Extensions for Using Data Elements from FHIR STU3 in FHIR R4B
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR STU3 in FHIR R4B - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R3_EligibilityResponse_R4B_CoverageEligibilityResponse

Official URL: http://hl7.org/fhir/3.0/StructureDefinition/profile-EligibilityResponse-for-CoverageEligibilityResponse Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R3_EligibilityResponse_R4B_CoverageEligibilityResponse

This cross-version profile allows STU3 EligibilityResponse content to be represented via FHIR R4B CoverageEligibilityResponse resources.

Usages:

  • This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... patient Σ 1..1 Reference(Patient) Intended recipient of products and services
... created Σ 1..1 dateTime Response creation date
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:request 0..1 Reference(Resource) STU3: Eligibility reference additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
... outcome Σ 1..1 code queued | complete | error | partial
Binding: RemittanceOutcome (required): The outcome of the processing.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:outcome 0..1 CodeableConcept STU3: complete | error | partial additional types additional codes
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome
Binding: RemittanceOutcome (required): The outcome of the processing.
Constraints: ext-1
... insurer Σ 1..1 Reference(Organization) Coverage issuer
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:insurer 0..1 Reference(Resource) STU3: Insurer issuing the coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​outcome Base required RemittanceOutcome 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.created, CoverageEligibilityResponse.request, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from CoverageEligibilityResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource
... meta
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:meta 0..1 (Complex) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.meta
... text
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:text 0..1 (Complex) STU3: text additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.text
... identifier
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:identifier 0..* Identifier STU3: Business Identifier additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.identifier
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:requestProvider 0..1 Reference(Resource) STU3: Responsible practitioner additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
..... extension:requestOrganization 0..1 Reference(Resource) STU3: Responsible organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... request
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:request 0..1 Reference(Resource) STU3: Eligibility reference additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... outcome
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:outcome 0..1 CodeableConcept STU3: complete | error | partial additional types additional codes
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome
Binding: RemittanceOutcome (required): The outcome of the processing.
... insurer
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:insurer 0..1 Reference(Resource) STU3: Insurer issuing the coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... insurance
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:contract 0..1 Reference(Cross-version Profile for STU3.Contract for use in FHIR R4B(0.1.0) | Contract) STU3: Contract details (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.insurance.contract
.... coverage
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:coverage 0..1 Reference(Resource) STU3: Updated Coverage details additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:meta 0..1 (Complex) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.meta
Constraints: ext-1
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible)
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example)
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:text 0..1 (Complex) STU3: text additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.text
Constraints: ext-1
.... status 1..1 code generated | extensions | additional | empty
Binding: NarrativeStatus (required)
.... div C 1..1 xhtml Limited xhtml content
Constraints: txt-1, txt-2
... contained 0..* Resource Contained, inline Resources
Constraints: dom-r4b
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier 0..* Identifier Business Identifier for coverage eligiblity request
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:identifier 0..* Identifier STU3: Business Identifier additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.identifier
Constraints: ext-1
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... purpose Σ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Patient) Intended recipient of products and services
... serviced[x] 0..1 Estimated date or dates of service
.... servicedDate date
.... servicedPeriod Period
... created Σ 1..1 dateTime Response creation date
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:requestProvider 0..1 Reference(Resource) STU3: Responsible practitioner additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... extension:requestOrganization 0..1 Reference(Resource) STU3: Responsible organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:request 0..1 Reference(Resource) STU3: Eligibility reference additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... outcome Σ 1..1 code queued | complete | error | partial
Binding: RemittanceOutcome (required): The outcome of the processing.
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:outcome 0..1 CodeableConcept STU3: complete | error | partial additional types additional codes
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome
Binding: RemittanceOutcome (required): The outcome of the processing.
