profile-CoverageEligibilityResponse
type: StructureDefinition
node role: treeRoot
id:
  v: profile-CoverageEligibilityResponse
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition profile-CoverageEligibilityResponse Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.3.0) CoverageEligibilityResponse resource #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fhir
extension:
  extension:
    url:
      v: packageId
      l: packageId
    value: Id
      v: hl7.fhir.uv.xver-r4.r4b
  extension:
    url:
      v: version
      l: version
    value: String
      v: 0.1.0
  url:
    v: http://hl7.org/fhir/StructureDefinition/package-source
    l: package-source
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 0
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r4b
        l: hl7.fhir.uv.xver-r4.r4b
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: trial-use
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r4b
        l: hl7.fhir.uv.xver-r4.r4b
url:
  v: http://hl7.org/fhir/4.0/StructureDefinition/profile-CoverageEligibilityResponse
  l: profile-CoverageEligibilityResponse
version:
  v: 0.1.0
name:
  v: Profile_R4_CoverageEligibilityResponse_R4B
title:
  v: Cross-version Profile for R4.CoverageEligibilityResponse for use in FHIR R4B
status:
  v: active
experimental:
  v: false
date:
  v: 2026-03-17T16:03:40.3794751-05:00
publisher:
  v: FHIR Infrastructure
contact:
  name:
    v: FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
description:
  v: This cross-version profile allows R4 CoverageEligibilityResponse content to be represented via FHIR R4B CoverageEligibilityResponse resources.
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
fhir version:
  v: 4.3.0
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
    l: workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
    l: fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: cdanetv4
  uri:
    v: http://www.cda-adc.ca/en/services/cdanet/
    l: cdanet
  name:
    v: Canadian Dental Association eclaims standard
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: CoverageEligibilityResponse
  l: CoverageEligibilityResponse
base definition:
  v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse|4.3.0
  l: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 4.3.0
  element:
    id:
      v: CoverageEligibilityResponse
    path:
      v: CoverageEligibilityResponse
    short:
      v: CoverageEligibilityResponse resource
    definition:
      v: This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: CoverageEligibilityResponse
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource|4.3.0
        l: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: 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
      expression:
        v: 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()
      xpath:
        v: not(exists(for $contained in f:contained return $contained[not(exists(parent::*/descendant::f:reference/@value=concat('#', $contained/*/f:id/@value)) or exists(descendant::f:reference[@value='#']))]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource|4.3.0
        l: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()

v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))

key:
  v: dom-5
severity:
  v: error
human:
  v: If a resource is contained in another resource, it SHALL NOT have a security label
expression:
  v: contained.meta.security.empty()
xpath:
  v: not(exists(f:contained/*/f:meta/f:security))
source:
  v: http://hl7.org/fhir/StructureDefinition/DomainResource|4.3.0
  l: http://hl7.org/fhir/StructureDefinition/DomainResource

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice
    l: elementdefinition-bestpractice
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation
    l: elementdefinition-bestpractice-explanation
  value: Markdown
    v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
key:
  v: dom-6
severity:
  v: warning
human:
  v: A resource should have narrative for robust management
expression:
  v: text.`div`.exists()
xpath:
  v: exists(f:text/h:div)
source:
  v: http://hl7.org/fhir/StructureDefinition/DomainResource|4.3.0
  l: http://hl7.org/fhir/StructureDefinition/DomainResource

v: false

v: false

v: false

identity:
  v: rim
map:
  v: Entity. Role, or Act

identity:
  v: workflow
map:
  v: Event

identity:
  v: w5
map:
  v: financial.support

id:
  v: CoverageEligibilityResponse.id
path:
  v: CoverageEligibilityResponse.id
short:
  v: Logical id of this artifact
definition:
  v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
comment:
  v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: id
      l: id
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.meta
path:
  v: CoverageEligibilityResponse.meta
short:
  v: Metadata about the resource
definition:
  v: The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
    l: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.implicitRules
path:
  v: CoverageEligibilityResponse.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
comment:
  v: Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.language
path:
  v: CoverageEligibilityResponse.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Canonical
      v: http://hl7.org/fhir/ValueSet/all-languages|4.3.0
      l: http://hl7.org/fhir/ValueSet/all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Language
  strength:
    v: preferred
  description:
    v: IETF language tag
  value set:
    v: http://hl7.org/fhir/ValueSet/languages|4.3.0
    l: http://hl7.org/fhir/ValueSet/languages

