportingInfo>?;  # Supporting information
    fhir:insurance @<OneOrMore_CoverageEligibilityRequest.insurance>?;  # Patient insurance information
    fhir:item @<OneOrMore_CoverageEligibilityRequest.item>?;  # Item to be evaluated for eligibiity
}  

# Event information
<CoverageEligibilityRequest.event> EXTENDS @<BackboneElement> CLOSED {   
    fhir:type @<CodeableConcept>;           # Specific event
    fhir:when @<dateTime>  OR 
    			@<Period>  ;  # Occurance date or period
}  

# Supporting information
<CoverageEligibilityRequest.supportingInfo> EXTENDS @<BackboneElement> CLOSED {   
    fhir:sequence @<positiveInt>;           # Information instance identifier
    fhir:information @<Reference> AND {fhir:link 
    			@<Resource> ? };  # Data to be provided
    fhir:appliesToAll @<boolean>?;          # Applies to all items
}  

# Applicable diagnosis
<CoverageEligibilityRequest.item.diagnosis> EXTENDS @<BackboneElement> CLOSED {   
    fhir:diagnosis @<CodeableConcept>  OR 
    			(@<Reference>  AND {fhir:link @<Condition> })  ?;  # Nature of illness or problem
}  

# Patient insurance information
<CoverageEligibilityRequest.insurance> EXTENDS @<BackboneElement> CLOSED {   
    fhir:focal @<boolean>?;                 # Applicable coverage
    fhir:coverage @<Reference> AND {fhir:link 
    			@<Coverage> ? };  # Insurance information
    fhir:businessArrangement @<string>?;    # Additional provider contract number
}  

# Item to be evaluated for eligibiity
<CoverageEligibilityRequest.item> EXTENDS @<BackboneElement> CLOSED {   
    fhir:supportingInfoSequence @<OneOrMore_positiveInt>?;  # Applicable exception or supporting 
                                            # information 
    fhir:category @<CodeableConcept>?;      # Benefit classification
    fhir:productOrService @<CodeableConcept>?;  # Billing, service, product, or drug 
                                            # code 
    fhir:modifier @<OneOrMore_CodeableConcept>?;  # Product or service billing 
                                            # modifiers 
    fhir:provider @<Reference> AND {fhir:link 
    			@<Practitioner> OR 
    			@<PractitionerRole> ? }?;  # Perfoming practitioner
    fhir:quantity @<Quantity>?;             # Count of products or services
    fhir:unitPrice @<Money>?;               # Fee, charge or cost per item
    fhir:facility @<Reference> AND {fhir:link 
    			@<Location> OR 
    			@<Organization> ? }?;  # Servicing facility
    fhir:diagnosis @<OneOrMore_CoverageEligibilityRequest.item.diagnosis>?;  # Applicable diagnosis
    fhir:detail @<OneOrMore_Reference_Resource>?;  # Product or service details
}  

#---------------------- Cardinality Types (OneOrMore) -------------------

<OneOrMore_Identifier> CLOSED {
    rdf:first @<Identifier>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Identifier> 
}

<OneOrMore_code> CLOSED {
    rdf:first @<code>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_code> 
}

<OneOrMore_CoverageEligibilityRequest.event> CLOSED {
    rdf:first @<CoverageEligibilityRequest.event>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.event> 
}

<OneOrMore_CoverageEligibilityRequest.supportingInfo> CLOSED {
    rdf:first @<CoverageEligibilityRequest.supportingInfo>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.supportingInfo> 
}

<OneOrMore_CoverageEligibilityRequest.insurance> CLOSED {
    rdf:first @<CoverageEligibilityRequest.insurance>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.insurance> 
}

<OneOrMore_CoverageEligibilityRequest.item> CLOSED {
    rdf:first @<CoverageEligibilityRequest.item>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.item> 
}

<OneOrMore_positiveInt> CLOSED {
    rdf:first @<positiveInt>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_positiveInt> 
}

<OneOrMore_CodeableConcept> CLOSED {
    rdf:first @<CodeableConcept>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CodeableConcept> 
}

<OneOrMore_CoverageEligibilityRequest.item.diagnosis> CLOSED {
    rdf:first @<CoverageEligibilityRequest.item.diagnosis>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.item.diagnosis> 
}

<OneOrMore_Reference_Resource> CLOSED {
    rdf:first @<Reference> AND {fhir:link 
			@<Resource> } ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Reference_Resource> 
}

#---------------------- Value Sets ------------------------

# A code specifying the types of information being requested.
fhirvs:eligibilityrequest-purpose ["auth-requirements" "benefits" "discovery" "validation"]

# This value set includes Status codes.
fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]