Constraints: ext-1
.... value 0..1 code Primitive value for code
... disposition 0..1 string Disposition Message
... insurer Σ 1..1 Reference(Organization) Coverage issuer
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:insurer 0..1 Reference(Resource) STU3: Insurer issuing the coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:contract 0..1 Reference(Cross-version Profile for STU3.Contract for use in FHIR R4B(0.1.0) | Contract) STU3: Contract details (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.insurance.contract
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... coverage Σ 1..1 Reference(Coverage) Insurance information
..... id 0..1 id Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:coverage 0..1 Reference(Resource) STU3: Updated Coverage details additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
.... inforce 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item C 0..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... provider 0..1 Reference(Practitioner | PractitionerRole) Performing practitioner
..... excluded 0..1 boolean Excluded from the plan
..... name 0..1 string Short name for the benefit
..... description 0..1 string Description of the benefit or services covered
..... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
..... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
..... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
..... benefit 0..* BackboneElement Benefit Summary
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Benefits allowed
....... allowedUnsignedInt unsignedInt
....... allowedString string
....... allowedMoney Money
...... used[x] 0..1 Benefits used
....... usedUnsignedInt unsignedInt
....... usedString string
....... usedMoney Money
..... authorizationRequired 0..1 boolean Authorization required flag
..... authorizationSupporting 0..* CodeableConcept Type of required supporting materials
Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
..... authorizationUrl 0..1 uri Preauthorization requirements endpoint
... preAuthRef 0..1 string Preauthorization reference
... form 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... error 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The error codes for adjudication processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​meta.security Base extensible SecurityLabels 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​meta.tag Base example Common Tags 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​language Base preferred Common Languages 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​text.status Base required NarrativeStatus 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​identifier.use Base required IdentifierUse 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​identifier.type Base extensible IdentifierType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​requestor.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​request.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​outcome Base required RemittanceOutcome 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurer.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.coverage.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.network Base example Network Type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit Base example Unit Type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.term Base example Benefit Term Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.authorizationSupporting Base example CoverageEligibilityResponse Auth Support Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​form Base example Forms 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​error.code Base example AdjudicationError 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ces-1 error CoverageEligibilityResponse.insurance.item SHALL contain a category or a billcode but not both. category.exists() xor productOrService.exists()
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
dom-r4b warning CoverageEligibilityResponse.contained Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1 error CoverageEligibilityResponse.meta, CoverageEligibilityResponse.meta.extension, CoverageEligibilityResponse.meta.extension:meta, CoverageEligibilityResponse.meta.versionId, CoverageEligibilityResponse.meta.lastUpdated, CoverageEligibilityResponse.meta.source, CoverageEligibilityResponse.meta.profile, CoverageEligibilityResponse.meta.security, CoverageEligibilityResponse.meta.tag, CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.language, CoverageEligibilityResponse.text, CoverageEligibilityResponse.text.extension, CoverageEligibilityResponse.text.extension:text, CoverageEligibilityResponse.text.status, CoverageEligibilityResponse.text.div, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier, CoverageEligibilityResponse.identifier.extension, CoverageEligibilityResponse.identifier.extension:identifier, CoverageEligibilityResponse.identifier.use, CoverageEligibilityResponse.identifier.type, CoverageEligibilityResponse.identifier.system, CoverageEligibilityResponse.identifier.value, CoverageEligibilityResponse.identifier.period, CoverageEligibilityResponse.identifier.assigner, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.serviced[x], CoverageEligibilityResponse.created, CoverageEligibilityResponse.requestor, CoverageEligibilityResponse.requestor.extension, CoverageEligibilityResponse.requestor.extension:requestProvider, CoverageEligibilityResponse.requestor.extension:requestOrganization, CoverageEligibilityResponse.requestor.reference, CoverageEligibilityResponse.requestor.type, CoverageEligibilityResponse.requestor.identifier, CoverageEligibilityResponse.requestor.display, CoverageEligibilityResponse.request, