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13.3.25 Resource CoverageEligibilityResponse - Conversions

Financial Management Work Group

Maturity Level: N/A

Standards Status: Informative

Security Category: N/A

Compartments: N/A

Following are maps for converting between the equivalent R4B resource and this R5 resource.

/// url = 'http://hl7.org/fhir/StructureMap/CoverageEligibilityResponse5to4'
/// name = 'CoverageEligibilityResponse5to4'
/// title = 'FML Conversion for CoverageEligibilityResponse: R5 to R4'
/// status = 'active'

conceptmap "EligibilityOutcome" {
  prefix s = "http://hl7.org/fhir/eligibility-outcome"
  prefix t = "http://hl7.org/fhir/4.0/remittance-outcome"

  s:queued - t:queued
  s:complete - t:complete
  s:error - t:error
  s:partial - t:partial
}

conceptmap "EligibilityResponsePurpose" {
  prefix s = "http://hl7.org/fhir/eligibilityresponse-purpose"
  prefix t = "http://hl7.org/fhir/4.0/eligibilityresponse-purpose"

  s:"auth-requirements" - t:"auth-requirements"
  s:benefits - t:benefits
  s:discovery - t:discovery
  s:validation - t:validation
}

conceptmap "EligibilityResponseStatus" {
  prefix s = "http://hl7.org/fhir/fm-status"
  prefix t = "http://hl7.org/fhir/4.0/fm-status"

  s:active - t:active
  s:cancelled - t:cancelled
  s:draft - t:draft
  s:"entered-in-error" - t:"entered-in-error"
}

uses "http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR5 as source
uses "http://hl7.org/fhir/4.0/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR4 as target

imports "http://hl7.org/fhir/StructureMap/*5to4"

group CoverageEligibilityResponse(source src : CoverageEligibilityResponseR5, target tgt : CoverageEligibilityResponseR4) extends DomainResource <<type+>> {
  src.identifier -> tgt.identifier;
  src.status as v -> tgt.status = translate(v, '#EligibilityResponseStatus', 'code');
  src.purpose as v -> tgt.purpose = translate(v, '#EligibilityResponsePurpose', 'code');
  src.patient -> tgt.patient;
  src.serviced : date -> tgt.serviced; // src.event as s -> tgt.event as t then CoverageEligibilityResponseEvent(s,t);
  src.serviced : Period -> tgt.serviced;
  src.created -> tgt.created;
  src.requestor -> tgt.requestor;
  src.request -> tgt.request;
  src.outcome as v -> tgt.outcome = translate(v, '#EligibilityOutcome', 'code');
  src.disposition -> tgt.disposition;
  src.insurer -> tgt.insurer;
  src.insurance as s -> tgt.insurance as t then CoverageEligibilityResponseInsurance(s, t);
  src.preAuthRef -> tgt.preAuthRef;
  src.form -> tgt.form;
  src.error as s -> tgt.error as t then CoverageEligibilityResponseError(s, t);
}

// group CoverageEligibilityResponseEvent(source src, target tgt) extends BackboneElement {
// src.type -> tgt.type;
// src.when : dateTime -> tgt.when;
// src.when : Period -> tgt.when;
// }
group CoverageEligibilityResponseInsurance(source src, target tgt) extends BackboneElement {
  src.coverage -> tgt.coverage;
  src.inforce -> tgt.inforce;
  src.benefitPeriod -> tgt.benefitPeriod;
  src.item as s -> tgt.item as t then CoverageEligibilityResponseInsuranceItem(s, t);
}

group CoverageEligibilityResponseInsuranceItem(source src, target tgt) extends BackboneElement {
  src.category -> tgt.category;
  src.productOrService -> tgt.productOrService;
  src.modifier -> tgt.modifier;
  src.provider -> tgt.provider;
  src.excluded -> tgt.excluded;
  src.name -> tgt.name;
  src.description -> tgt.description;
  src.network -> tgt.network;
  src.unit -> tgt.unit;
  src.term -> tgt.term;
  src.benefit as s -> tgt.benefit as t then CoverageEligibilityResponseInsuranceItemBenefit(s, t);
  src.authorizationRequired -> tgt.authorizationRequired;
  src.authorizationSupporting -> tgt.authorizationSupporting;
  src.authorizationUrl -> tgt.authorizationUrl;
}

group CoverageEligibilityResponseInsuranceItemBenefit(source src, target tgt) extends BackboneElement {
  src.type -> tgt.type;
  src.allowed : unsignedInt -> tgt.allowed;
  src.allowed : string -> tgt.allowed;
  src.allowed : Money -> tgt.allowed;
  src.used : unsignedInt -> tgt.used;
  src.used : string -> tgt.used;
  src.used : Money -> tgt.used;
}

group CoverageEligibilityResponseError(source src, target tgt) extends BackboneElement {
  src.code -> tgt.code;
}

