ext-R4B-CoverageEligibilityRequest.insurance
type: StructureDefinition
node role: treeRoot
id:
  v: ext-R4B-CoverageEligibilityRequest.insurance
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition ext-R4B-CoverageEligibilityRequest.insurance Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Extension 0..* Extension R4B: Patient insurance information (new) #xD; Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:focal 0..1 Extension R4B: Applicable coverage (new) #xD; url 1..1 uri "focal" #xD; value[x] 0..1 boolean Applicable coverage #xD; extension:coverage 1..1 Extension R4B: Insurance information additional types #xD; url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference" #xD; extension:businessArrangement 0..1 Extension R4B: Additional provider contract number #xD; url 1..1 uri "businessArrangement" #xD; value[x] 0..1 string Additional provider contract number #xD; url 1..1 uri "http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance" #xD; value[x] 0..0 Value of extension #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:
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      v: packageId
      l: packageId
    value: Id
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  extension:
    url:
      v: version
      l: version
    value: String
      v: 0.1.0
  extension:
    url:
      v: uri
      l: uri
    value: Uri
      v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3
      l: hl7.fhir.uv.xver-r4b.r3
  url:
    v: http://hl7.org/fhir/StructureDefinition/package-source
    l: package-source
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        l: hl7.fhir.uv.xver-r4b.r3
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: Uri
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3
        l: hl7.fhir.uv.xver-r4b.r3
url:
  v: http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance
  l: extension-CoverageEligibilityRequest.insurance
version:
  v: 0.1.0
name:
  v: ExtensionCoverageEligibilityRequest_Insurance
title:
  v: R4B: Patient insurance information (new)
status:
  v: active
experimental:
  v: false
date:
  v: 2026-03-17T21:02:03.8104715+00:00
publisher:
  v: FHIR Infrastructure
contact:
  name:
    v: FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
description:
  v: R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement)
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
purpose:
  v: This extension is part of the cross-version definitions generated to enable use of the element `CoverageEligibilityRequest.insurance` as defined in FHIR R4B in FHIR STU3. The source element is defined as: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement` Across FHIR versions, the element set has been mapped as: * R4B: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement` * R4: `CoverageEligibilityRequest.insurance` 0..* `BackboneElement` Following are the generation technical comments: Element `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
fhir version:
  v: 3.0.2
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: complex-type
abstract:
  v: false
context type:
  v: resource
context:
  v: EligibilityRequest
type:
  v: Extension
base definition:
  v: http://hl7.org/fhir/StructureDefinition/Extension
  l: Extension
derivation:
  v: constraint
snapshot:
  element:
    id:
      v: Extension
    path:
      v: Extension
    short:
      v: R4B: Patient insurance information (new)
    definition:
      v: R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement)
    comment:
      v: Element `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.
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    condition:
      v: ele-1
    constraint:
      key:
        v: ele-1
      severity:
        v: error
      human:
        v: All FHIR elements must have a @value or children
      expression:
        v: hasValue() | (children().count() > id.count())
      xpath:
        v: @value|f:*|h:div
      source:
        v: http://hl7.org/fhir/StructureDefinition/Element
        l: 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:
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      source:
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    is modifier:
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    path:
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    representation:
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    short:
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    definition:
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code:
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  l: string

identity:
  v: rim
map:
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id:
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path:
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slicing:
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    path:
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  description:
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  ordered:
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short:
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definition:
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type:
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id:
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path:
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slice name:
  v: focal
short:
  v: R4B: Applicable coverage (new)
definition:
  v: R4B: `CoverageEligibilityRequest.insurance.focal` (new:boolean)
comment:
  v: Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.
requirements:
  v: To identify which coverage in the list is being used to evaluate this request. Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
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id:
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representation:
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short:
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definition:
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id:
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slicing:
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  description:
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short:
  v: Additional Content defined by implementations
definition:
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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:
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alias:
  v: user content
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id:
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path:
  v: Extension.extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
min:
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base:
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  min:
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type:
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fixed: Uri
  v: focal
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  map:
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id:
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path:
  v: Extension.extension.value[x]
short:
  v: Applicable coverage
definition:
  v: A flag to indicate that this Coverage is to be used for evaluation of this request when set to true.
comment:
  v: A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.
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mapping:
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id:
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path:
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slice name:
  v: coverage
short:
  v: R4B: Insurance information additional types
definition:
  v: R4B: `CoverageEligibilityRequest.insurance.coverage` additional types from child elements (display, identifier, reference, type)
comment:
  v: Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`. The mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.
requirements:
  v: Required to allow the adjudicator to locate the correct policy and history within their information system. Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`. The mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.
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id:
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representation:
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short:
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definition:
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id:
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short:
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definition:
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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:
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id:
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path:
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representation:
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short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
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fixed: Uri
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mapping:
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  map:
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id:
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path:
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short:
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definition:
  v: Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
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type:
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type:
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type:
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type:
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type:
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type:
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type:
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type:
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type:
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mapping:
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id:
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path:
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slice name:
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short:
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definition:
  v: R4B: `CoverageEligibilityRequest.insurance.businessArrangement`
comment:
  v: Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.
requirements:
  v: Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.
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representation:
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short:
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definition:
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id:
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path:
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slicing:
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  description:
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  rules:
    v: open
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. In order 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.
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:
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alias:
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id:
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path:
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representation:
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short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
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id:
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path:
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short:
  v: Additional provider contract number
definition:
  v: A business agreement number established between the provider and the insurer for special business processing purposes.
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type:
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mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.url
path:
  v: Extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
min:
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type:
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fixed: Uri
  v: http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance
  l: extension-CoverageEligibilityRequest.insurance
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.value[x]
path:
  v: Extension.value[x]
short:
  v: Value of extension
definition:
  v: Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
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base:
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type:
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type:
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    v: boolean
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type:
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    v: decimal
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type:
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type:
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type:
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type:
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    v: time
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    v: unsignedInt
    l: unsignedInt
type:
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    v: uri
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type:
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    v: Address
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type:
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type:
  code:
    v: Annotation
    l: Annotation
type:
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type:
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type:
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type:
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type:
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    v: Identifier
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type:
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    v: Money
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type:
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type:
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    l: Quantity
type:
  code:
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type:
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type:
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type:
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type:
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type:
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type:
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mapping:
  identity:
    v: rim
  map:
    v: N/A

