Extensions for Using Data Elements from FHIR R5 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR STU3 - Downloaded Version null See the Directory of published versions
| Official URL: http://hl7.org/fhir/5.0/StructureDefinition/profile-CoverageEligibilityResponse-for-EligibilityResponse | Version: 0.1.0 | |||
| Standards status: Trial-use | Maturity Level: 0 | Computable Name: Profile_R5_CoverageEligibilityResponse_R3_EligibilityResponse | ||
This cross-version profile allows R5 CoverageEligibilityResponse content to be represented via FHIR STU3 EligibilityResponse resources.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Path | Status | Usage | ValueSet | Version | Source |
| EligibilityResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource |
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
|
| dom-4 | error | EligibilityResponse | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from EligibilityResponse
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||
|---|---|---|---|---|---|---|---|---|
  EligibilityResponse |
0..* | EligibilityResponse | EligibilityResponse resource | |||||
  id |
Σ | 0..1 | id | Logical id of this artifact | ||||
 meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: Common Languages  (extensible): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
  Slices for extension |
2..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
   extension:purpose |
1..* | code | R5: auth-requirements | benefits | discovery | validation (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.purpose Binding: R5EligibilityresponsePurposeForR3 (0.1.0) (required): A code specifying the types of information being requested. | |||||
| extension:patient |
1..1 | Reference(Cross-version Profile for R5.Patient for use in FHIR STU3(0.1.0) | Patient) | R5: Intended recipient of products and services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.patient | |||||
| extension:event |
0..* | (Complex) | R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.event | |||||
| extension:serviced |
0..1 | date, Period | R5: Estimated date or dates of service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.serviced | |||||
| extension:requestor |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for the request URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
 extension:preAuthRef |
0..1 | string | R5: Preauthorization reference (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.preAuthRef | |||||
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier | |||||
| status |
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required): A code specifying the state of the resource instance. | ||||
| created |
0..1 | dateTime | Creation date | |||||
 requestProvider |
0..1 | Reference(Practitioner) | Responsible practitioner | |||||
| requestOrganization |
0..1 | Reference(Organization) | Responsible organization | |||||
| request |
0..1 | Reference(EligibilityRequest) | Eligibility reference | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:request |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Eligibility request reference additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
 display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| outcome |
0..1 | CodeableConcept | complete | error | partial Binding: Claim Processing Codes (required): The outcome of the processing. | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:outcome |
1..1 | code | R5: queued | complete | error | partial URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.outcome Binding: Claim Processing Codes (required): The outcome of the processing. | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| disposition |
0..1 | string | Disposition Message | |||||
| insurer |
0..1 | Reference(Organization) | Insurer issuing the coverage | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:insurer |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Coverage issuer additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| inforce |
0..1 | boolean | Coverage inforce indicator | |||||
| insurance |
0..* | BackboneElement | Details by insurance coverage | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:benefitPeriod |
0..1 | Period | R5: When the benefits are applicable (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.benefitPeriod | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| coverage |
0..1 | Reference(Coverage) | Updated Coverage details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:coverage |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Insurance information additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| contract |
0..1 | Reference(Contract) | Contract details | |||||
 benefitBalance |
0..* | BackboneElement | Benefits by Category | |||||
 id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:modifier |
0..* | CodeableConcept | R5: Product or service billing modifiers (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.modifier Binding: Modifier type Codes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| extension:provider |
0..1 | Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole) | R5: Performing practitioner (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.provider | |||||
| extension:authorizationRequired |
0..1 | boolean | R5: Authorization required flag (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.authorizationRequired | |||||
| extension:authorizationSupporting |
0..* | CodeableConcept | R5: Type of required supporting materials (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.authorizationSupporting Binding: R5CoverageeligibilityresponseExAuthSupportForR3 (0.1.0) (example): Type of supporting information to provide with a preauthorization. | |||||
| extension:authorizationUrl |
0..1 | uri | R5: Preauthorization requirements endpoint (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.authorizationUrl | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Type of services covered Binding: Benefit Category Codes (example): Benefit categories such as: oral, medical, vision etc. | |||||