/// url = 'http://hl7.org/fhir/StructureMap/CoverageEligibilityResponse5to4B'
/// name = 'CoverageEligibilityResponse5to4B'
/// title = 'FML Conversion for CoverageEligibilityResponse: R5 to R4B'
/// status = 'active'

conceptmap "EligibilityOutcome" {
  prefix s = "http://hl7.org/fhir/eligibility-outcome"
  prefix t = "http://hl7.org/fhir/4.3/remittance-outcome"

  s:queued - t:queued
  s:complete - t:complete
  s:error - t:error
  s:partial - t:partial
}

conceptmap "EligibilityResponsePurpose" {
  prefix s = "http://hl7.org/fhir/eligibilityresponse-purpose"
  prefix t = "http://hl7.org/fhir/4.3/eligibilityresponse-purpose"

  s:"auth-requirements" - t:"auth-requirements"
  s:benefits - t:benefits
  s:discovery - t:discovery
  s:validation - t:validation
}

conceptmap "EligibilityResponseStatus" {
  prefix s = "http://hl7.org/fhir/fm-status"
  prefix t = "http://hl7.org/fhir/4.3/fm-status"

  s:active - t:active
  s:cancelled - t:cancelled
  s:draft - t:draft
  s:"entered-in-error" - t:"entered-in-error"
}

uses "http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR5 as source
uses "http://hl7.org/fhir/4.3/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR4B as target

imports "http://hl7.org/fhir/StructureMap/*5to4B"

group CoverageEligibilityResponse(source src : CoverageEligibilityResponseR5, target tgt : CoverageEligibilityResponseR4B) extends DomainResource <<type+>> {
  src.identifier -> tgt.identifier;
  src.status as v -> tgt.status = translate(v, '#EligibilityResponseStatus', 'code');
  src.purpose as v -> tgt.purpose = translate(v, '#EligibilityResponsePurpose', 'code');
  src.patient -> tgt.patient;
  src.serviced : date -> tgt.serviced; // src.event as s -> tgt.event as t then CoverageEligibilityResponseEvent(s,t);
  src.serviced : Period -> tgt.serviced;
  src.created -> tgt.created;
  src.requestor -> tgt.requestor;
  src.request -> tgt.request;
  src.outcome as v -> tgt.outcome = translate(v, '#EligibilityOutcome', 'code');
  src.disposition -> tgt.disposition;
  src.insurer -> tgt.insurer;
  src.insurance as s -> tgt.insurance as t then CoverageEligibilityResponseInsurance(s, t);
  src.preAuthRef -> tgt.preAuthRef;
  src.form -> tgt.form;
  src.error as s -> tgt.error as t then CoverageEligibilityResponseError(s, t);
}

// group CoverageEligibilityResponseEvent(source src, target tgt) extends BackboneElement {
// src.type -> tgt.type;
// src.when : dateTime -> tgt.when;
// src.when : Period -> tgt.when;
// }
group CoverageEligibilityResponseInsurance(source src, target tgt) extends BackboneElement {
  src.coverage -> tgt.coverage;
  src.inforce -> tgt.inforce;
  src.benefitPeriod -> tgt.benefitPeriod;
  src.item as s -> tgt.item as t then CoverageEligibilityResponseInsuranceItem(s, t);
}

group CoverageEligibilityResponseInsuranceItem(source src, target tgt) extends BackboneElement {
  src.category -> tgt.category;
  src.productOrService -> tgt.productOrService;
  src.modifier -> tgt.modifier;
  src.provider -> tgt.provider;
  src.excluded -> tgt.excluded;
  src.name -> tgt.name;
  src.description -> tgt.description;
  src.network -> tgt.network;
  src.unit -> tgt.unit;
  src.term -> tgt.term;
  src.benefit as s -> tgt.benefit as t then CoverageEligibilityResponseInsuranceItemBenefit(s, t);
  src.authorizationRequired -> tgt.authorizationRequired;
  src.authorizationSupporting -> tgt.authorizationSupporting;
  src.authorizationUrl -> tgt.authorizationUrl;
}

group CoverageEligibilityResponseInsuranceItemBenefit(source src, target tgt) extends BackboneElement {
  src.type -> tgt.type;
  src.allowed : unsignedInt -> tgt.allowed;
  src.allowed : string -> tgt.allowed;
  src.allowed : Money -> tgt.allowed;
  src.used : unsignedInt -> tgt.used;
  src.used : string -> tgt.used;
  src.used : Money -> tgt.used;
}

group CoverageEligibilityResponseError(source src, target tgt) extends BackboneElement {
  src.code -> tgt.code;
}