id:
  v: CoverageEligibilityResponse.text
path:
  v: CoverageEligibilityResponse.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
comment:
  v: Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
    l: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: CoverageEligibilityResponse.contained
path:
  v: CoverageEligibilityResponse.contained
short:
  v: Contained, inline Resources
definition:
  v: These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
comment:
  v: This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
    l: Resource
constraint:
  key:
    v: dom-r4b
  severity:
    v: warning
  human:
    v: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
  expression:
    v: ($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)
  xpath:
    v: not(f:Citation|f:Evidence|f:EvidenceReport|f:EvidenceVariable|f:MedicinalProductDefinition|f:PackagedProductDefinition|f:AdministrableProductDefinition|f:Ingredient|f:ClinicalUseDefinition|f:RegulatedAuthorization|f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic) or not(parent::f:Citation|parent::f:Evidence|parent::f:EvidenceReport|parent::f:EvidenceVariable|parent::f:MedicinalProductDefinition|parent::f:PackagedProductDefinition|parent::f:AdministrableProductDefinition|parent::f:Ingredient|parent::f:ClinicalUseDefinition|parent::f:RegulatedAuthorization|parent::f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic)
  source:
    v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.extension
path:
  v: CoverageEligibilityResponse.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.modifierExtension
path:
  v: CoverageEligibilityResponse.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.identifier
path:
  v: CoverageEligibilityResponse.identifier
short:
  v: Business Identifier for coverage eligiblity request
definition:
  v: A unique identifier assigned to this coverage eligiblity request.
requirements:
  v: Allows coverage eligibility requests to be distinguished and referenced.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
    l: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: CoverageEligibilityResponse.status
path:
  v: CoverageEligibilityResponse.status
short:
  v: active | cancelled | draft | entered-in-error
definition:
  v: The status of the resource instance.
comment:
  v: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
requirements:
  v: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: EligibilityResponseStatus
  strength:
    v: required
  description:
    v: A code specifying the state of the resource instance.
  value set:
    v: http://hl7.org/fhir/ValueSet/fm-status|4.3.0
    l: http://hl7.org/fhir/ValueSet/fm-status
mapping:
  identity:
    v: workflow
  map:
    v: Event.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status

id:
  v: CoverageEligibilityResponse.purpose
path:
  v: CoverageEligibilityResponse.purpose
short:
  v: auth-requirements | benefits | discovery | validation
definition:
  v: Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified.
requirements:
  v: To indicate the processing actions requested.
min:
  v: 1
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.purpose
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: EligibilityResponsePurpose
  strength:
    v: required
  description:
    v: A code specifying the types of information being requested.
  value set:
    v: http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|4.3.0
    l: http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: CoverageEligibilityResponse.patient
path:
  v: CoverageEligibilityResponse.patient
short:
  v: Intended recipient of products and services
definition:
  v: The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
requirements:
  v: Required to provide context and coverage validation.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.patient
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.subject
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: C06,C07,C08, C05, C04
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: CoverageEligibilityResponse.serviced[x]
path:
  v: CoverageEligibilityResponse.serviced[x]
short:
  v: Estimated date or dates of service
definition:
  v: The date or dates when the enclosed suite of services were performed or completed.
requirements:
  v: Required to provide time context for the request.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.serviced[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
    l: date
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: F09

id:
  v: CoverageEligibilityResponse.created
path:
  v: CoverageEligibilityResponse.created
short:
  v: Response creation date
definition:
  v: The date this resource was created.
requirements:
  v: Need to record a timestamp for use by both the recipient and the issuer.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.created
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.recorded