| subCategory |
0..1 | CodeableConcept | Detailed services covered within the type Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| excluded |
0..1 | boolean | Excluded from the plan | |||||
| name |
0..1 | string | Short name for the benefit | |||||
| description |
0..1 | string | Description of the benefit or services covered | |||||
| network |
0..1 | CodeableConcept | In or out of network Binding: Network Type Codes (example): Code to classify in or out of network services | |||||
| unit |
0..1 | CodeableConcept | Individual or family Binding: Unit Type Codes (example): Unit covered/serviced - individual or family | |||||
| term |
0..1 | CodeableConcept | Annual or lifetime Binding: Benefit Term Codes (example): Coverage unit - annual, lifetime | |||||
| financial |
0..* | BackboneElement | Benefit Summary | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:used |
0..1 | string | R5: used additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.benefit.used | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
1..1 | CodeableConcept | Deductable, visits, benefit amount Binding: Benefit Type Codes (example): Deductable, visits, co-pay, etc. | |||||
 allowed[x] |
0..1 | Benefits allowed | ||||||
| allowedUnsignedInt |
unsignedInt | |||||||
| allowedString |
string | |||||||
| allowedMoney |
Money | |||||||
| used[x] |
0..1 | Benefits used | ||||||
| usedUnsignedInt |
unsignedInt | |||||||
| usedMoney |
Money | |||||||
| form |
0..1 | CodeableConcept | Printed Form Identifier Binding: Form Codes (example): The forms codes. | |||||
| error |
0..* | BackboneElement | Processing errors | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:expression |
0..* | string | R5: FHIRPath of element(s) related to issue (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.error.expression | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| code |
1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing. | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| EligibilityResponse.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| EligibilityResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.outcome | Base | required | Claim Processing Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.category | Base | example | Benefit Category Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.subCategory | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.network | Base | example | Network Type Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.unit | Base | example | Unit Type Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.term | Base | example | Benefit Term Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.financial.type | Base | example | Benefit Type Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.form | Base | example | Form Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.error.code | Base | example | Adjudication Error Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource |
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
|
| dom-4 | error | EligibilityResponse | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from EligibilityResponse
Summary
Mandatory: 2 elements(8 nested mandatory elements)
Extensions
This structure refers to these extensions:
Maturity: 0
Key Elements View
| Path | Status | Usage | ValueSet | Version | Source |
| EligibilityResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource |
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
|
| dom-4 | error | EligibilityResponse | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from EligibilityResponse
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| EligibilityResponse |
0..* | EligibilityResponse | EligibilityResponse resource | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: Common Languages (extensible): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
2..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:purpose |
1..* | code | R5: auth-requirements | benefits | discovery | validation (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.purpose Binding: R5EligibilityresponsePurposeForR3 (0.1.0) (required): A code specifying the types of information being requested. | |||||
| extension:patient |
1..1 | Reference(Cross-version Profile for R5.Patient for use in FHIR STU3(0.1.0) | Patient) | R5: Intended recipient of products and services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.patient | |||||
| extension:event |
0..* | (Complex) | R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.event | |||||
| extension:serviced |
0..1 | date, Period | R5: Estimated date or dates of service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.serviced | |||||
| extension:requestor |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for the request URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| extension:preAuthRef |
0..1 | string | R5: Preauthorization reference (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.preAuthRef | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier | |||||
| status |
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required): A code specifying the state of the resource instance. | ||||
| created |
0..1 | dateTime | Creation date | |||||
| requestProvider |
0..1 | Reference(Practitioner) | Responsible practitioner | |||||
| requestOrganization |
0..1 | Reference(Organization) | Responsible organization | |||||
| request |
0..1 | Reference(EligibilityRequest) | Eligibility reference | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:request |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Eligibility request reference additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| outcome |
0..1 | CodeableConcept | complete | error | partial Binding: Claim Processing Codes (required): The outcome of the processing. | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:outcome |
1..1 | code | R5: queued | complete | error | partial URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.outcome Binding: Claim Processing Codes (required): The outcome of the processing. | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| disposition |