/// url = 'http://hl7.org/fhir/StructureMap/CoverageEligibilityResponse4Bto5'
/// name = 'CoverageEligibilityResponse4Bto5'
/// title = 'FML Conversion for CoverageEligibilityResponse: R4B to R5'
/// status = 'active'

conceptmap "EligibilityOutcome" {
  prefix s = "http://hl7.org/fhir/4.3/remittance-outcome"
  prefix t = "http://hl7.org/fhir/eligibility-outcome"

  s:queued - t:queued
  s:complete - t:complete
  s:error - t:error
  s:partial - t:partial
}

conceptmap "EligibilityResponsePurpose" {
  prefix s = "http://hl7.org/fhir/4.3/eligibilityresponse-purpose"
  prefix t = "http://hl7.org/fhir/eligibilityresponse-purpose"

  s:"auth-requirements" - t:"auth-requirements"
  s:benefits - t:benefits
  s:discovery - t:discovery
  s:validation - t:validation
}

conceptmap "EligibilityResponseStatus" {
  prefix s = "http://hl7.org/fhir/4.3/fm-status"
  prefix t = "http://hl7.org/fhir/fm-status"

  s:active - t:active
  s:cancelled - t:cancelled
  s:draft - t:draft
  s:"entered-in-error" - t:"entered-in-error"
}

uses "http://hl7.org/fhir/4.3/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR4B as source
uses "http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR5 as target

imports "http://hl7.org/fhir/StructureMap/*4Bto5"

group CoverageEligibilityResponse(source src : CoverageEligibilityResponseR4B, target tgt : CoverageEligibilityResponseR5) extends DomainResource <<type+>> {
  src.identifier -> tgt.identifier;
  src.status as v -> tgt.status = translate(v, '#EligibilityResponseStatus', 'code');
  src.purpose as v -> tgt.purpose = translate(v, '#EligibilityResponsePurpose', 'code');
  src.patient -> tgt.patient;
  src.serviced : date -> tgt.serviced; // src.event as s -> tgt.event as t then CoverageEligibilityResponseEvent(s,t);
  src.serviced : Period -> tgt.serviced;
  src.created -> tgt.created;
  src.requestor -> tgt.requestor;
  src.request -> tgt.request;
  src.outcome as v -> tgt.outcome = translate(v, '#EligibilityOutcome', 'code');
  src.disposition -> tgt.disposition;
  src.insurer -> tgt.insurer;
  src.insurance as s -> tgt.insurance as t then CoverageEligibilityResponseInsurance(s, t);
  src.preAuthRef -> tgt.preAuthRef;
  src.form -> tgt.form;
  src.error as s -> tgt.error as t then CoverageEligibilityResponseError(s, t);
}

// group CoverageEligibilityResponseEvent(source src, target tgt) extends BackboneElement {
// src.type -> tgt.type;
// src.when : dateTime -> tgt.when;
// src.when : Period -> tgt.when;
// }
group CoverageEligibilityResponseInsurance(source src, target tgt) extends BackboneElement {
  src.coverage -> tgt.coverage;
  src.inforce -> tgt.inforce;
  src.benefitPeriod -> tgt.benefitPeriod;
  src.item as s -> tgt.item as t then CoverageEligibilityResponseInsuranceItem(s, t);
}

group CoverageEligibilityResponseInsuranceItem(source src, target tgt) extends BackboneElement {
  src.category -> tgt.category;
  src.productOrService -> tgt.productOrService;
  src.modifier -> tgt.modifier;
  src.provider -> tgt.provider;
  src.excluded -> tgt.excluded;
  src.name -> tgt.name;
  src.description -> tgt.description;
  src.network -> tgt.network;
  src.unit -> tgt.unit;
  src.term -> tgt.term;
  src.benefit as s -> tgt.benefit as t then CoverageEligibilityResponseInsuranceItemBenefit(s, t);
  src.authorizationRequired -> tgt.authorizationRequired;
  src.authorizationSupporting -> tgt.authorizationSupporting;
  src.authorizationUrl -> tgt.authorizationUrl;
}

group CoverageEligibilityResponseInsuranceItemBenefit(source src, target tgt) extends BackboneElement {
  src.type -> tgt.type;
  src.allowed : unsignedInt -> tgt.allowed;
  src.allowed : string -> tgt.allowed;
  src.allowed : Money -> tgt.allowed;
  src.used : unsignedInt -> tgt.used;
  src.used : string -> tgt.used;
  src.used : Money -> tgt.used;
}

group CoverageEligibilityResponseError(source src, target tgt) extends BackboneElement {
  src.code -> tgt.code;
}

