Extensions for Using Data Elements from FHIR STU3 in FHIR R5 - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R3_EligibilityResponse_R5_CoverageEligibilityResponse

This cross-version profile allows STU3 EligibilityResponse content to be represented via FHIR R5 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.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse(5.0.0)	CoverageEligibilityResponse resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
modifierExtension	?!Σ	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.
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
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
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (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: ClaimProcessingCodes (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
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	Eligibility Response Purpose	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​outcome	Base	required	Eligibility Outcome	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').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.request.reference, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer, CoverageEligibilityResponse.insurer.reference	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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse(5.0.0)	CoverageEligibilityResponse resource
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	Meta	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
requestor
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: ClaimProcessingCodes (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 R5(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
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse(5.0.0)	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	Meta	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: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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): The status of a resource narrative.
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	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): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	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
event		0..*	BackboneElement	Event information
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	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (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: ClaimProcessingCodes (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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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 R5(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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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	C	0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService	C	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: FormCodes (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	Σ	1..1	CodeableConcept	Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The error codes for adjudication processing.
expression	Σ	0..*	string	FHIRPath of element(s) related to issue
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​meta.security	Base	extensible	All Security Labels	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​meta.tag	Base	example	Common Tags	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​language	Base	required	All Languages	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​text.status	Base	required	NarrativeStatus	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​identifier.use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​identifier.type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	Eligibility Response Purpose	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​event.type	Base	example	Dates Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​requestor.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​request.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​outcome	Base	required	Eligibility Outcome	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurer.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​insurance.coverage.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​insurance.item.category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.network	Base	example	Network Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	example	Unit Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	example	Benefit Term Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	example	Benefit Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.authorizationSupporting	Base	example	CoverageEligibilityResponse Auth Support Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​form	Base	example	Form Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​error.code	Base	example	Adjudication Error Codes	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').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.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.event, CoverageEligibilityResponse.event.extension, CoverageEligibilityResponse.event.modifierExtension, CoverageEligibilityResponse.event.type, CoverageEligibilityResponse.event.when[x], 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, CoverageEligibilityResponse.error.expression	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.event.extension, CoverageEligibilityResponse.event.modifierExtension, 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()

This structure is derived from CoverageEligibilityResponse

Summary

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.meta|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.text|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.identifier|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.insurance.contract|0.1.0

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse(5.0.0)	CoverageEligibilityResponse resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
modifierExtension	?!Σ	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.
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
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
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (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: ClaimProcessingCodes (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
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	Eligibility Response Purpose	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​outcome	Base	required	Eligibility Outcome	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').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.request.reference, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.outcome.extension, CoverageEligibilityResponse.outcome.extension:outcome, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurer.extension, CoverageEligibilityResponse.insurer.extension:insurer, CoverageEligibilityResponse.insurer.reference	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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse(5.0.0)	CoverageEligibilityResponse resource
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	Meta	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
requestor
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: ClaimProcessingCodes (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 R5(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
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse(5.0.0)	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	Meta	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: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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): The status of a resource narrative.
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	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): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	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
event		0..*	BackboneElement	Event information
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	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (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: ClaimProcessingCodes (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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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 R5(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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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	C	0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService	C	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: FormCodes (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	Σ	1..1	CodeableConcept	Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The error codes for adjudication processing.
expression	Σ	0..*	string	FHIRPath of element(s) related to issue
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​meta.security	Base	extensible	All Security Labels	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​meta.tag	Base	example	Common Tags	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​language	Base	required	All Languages	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​text.status	Base	required	NarrativeStatus	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​identifier.use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​identifier.type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​status	Base	required	Financial Resource Status Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​purpose	Base	required	Eligibility Response Purpose	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​event.type	Base	example	Dates Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​requestor.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​request.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​outcome	Base	required	Eligibility Outcome	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurer.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​insurance.coverage.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
CoverageEligibilityResponse.​insurance.item.category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.network	Base	example	Network Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit	Base	example	Unit Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.term	Base	example	Benefit Term Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type	Base	example	Benefit Type Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​insurance.item.authorizationSupporting	Base	example	CoverageEligibilityResponse Auth Support Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​form	Base	example	Form Codes	📍5.0.0	FHIR Std.
CoverageEligibilityResponse.​error.code	Base	example	Adjudication Error Codes	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').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.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.event, CoverageEligibilityResponse.event.extension, CoverageEligibilityResponse.event.modifierExtension, CoverageEligibilityResponse.event.type, CoverageEligibilityResponse.event.when[x], 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, CoverageEligibilityResponse.error.expression	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.event.extension, CoverageEligibilityResponse.event.modifierExtension, 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()

This structure is derived from CoverageEligibilityResponse

Summary

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.meta|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.text|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.identifier|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.outcome|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-EligibilityResponse.insurance.contract|0.1.0

Maturity: 0

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