0..1 | string | Disposition Message | |||||
| insurer |
0..1 | Reference(Organization) | Insurer issuing the coverage | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:insurer |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Coverage issuer additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| inforce |
0..1 | boolean | Coverage inforce indicator | |||||
| insurance |
0..* | BackboneElement | Details by insurance coverage | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:benefitPeriod |
0..1 | Period | R5: When the benefits are applicable (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.benefitPeriod | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| coverage |
0..1 | Reference(Coverage) | Updated Coverage details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:coverage |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Insurance information additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| contract |
0..1 | Reference(Contract) | Contract details | |||||
| benefitBalance |
0..* | BackboneElement | Benefits by Category | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:modifier |
0..* | CodeableConcept | R5: Product or service billing modifiers (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.modifier Binding: Modifier type Codes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| extension:provider |
0..1 | Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole) | R5: Performing practitioner (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.provider | |||||
| extension:authorizationRequired |
0..1 | boolean | R5: Authorization required flag (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.authorizationRequired | |||||
| extension:authorizationSupporting |
0..* | CodeableConcept | R5: Type of required supporting materials (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.authorizationSupporting Binding: R5CoverageeligibilityresponseExAuthSupportForR3 (0.1.0) (example): Type of supporting information to provide with a preauthorization. | |||||
| extension:authorizationUrl |
0..1 | uri | R5: Preauthorization requirements endpoint (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.authorizationUrl | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Type of services covered Binding: Benefit Category Codes (example): Benefit categories such as: oral, medical, vision etc. | |||||
| subCategory |
0..1 | CodeableConcept | Detailed services covered within the type Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| excluded |
0..1 | boolean | Excluded from the plan | |||||
| name |
0..1 | string | Short name for the benefit | |||||
| description |
0..1 | string | Description of the benefit or services covered | |||||
| network |
0..1 | CodeableConcept | In or out of network Binding: Network Type Codes (example): Code to classify in or out of network services | |||||
| unit |
0..1 | CodeableConcept | Individual or family Binding: Unit Type Codes (example): Unit covered/serviced - individual or family | |||||
| term |
0..1 | CodeableConcept | Annual or lifetime Binding: Benefit Term Codes (example): Coverage unit - annual, lifetime | |||||
| financial |
0..* | BackboneElement | Benefit Summary | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:used |
0..1 | string | R5: used additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.insurance.item.benefit.used | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
1..1 | CodeableConcept | Deductable, visits, benefit amount Binding: Benefit Type Codes (example): Deductable, visits, co-pay, etc. | |||||
| allowed[x] |
0..1 | Benefits allowed | ||||||
| allowedUnsignedInt |
unsignedInt | |||||||
| allowedString |
string | |||||||
| allowedMoney |
Money | |||||||
| used[x] |
0..1 | Benefits used | ||||||
| usedUnsignedInt |
unsignedInt | |||||||
| usedMoney |
Money | |||||||
| form |
0..1 | CodeableConcept | Printed Form Identifier Binding: Form Codes (example): The forms codes. | |||||
| error |
0..* | BackboneElement | Processing errors | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:expression |
0..* | string | R5: FHIRPath of element(s) related to issue (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-CoverageEligibilityResponse.error.expression | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| code |
1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing. | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| EligibilityResponse.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| EligibilityResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.outcome | Base | required | Claim Processing Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.category | Base | example | Benefit Category Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.subCategory | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.network | Base | example | Network Type Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.unit | Base | example | Unit Type Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.term | Base | example | Benefit Term Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.insurance.benefitBalance.financial.type | Base | example | Benefit Type Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.form | Base | example | Form Codes | 📍3.0.2 | FHIR Std. |
| EligibilityResponse.error.code | Base | example | Adjudication Error Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | EligibilityResponse | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource |
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
|
| dom-4 | error | EligibilityResponse | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from EligibilityResponse
Summary
Mandatory: 2 elements(8 nested mandatory elements)
Extensions
This structure refers to these extensions:
Maturity: 0
Other representations of profile: CSV, Excel, Schematron
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r5.r3#0.1.0 based on FHIR 3.0.2. Generated 2026-03-20
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