id:
  v: CoverageEligibilityResponse.requestor
path:
  v: CoverageEligibilityResponse.requestor
short:
  v: Party responsible for the request
definition:
  v: The provider which is responsible for the request.
comment:
  v: Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.requestor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/PractitionerRole
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source
mapping:
  identity:
    v: cdanetv4
  map:
    v: B01

id:
  v: CoverageEligibilityResponse.request
path:
  v: CoverageEligibilityResponse.request
short:
  v: Eligibility request reference
definition:
  v: Reference to the original request resource.
requirements:
  v: Needed to allow the response to be linked to the request.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.request
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.basedOn
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.why[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: A02|G01

id:
  v: CoverageEligibilityResponse.outcome
path:
  v: CoverageEligibilityResponse.outcome
short:
  v: queued | complete | error | partial
definition:
  v: The outcome of the request processing.
comment:
  v: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
requirements:
  v: To advise the requestor of an overall processing outcome.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.outcome
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RemittanceOutcome
  strength:
    v: required
  description:
    v: The outcome of the processing.
  value set:
    v: http://hl7.org/fhir/ValueSet/remittance-outcome|4.3.0
    l: http://hl7.org/fhir/ValueSet/remittance-outcome

id:
  v: CoverageEligibilityResponse.disposition
path:
  v: CoverageEligibilityResponse.disposition
short:
  v: Disposition Message
definition:
  v: A human readable description of the status of the adjudication.
requirements:
  v: Provided for user display.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.disposition
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.note

id:
  v: CoverageEligibilityResponse.insurer
path:
  v: CoverageEligibilityResponse.insurer
short:
  v: Coverage issuer
definition:
  v: The Insurer who issued the coverage in question and is the author of the response.
requirements:
  v: Need to identify the author.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurer
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.insurance
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint
    l: structuredefinition-display-hint
  value: String
    v: 380;0
path:
  v: CoverageEligibilityResponse.insurance
short:
  v: Patient insurance information
definition:
  v: Financial instruments for reimbursement for the health care products and services.
comment:
  v: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
requirements:
  v: There must be at least one coverage for which eligibility is requested.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.id
path:
  v: CoverageEligibilityResponse.insurance.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.extension
path:
  v: CoverageEligibilityResponse.insurance.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.modifierExtension
path:
  v: CoverageEligibilityResponse.insurance.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.insurance.coverage
path:
  v: CoverageEligibilityResponse.insurance.coverage
short:
  v: Insurance information
definition:
  v: Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
requirements:
  v: Required to allow the adjudicator to locate the correct policy and history within their information system.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.coverage
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Coverage|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Coverage
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.insurance.inforce
path:
  v: CoverageEligibilityResponse.insurance.inforce
short:
  v: Coverage inforce indicator
definition:
  v: Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.
requirements:
  v: Needed to convey the answer to the eligibility validation request.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.inforce
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.benefitPeriod
path:
  v: CoverageEligibilityResponse.insurance.benefitPeriod
short:
  v: When the benefits are applicable
definition:
  v: The term of the benefits documented in this response.
requirements:
  v: Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.benefitPeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint
    l: structuredefinition-display-hint
  value: String
    v: 340;120
path:
  v: CoverageEligibilityResponse.insurance.item
short:
  v: Benefits and authorization details
definition:
  v: Benefits and optionally current balances, and authorization details by category or service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ces-1
  severity:
    v: error
  human:
    v: SHALL contain a category or a billcode but not both.
  expression:
    v: category.exists() xor productOrService.exists()
  xpath:
    v: exists(f:category) or exists(f:productOrService)
  source:
    v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.id
path:
  v: CoverageEligibilityResponse.insurance.item.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.extension
path:
  v: CoverageEligibilityResponse.insurance.item.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.modifierExtension
path:
  v: CoverageEligibilityResponse.insurance.item.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.insurance.item.category
path:
  v: CoverageEligibilityResponse.insurance.item.category
short:
  v: Benefit classification
definition:
  v: Code to identify the general type of benefits under which products and services are provided.
comment:
  v: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
requirements:
  v: Needed to convey the category of service or product for which eligibility is sought.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitCategory
  strength:
    v: example
  description:
    v: Benefit categories such as: oral, medical, vision etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.3.0
    l: http://hl7.org/fhir/ValueSet/ex-benefitcategory