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.request.reference, CoverageEligibilityResponse.request.type, CoverageEligibilityResponse.request.identifier, CoverageEligibilityResponse.request.display, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer, CoverageEligibilityResponse.insurer.reference, CoverageEligibilityResponse.insurer.type, CoverageEligibilityResponse.insurer.identifier, CoverageEligibilityResponse.insurer.display, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.extension:contract, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, CoverageEligibilityResponse.insurance.coverage.extension, CoverageEligibilityResponse.insurance.coverage.extension:coverage, CoverageEligibilityResponse.insurance.coverage.reference, CoverageEligibilityResponse.insurance.coverage.type, CoverageEligibilityResponse.insurance.coverage.identifier, CoverageEligibilityResponse.insurance.coverage.display, CoverageEligibilityResponse.insurance.inforce, CoverageEligibilityResponse.insurance.benefitPeriod, CoverageEligibilityResponse.insurance.item, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.category, CoverageEligibilityResponse.insurance.item.productOrService, CoverageEligibilityResponse.insurance.item.modifier, CoverageEligibilityResponse.insurance.item.provider, CoverageEligibilityResponse.insurance.item.excluded, CoverageEligibilityResponse.insurance.item.name, CoverageEligibilityResponse.insurance.item.description, CoverageEligibilityResponse.insurance.item.network, CoverageEligibilityResponse.insurance.item.unit, CoverageEligibilityResponse.insurance.item.term, CoverageEligibilityResponse.insurance.item.benefit, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.type, CoverageEligibilityResponse.insurance.item.benefit.allowed[x], CoverageEligibilityResponse.insurance.item.benefit.used[x], CoverageEligibilityResponse.insurance.item.authorizationRequired, CoverageEligibilityResponse.insurance.item.authorizationSupporting, CoverageEligibilityResponse.insurance.item.authorizationUrl, CoverageEligibilityResponse.preAuthRef, CoverageEligibilityResponse.form, CoverageEligibilityResponse.error, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension, CoverageEligibilityResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.meta.extension, CoverageEligibilityResponse.meta.extension:meta, CoverageEligibilityResponse.text.extension, CoverageEligibilityResponse.text.extension:text, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier.extension, CoverageEligibilityResponse.identifier.extension:identifier, CoverageEligibilityResponse.requestor.extension, CoverageEligibilityResponse.requestor.extension:requestProvider, CoverageEligibilityResponse.requestor.extension:requestOrganization, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.extension:contract, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage.extension, CoverageEligibilityResponse.insurance.coverage.extension:coverage, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1 error CoverageEligibilityResponse.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2 error CoverageEligibilityResponse.text.div The narrative SHALL have some non-whitespace content htmlChecks()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... patient Σ 1..1 Reference(Patient) Intended recipient of products and services
... created Σ 1..1 dateTime Response creation date
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:request 0..1 Reference(Resource) STU3: Eligibility reference additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
... outcome Σ 1..1 code queued | complete | error | partial
Binding: RemittanceOutcome (required): The outcome of the processing.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:outcome 0..1 CodeableConcept STU3: complete | error | partial additional types additional codes
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome
Binding: RemittanceOutcome (required): The outcome of the processing.
Constraints: ext-1
... insurer Σ 1..1 Reference(Organization) Coverage issuer
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:insurer 0..1 Reference(Resource) STU3: Insurer issuing the coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​outcome Base required RemittanceOutcome 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.created, CoverageEligibilityResponse.request, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from CoverageEligibilityResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource
... meta
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:meta 0..1 (Complex) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.meta
... text
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:text 0..1 (Complex) STU3: text additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.text
... identifier
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:identifier 0..* Identifier STU3: Business Identifier additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.identifier
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:requestProvider 0..1 Reference(Resource) STU3: Responsible practitioner additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
..... extension:requestOrganization 0..1 Reference(Resource) STU3: Responsible organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... request
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:request 0..1 Reference(Resource) STU3: Eligibility reference additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... outcome
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:outcome 0..1 CodeableConcept STU3: complete | error | partial additional types additional codes
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome
Binding: RemittanceOutcome (required): The outcome of the processing.