/// url = 'http://hl7.org/fhir/StructureMap/CoverageEligibilityResponse4to5'
/// name = 'CoverageEligibilityResponse4to5'
/// title = 'FML Conversion for CoverageEligibilityResponse: R4 to R5'
/// status = 'active'

conceptmap "EligibilityOutcome" {
  prefix s = "http://hl7.org/fhir/4.0/remittance-outcome"
  prefix t = "http://hl7.org/fhir/eligibility-outcome"

  s:queued - t:queued
  s:complete - t:complete
  s:error - t:error
  s:partial - t:partial
}

conceptmap "EligibilityResponsePurpose" {
  prefix s = "http://hl7.org/fhir/4.0/eligibilityresponse-purpose"
  prefix t = "http://hl7.org/fhir/eligibilityresponse-purpose"

  s:"auth-requirements" - t:"auth-requirements"
  s:benefits - t:benefits
  s:discovery - t:discovery
  s:validation - t:validation
}

conceptmap "EligibilityResponseStatus" {
  prefix s = "http://hl7.org/fhir/4.0/fm-status"
  prefix t = "http://hl7.org/fhir/fm-status"

  s:active - t:active
  s:cancelled - t:cancelled
  s:draft - t:draft
  s:"entered-in-error" - t:"entered-in-error"
}

uses "http://hl7.org/fhir/4.0/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR4 as source
uses "http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse" alias CoverageEligibilityResponseR5 as target

imports "http://hl7.org/fhir/StructureMap/*4to5"

group CoverageEligibilityResponse(source src : CoverageEligibilityResponseR4, target tgt : CoverageEligibilityResponseR5) extends DomainResource <<type+>> {
  src.identifier -> tgt.identifier;
  src.status as v -> tgt.status = translate(v, '#EligibilityResponseStatus', 'code');
  src.purpose as v -> tgt.purpose = translate(v, '#EligibilityResponsePurpose', 'code');
  src.patient -> tgt.patient;
  src.serviced : date -> tgt.serviced; // src.event as s -> tgt.event as t then CoverageEligibilityResponseEvent(s,t);
  src.serviced : Period -> tgt.serviced;
  src.created -> tgt.created;
  src.requestor -> tgt.requestor;
  src.request -> tgt.request;
  src.outcome as v -> tgt.outcome = translate(v, '#EligibilityOutcome', 'code');
  src.disposition -> tgt.disposition;
  src.insurer -> tgt.insurer;
  src.insurance as s -> tgt.insurance as t then CoverageEligibilityResponseInsurance(s, t);
  src.preAuthRef -> tgt.preAuthRef;
  src.form -> tgt.form;
  src.error as s -> tgt.error as t then CoverageEligibilityResponseError(s, t);
}

// group CoverageEligibilityResponseEvent(source src, target tgt) extends BackboneElement {
// src.type -> tgt.type;
// src.when : dateTime -> tgt.when;
// src.when : Period -> tgt.when;
// }
group CoverageEligibilityResponseInsurance(source src, target tgt) extends BackboneElement {
  src.coverage -> tgt.coverage;
  src.inforce -> tgt.inforce;
  src.benefitPeriod -> tgt.benefitPeriod;
  src.item as s -> tgt.item as t then CoverageEligibilityResponseInsuranceItem(s, t);
}

group CoverageEligibilityResponseInsuranceItem(source src, target tgt) extends BackboneElement {
  src.category -> tgt.category;
  src.productOrService -> tgt.productOrService;
  src.modifier -> tgt.modifier;
  src.provider -> tgt.provider;
  src.excluded -> tgt.excluded;
  src.name -> tgt.name;
  src.description -> tgt.description;
  src.network -> tgt.network;
  src.unit -> tgt.unit;
  src.term -> tgt.term;
  src.benefit as s -> tgt.benefit as t then CoverageEligibilityResponseInsuranceItemBenefit(s, t);
  src.authorizationRequired -> tgt.authorizationRequired;
  src.authorizationSupporting -> tgt.authorizationSupporting;
  src.authorizationUrl -> tgt.authorizationUrl;
}

group CoverageEligibilityResponseInsuranceItemBenefit(source src, target tgt) extends BackboneElement {
  src.type -> tgt.type;
  src.allowed : unsignedInt -> tgt.allowed;
  src.allowed : string -> tgt.allowed;
  src.allowed : Money -> tgt.allowed;
  src.used : unsignedInt -> tgt.used;
  src.used : string -> tgt.used;
  src.used : Money -> tgt.used;
}

group CoverageEligibilityResponseError(source src, target tgt) extends BackboneElement {
  src.code -> tgt.code;
}