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: This contains the product, service, drug or other billing code for the item.
comment:
  v: Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI).
requirements:
  v: Needed to convey the actual service or product for which eligibility is sought.
alias:
  v: Drug Code
alias:
  v: Bill Code
alias:
  v: Service Code
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.productOrService
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-uscls|4.3.0
    l: http://hl7.org/fhir/ValueSet/service-uscls

id:
  v: CoverageEligibilityResponse.insurance.item.modifier
path:
  v: CoverageEligibilityResponse.insurance.item.modifier
short:
  v: Product or service billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
requirements:
  v: To support provision of the item or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers|4.3.0
    l: http://hl7.org/fhir/ValueSet/claim-modifiers

id:
  v: CoverageEligibilityResponse.insurance.item.provider
path:
  v: CoverageEligibilityResponse.insurance.item.provider
short:
  v: Performing practitioner
definition:
  v: The practitioner who is eligible for the provision of the product or service.
requirements:
  v: Needed to convey the eligible provider.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.provider
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/PractitionerRole
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source
mapping:
  identity:
    v: cdanetv4
  map:
    v: B01

id:
  v: CoverageEligibilityResponse.insurance.item.excluded
path:
  v: CoverageEligibilityResponse.insurance.item.excluded
short:
  v: Excluded from the plan
definition:
  v: True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.
requirements:
  v: Needed to identify items that are specifically excluded from the coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.excluded
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.name
path:
  v: CoverageEligibilityResponse.insurance.item.name
short:
  v: Short name for the benefit
definition:
  v: A short name or tag for the benefit.
comment:
  v: For example: MED01, or DENT2.
requirements:
  v: Required to align with other plan names.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.name
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.description
path:
  v: CoverageEligibilityResponse.insurance.item.description
short:
  v: Description of the benefit or services covered
definition:
  v: A richer description of the benefit or services covered.
comment:
  v: For example 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.
requirements:
  v: Needed for human readable reference.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.description
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.network
path:
  v: CoverageEligibilityResponse.insurance.item.network
short:
  v: In or out of network
definition:
  v: Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.
requirements:
  v: Needed as in or out of network providers are treated differently under the coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.network
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitNetwork
  strength:
    v: example
  description:
    v: Code to classify in or out of network services.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-network|4.3.0
    l: http://hl7.org/fhir/ValueSet/benefit-network

id:
  v: CoverageEligibilityResponse.insurance.item.unit
path:
  v: CoverageEligibilityResponse.insurance.item.unit
short:
  v: Individual or family
definition:
  v: Indicates if the benefits apply to an individual or to the family.
requirements:
  v: Needed for the understanding of the benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.unit
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitUnit
  strength:
    v: example
  description:
    v: Unit covered/serviced - individual or family.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-unit|4.3.0
    l: http://hl7.org/fhir/ValueSet/benefit-unit

id:
  v: CoverageEligibilityResponse.insurance.item.term
path:
  v: CoverageEligibilityResponse.insurance.item.term
short:
  v: Annual or lifetime
definition:
  v: The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.
requirements:
  v: Needed for the understanding of the benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.term
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitTerm
  strength:
    v: example
  description:
    v: Coverage unit - annual, lifetime.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-term|4.3.0
    l: http://hl7.org/fhir/ValueSet/benefit-term

id:
  v: CoverageEligibilityResponse.insurance.item.benefit
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint
    l: structuredefinition-display-hint
  value: String
    v: 340;320
path:
  v: CoverageEligibilityResponse.insurance.item.benefit
short:
  v: Benefit Summary
definition:
  v: Benefits used to date.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.id
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.extension
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.modifierExtension
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
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  v: 0
max:
  v: *
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  path:
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    v: 0
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    v: *
type:
  code:
    v: Extension
    l: Extension
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  key:
    v: ele-1
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    v: error
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    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
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  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type
short:
  v: Benefit classification
definition:
  v: Classification of benefit being provided.
comment:
  v: For example: deductible, visits, benefit amount.
requirements:
  v: Needed to convey the nature of the benefit.
min:
  v: 1
max:
  v: 1
base:
  path:
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    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitType
  strength:
    v: example
  description:
    v: Deductable, visits, co-pay, etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-type|4.3.0
    l: http://hl7.org/fhir/ValueSet/benefit-type