... insurer
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:insurer 0..1 Reference(Resource) STU3: Insurer issuing the coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... insurance
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:contract 0..1 Reference(Cross-version Profile for STU3.Contract for use in FHIR R4B(0.1.0) | Contract) STU3: Contract details (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.insurance.contract
.... coverage
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:coverage 0..1 Reference(Resource) STU3: Updated Coverage details additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:meta 0..1 (Complex) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.meta
Constraints: ext-1
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible)
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example)
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:text 0..1 (Complex) STU3: text additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.text
Constraints: ext-1
.... status 1..1 code generated | extensions | additional | empty
Binding: NarrativeStatus (required)
.... div C 1..1 xhtml Limited xhtml content
Constraints: txt-1, txt-2
... contained 0..* Resource Contained, inline Resources
Constraints: dom-r4b
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier 0..* Identifier Business Identifier for coverage eligiblity request
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:identifier 0..* Identifier STU3: Business Identifier additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.identifier
Constraints: ext-1
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... purpose Σ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Patient) Intended recipient of products and services
... serviced[x] 0..1 Estimated date or dates of service
.... servicedDate date
.... servicedPeriod Period
... created Σ 1..1 dateTime Response creation date
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:requestProvider 0..1 Reference(Resource) STU3: Responsible practitioner additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... extension:requestOrganization 0..1 Reference(Resource) STU3: Responsible organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:request 0..1 Reference(Resource) STU3: Eligibility reference additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... outcome Σ 1..1 code queued | complete | error | partial
Binding: RemittanceOutcome (required): The outcome of the processing.
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:outcome 0..1 CodeableConcept STU3: complete | error | partial additional types additional codes
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome
Binding: RemittanceOutcome (required): The outcome of the processing.
Constraints: ext-1
.... value 0..1 code Primitive value for code
... disposition 0..1 string Disposition Message
... insurer Σ 1..1 Reference(Organization) Coverage issuer
.... id 0..1 id Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:insurer 0..1 Reference(Resource) STU3: Insurer issuing the coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:contract 0..1 Reference(Cross-version Profile for STU3.Contract for use in FHIR R4B(0.1.0) | Contract) STU3: Contract details (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.insurance.contract
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... coverage Σ 1..1 Reference(Coverage) Insurance information
..... id 0..1 id Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:coverage 0..1 Reference(Resource) STU3: Updated Coverage details additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
.... inforce 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item C 0..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... provider 0..1 Reference(Practitioner | PractitionerRole) Performing practitioner
..... excluded 0..1 boolean Excluded from the plan
..... name 0..1 string Short name for the benefit
..... description 0..1 string Description of the benefit or services covered
..... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
..... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
..... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
..... benefit 0..* BackboneElement Benefit Summary
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Benefits allowed
....... allowedUnsignedInt unsignedInt
....... allowedString string
....... allowedMoney Money
...... used[x] 0..1 Benefits used
....... usedUnsignedInt unsignedInt
....... usedString string
....... usedMoney Money
..... authorizationRequired 0..1 boolean Authorization required flag
..... authorizationSupporting 0..* CodeableConcept Type of required supporting materials
Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
..... authorizationUrl 0..1 uri Preauthorization requirements endpoint
... preAuthRef 0..1 string Preauthorization reference
... form 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... error 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The error codes for adjudication processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​meta.security Base extensible SecurityLabels 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​meta.tag Base example Common Tags 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​language Base preferred Common Languages 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​text.status Base required NarrativeStatus 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​identifier.use Base required IdentifierUse 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​identifier.type Base extensible IdentifierType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​requestor.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​request.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​outcome Base required RemittanceOutcome 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurer.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.coverage.type Base extensible ResourceType 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.network Base example Network Type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit Base example Unit Type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.term Base example Benefit Term Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​insurance.item.authorizationSupporting Base example CoverageEligibilityResponse Auth Support Codes 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​form Base example Forms 📍4.3.0 FHIR Std.