element:
  id:
    v: Extension
  path:
    v: Extension
  short:
    v: R4B: Patient insurance information (new)
  definition:
    v: R4B: `CoverageEligibilityRequest.insurance` (new:BackboneElement)
  comment:
    v: Element `CoverageEligibilityRequest.insurance` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.
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    v: *
  base:
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      v: Extension
    min:
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  is modifier:
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element:
  id:
    v: Extension.extension
  path:
    v: Extension.extension
  slicing:
    discriminator:
      type:
        v: value
      path:
        v: url
    ordered:
      v: false
    rules:
      v: open
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  base:
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      v: Extension.extension
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element:
  id:
    v: Extension.extension:focal
  path:
    v: Extension.extension
  slice name:
    v: focal
  short:
    v: R4B: Applicable coverage (new)
  definition:
    v: R4B: `CoverageEligibilityRequest.insurance.focal` (new:boolean)
  comment:
    v: Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.
  requirements:
    v: To identify which coverage in the list is being used to evaluate this request. Element `CoverageEligibilityRequest.insurance.focal` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.focal` has a context of EligibilityRequest based on following the parent source element upwards and mapping to `EligibilityRequest`. Element `CoverageEligibilityRequest.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
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element:
  id:
    v: Extension.extension:focal.url
  path:
    v: Extension.extension.url
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    v: 1
  max:
    v: 1
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    path:
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  fixed: Uri
    v: focal
    l: focal
element:
  id:
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  path:
    v: Extension.extension.value[x]
  short:
    v: Applicable coverage
  definition:
    v: A flag to indicate that this Coverage is to be used for evaluation of this request when set to true.
  comment:
    v: A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.
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    v: 1
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  type:
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      l: boolean
element:
  id:
    v: Extension.extension:coverage
  path:
    v: Extension.extension
  slice name:
    v: coverage
  short:
    v: R4B: Insurance information additional types
  definition:
    v: R4B: `CoverageEligibilityRequest.insurance.coverage` additional types from child elements (display, identifier, reference, type)
  comment:
    v: Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`. The mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.
  requirements:
    v: Required to allow the adjudicator to locate the correct policy and history within their information system. Element `CoverageEligibilityRequest.insurance.coverage` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.coverage` is mapped to FHIR STU3 element `EligibilityRequest.coverage` as `SourceIsBroaderThanTarget`. The mappings for `CoverageEligibilityRequest.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `CoverageEligibilityRequest.insurance.coverage` with unmapped reference targets: Coverage.
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    v: 1
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element:
  id:
    v: Extension.extension:coverage.url
  path:
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  fixed: Uri
    v: http://hl7.org/fhir/StructureDefinition/alternate-reference
    l: alternate-reference
element:
  id:
    v: Extension.extension:businessArrangement
  path:
    v: Extension.extension
  slice name:
    v: businessArrangement
  short:
    v: R4B: Additional provider contract number
  definition:
    v: R4B: `CoverageEligibilityRequest.insurance.businessArrangement`
  comment:
    v: Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.
  requirements:
    v: Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. Element `CoverageEligibilityRequest.insurance.businessArrangement` is part of an existing definition because parent element `CoverageEligibilityRequest.insurance` requires a cross-version extension. Element `CoverageEligibilityRequest.insurance.businessArrangement` is mapped to FHIR STU3 element `EligibilityRequest.businessArrangement` as `Equivalent`.
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element:
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    v: 1
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  fixed: Uri

path:
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max:
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Uri
v: businessArrangement
l: businessArrangement

id:
  v: Extension.extension:businessArrangement.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Additional provider contract number
definition:
  v: A business agreement number established between the provider and the insurer for special business processing purposes.
min:
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base:
  path:
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type:
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id:
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base:
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fixed: Uri
  v: http://hl7.org/fhir/4.3/StructureDefinition/extension-CoverageEligibilityRequest.insurance
  l: extension-CoverageEligibilityRequest.insurance

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path:
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