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
short:
  v: Benefits allowed
definition:
  v: The quantity of the benefit which is permitted under the coverage.
requirements:
  v: Needed to convey the benefits offered under the coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: unsignedInt
    l: unsignedInt
type:
  code:
    v: string
    l: string
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.used[x]
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.used[x]
short:
  v: Benefits used
definition:
  v: The quantity of the benefit which have been consumed to date.
requirements:
  v: Needed to convey the benefits consumed to date.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit.used[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: unsignedInt
    l: unsignedInt
type:
  code:
    v: string
    l: string
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationRequired
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationRequired
short:
  v: Authorization required flag
definition:
  v: A boolean flag indicating whether a preauthorization is required prior to actual service delivery.
requirements:
  v: Needed to convey that preauthorization is required.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.authorizationRequired
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
short:
  v: Type of required supporting materials
definition:
  v: Codes or comments regarding information or actions associated with the preauthorization.
requirements:
  v: Needed to inform the provider of collateral materials or actions needed for preauthorization.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: AuthSupporting
  strength:
    v: example
  description:
    v: Type of supporting information to provide with a preauthorization.
  value set:
    v: http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support|4.3.0
    l: http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationUrl
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationUrl
short:
  v: Preauthorization requirements endpoint
definition:
  v: A web location for obtaining requirements or descriptive information regarding the preauthorization.
requirements:
  v: Needed to enable insurers to advise providers of informative information.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.authorizationUrl
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.preAuthRef
path:
  v: CoverageEligibilityResponse.preAuthRef
short:
  v: Preauthorization reference
definition:
  v: A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.
requirements:
  v: To provide any preauthorization reference for provider use.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.preAuthRef
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: cdanetv4
  map:
    v: F03
mapping:
  identity:
    v: rim
  map:
    v: 23

id:
  v: CoverageEligibilityResponse.form
path:
  v: CoverageEligibilityResponse.form
short:
  v: Printed form identifier
definition:
  v: A code for the form to be used for printing the content.
comment:
  v: May be needed to identify specific jurisdictional forms.
requirements:
  v: Needed to specify the specific form used for producing output for this response.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.form
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Forms
  strength:
    v: example
  description:
    v: The forms codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/forms|4.3.0
    l: http://hl7.org/fhir/ValueSet/forms
mapping:
  identity:
    v: cdanetv4
  map:
    v: G42

id:
  v: CoverageEligibilityResponse.error
path:
  v: CoverageEligibilityResponse.error
short:
  v: Processing errors
definition:
  v: Errors encountered during the processing of the request.
requirements:
  v: Need to communicate processing issues to the requestor.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.error
  min:
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  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
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    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
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    v: @value|f:*|h:div|self::f:Parameters
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    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.error.id
path:
  v: CoverageEligibilityResponse.error.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.error.extension
path:
  v: CoverageEligibilityResponse.error.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.error.modifierExtension
path:
  v: CoverageEligibilityResponse.error.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.error.code
path:
  v: CoverageEligibilityResponse.error.code
short:
  v: Error code detailing processing issues
definition:
  v: An error code,from a specified code system, which details why the eligibility check could not be performed.
requirements:
  v: Required to convey processing errors.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.error.code
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element|4.3.0
    l: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: AdjudicationError
  strength:
    v: example
  description:
    v: The error codes for adjudication processing.
  value set:
    v: http://hl7.org/fhir/ValueSet/adjudication-error|4.3.0
    l: http://hl7.org/fhir/ValueSet/adjudication-error

element:
  id:
    v: CoverageEligibilityResponse
  path:
    v: CoverageEligibilityResponse