CoverageEligibilityResponse.​error.code Base example AdjudicationError 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ces-1 error CoverageEligibilityResponse.insurance.item SHALL contain a category or a billcode but not both. category.exists() xor productOrService.exists()
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
dom-r4b warning CoverageEligibilityResponse.contained Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1 error CoverageEligibilityResponse.meta, CoverageEligibilityResponse.meta.extension, CoverageEligibilityResponse.meta.extension:meta, CoverageEligibilityResponse.meta.versionId, CoverageEligibilityResponse.meta.lastUpdated, CoverageEligibilityResponse.meta.source, CoverageEligibilityResponse.meta.profile, CoverageEligibilityResponse.meta.security, CoverageEligibilityResponse.meta.tag, CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.language, CoverageEligibilityResponse.text, CoverageEligibilityResponse.text.extension, CoverageEligibilityResponse.text.extension:text, CoverageEligibilityResponse.text.status, CoverageEligibilityResponse.text.div, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier, CoverageEligibilityResponse.identifier.extension, CoverageEligibilityResponse.identifier.extension:identifier, CoverageEligibilityResponse.identifier.use, CoverageEligibilityResponse.identifier.type, CoverageEligibilityResponse.identifier.system, CoverageEligibilityResponse.identifier.value, CoverageEligibilityResponse.identifier.period, CoverageEligibilityResponse.identifier.assigner, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.serviced[x], CoverageEligibilityResponse.created, CoverageEligibilityResponse.requestor, CoverageEligibilityResponse.requestor.extension, CoverageEligibilityResponse.requestor.extension:requestProvider, CoverageEligibilityResponse.requestor.extension:requestOrganization, CoverageEligibilityResponse.requestor.reference, CoverageEligibilityResponse.requestor.type, CoverageEligibilityResponse.requestor.identifier, CoverageEligibilityResponse.requestor.display, CoverageEligibilityResponse.request, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.request.reference, CoverageEligibilityResponse.request.type, CoverageEligibilityResponse.request.identifier, CoverageEligibilityResponse.request.display, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer, CoverageEligibilityResponse.insurer.reference, CoverageEligibilityResponse.insurer.type, CoverageEligibilityResponse.insurer.identifier, CoverageEligibilityResponse.insurer.display, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.extension:contract, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, CoverageEligibilityResponse.insurance.coverage.extension, CoverageEligibilityResponse.insurance.coverage.extension:coverage, CoverageEligibilityResponse.insurance.coverage.reference, CoverageEligibilityResponse.insurance.coverage.type, CoverageEligibilityResponse.insurance.coverage.identifier, CoverageEligibilityResponse.insurance.coverage.display, CoverageEligibilityResponse.insurance.inforce, CoverageEligibilityResponse.insurance.benefitPeriod, CoverageEligibilityResponse.insurance.item, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.category, CoverageEligibilityResponse.insurance.item.productOrService, CoverageEligibilityResponse.insurance.item.modifier, CoverageEligibilityResponse.insurance.item.provider, CoverageEligibilityResponse.insurance.item.excluded, CoverageEligibilityResponse.insurance.item.name, CoverageEligibilityResponse.insurance.item.description, CoverageEligibilityResponse.insurance.item.network, CoverageEligibilityResponse.insurance.item.unit, CoverageEligibilityResponse.insurance.item.term, CoverageEligibilityResponse.insurance.item.benefit, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.type, CoverageEligibilityResponse.insurance.item.benefit.allowed[x], CoverageEligibilityResponse.insurance.item.benefit.used[x], CoverageEligibilityResponse.insurance.item.authorizationRequired, CoverageEligibilityResponse.insurance.item.authorizationSupporting, CoverageEligibilityResponse.insurance.item.authorizationUrl, CoverageEligibilityResponse.preAuthRef, CoverageEligibilityResponse.form, CoverageEligibilityResponse.error, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension, CoverageEligibilityResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.meta.extension, CoverageEligibilityResponse.meta.extension:meta, CoverageEligibilityResponse.text.extension, CoverageEligibilityResponse.text.extension:text, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier.extension, CoverageEligibilityResponse.identifier.extension:identifier, CoverageEligibilityResponse.requestor.extension, CoverageEligibilityResponse.requestor.extension:requestProvider, CoverageEligibilityResponse.requestor.extension:requestOrganization, CoverageEligibilityResponse.request.extension, CoverageEligibilityResponse.request.extension:request, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.extension:contract, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage.extension, CoverageEligibilityResponse.insurance.coverage.extension:coverage, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1 error CoverageEligibilityResponse.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2 error CoverageEligibilityResponse.text.div The narrative SHALL have some non-whitespace content htmlChecks()

 

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