Extensions for Using Data Elements from FHIR R4 in FHIR R4B - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R4_CoverageEligibilityResponse_R4B

This cross-version profile allows R4 CoverageEligibilityResponse 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.

• Key Elements Table
• Differential Table
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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.
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
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The outcome of the processing.
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
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.outcome, CoverageEligibilityResponse.insurer	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	CoverageEligibilityResponse.modifierExtension	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(4.3.0)	CoverageEligibilityResponse resource
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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
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: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
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
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
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
request	Σ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The outcome of the processing.
disposition		0..1	string	Disposition Message
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
insurance		0..*	BackboneElement	Patient insurance 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
coverage	Σ	1..1	Reference(Coverage)	Insurance information
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.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​language	Base	preferred	Common Languages	📍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.​outcome	Base	required	RemittanceOutcome	📍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.implicitRules, CoverageEligibilityResponse.language, CoverageEligibilityResponse.text, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.serviced[x], CoverageEligibilityResponse.created, CoverageEligibilityResponse.requestor, CoverageEligibilityResponse.request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, 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.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, 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()

This structure is derived from CoverageEligibilityResponse

Summary

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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.
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
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The outcome of the processing.
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
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.outcome, CoverageEligibilityResponse.insurer	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	CoverageEligibilityResponse.modifierExtension	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(4.3.0)	CoverageEligibilityResponse resource
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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
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: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
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
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
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
request	Σ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The outcome of the processing.
disposition		0..1	string	Disposition Message
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
insurance		0..*	BackboneElement	Patient insurance 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
coverage	Σ	1..1	Reference(Coverage)	Insurance information
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.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
CoverageEligibilityResponse.​language	Base	preferred	Common Languages	📍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.​outcome	Base	required	RemittanceOutcome	📍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.implicitRules, CoverageEligibilityResponse.language, CoverageEligibilityResponse.text, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.serviced[x], CoverageEligibilityResponse.created, CoverageEligibilityResponse.requestor, CoverageEligibilityResponse.request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, 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.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, 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()

This structure is derived from CoverageEligibilityResponse

Summary

Maturity: 0

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