openIMIS FHIR R4 Implementation Guide
1.0.0 - ci-build

openIMIS FHIR R4 Implementation Guide - Local Development build (v1.0.0). See the Directory of published versions

Resource Profile: openIMIS CoverageEligibilityRequest

Official URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/openimis-coverage-eligibility-request Version: 1.0.0
Active as of 2022-05-31 Responsible: openIMIS Initiative Computable Name: OpenIMISCoverageEligibilityRequest

Defines a CoverageEligibilityRequest for openIMIS to enquire an Insuree.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CoverageEligibilityRequest

Summary

Mandatory: 4 elements (3 nested mandatory elements)
Prohibited: 16 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element CoverageEligibilityRequest.identifier is sliced based on the value of value:type.coding.code (Closed)
  • The element CoverageEligibilityRequest.item is sliced based on the value of value:category.coding.code (Closed)

This structure is derived from CoverageEligibilityRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... Slices for identifier 1..1IdentifierBusiness Identifier for coverage eligiblity request
Slice: Unordered, Closed by value:type.coding.code
.... identifier:All Slices Content/Rules for all slices
..... type 1..1CodeableConceptDescription of identifier
...... coding
....... code 0..1codeSymbol in syntax defined by the system
Binding: openIMIS Identifiers Value Set (required)
..... value 1..1stringThe value that is unique
.... identifier:UUID 1..1IdentifierBusiness Identifier for coverage eligiblity request
..... type
...... coding
....... code 1..1codeExternal System generated UUID
Required Pattern: UUID
... status 1..1codeactive | cancelled | draft | entered-in-error
Required Pattern: active
... priority 0..0
... patient 1..1Reference(openIMIS Patient)Intended recipient of products and services
... serviced[x] 0..0
... enterer 0..0
... provider 0..0
... insurer 1..1Reference(openIMIS Insurance Organization)Coverage issuer
... facility 0..0
... supportingInfo 0..0
... insurance 0..0
... Slices for item 0..2BackboneElementItem to be evaluated for eligibiity
Slice: Unordered, Closed by value:category.coding.code
.... item:All Slices Content/Rules for all slices
..... supportingInfoSequence 0..0
..... category 0..1CodeableConceptCategory
Binding: Category of the item (Coverage) (required)
..... productOrService 1..1CodeableConceptItem Code
...... coding 0..0
...... text 1..1stringItem/Service Code
..... modifier 0..0
..... provider 0..0
..... quantity 0..0
..... unitPrice 0..0
..... facility 0..0
..... diagnosis 0..0
..... detail 0..0
.... item:item 0..1BackboneElementItem to be evaluated for eligibiity
..... category 0..1CodeableConceptCoverage eligibility for item
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: item
....... display1..1stringRepresentation defined by the system
Fixed Value: Item
.... item:service 0..1BackboneElementItem to be evaluated for eligibiity
..... category 0..1CodeableConceptCoverage eligibility for service
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: service
....... display1..1stringRepresentation defined by the system
Fixed Value: Service

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier 1..1IdentifierBusiness Identifier for coverage eligiblity request
Slice: Unordered, Closed by value:type.coding.code
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ0..*CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ0..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ0..1codeSymbol in syntax defined by the system
Binding: openIMIS Identifiers Value Set (required)
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:UUID 1..1IdentifierBusiness Identifier for coverage eligiblity request
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ0..*CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ0..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ1..1codeExternal System generated UUID
Required Pattern: UUID
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... purpose Σ1..1codeauth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.



Required Pattern: benefits
... patient Σ1..1Reference(openIMIS Patient)Intended recipient of products and services
... created Σ1..1dateTimeCreation date
... insurer Σ1..1Reference(openIMIS Insurance Organization)Coverage issuer
... Slices for item 0..2BackboneElementItem to be evaluated for eligibiity
Slice: Unordered, Closed by value:category.coding.code
.... item:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 0..1CodeableConceptCategory
Binding: Category of the item (Coverage) (required)
..... productOrService 1..1CodeableConceptItem Code
Binding: USCLSCodes (example): Allowable service and product codes.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... text Σ1..1stringItem/Service Code
.... item:item 0..1BackboneElementItem to be evaluated for eligibiity
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... supportingInfoSequence 0..*positiveIntApplicable exception or supporting information
..... category 0..1CodeableConceptCoverage eligibility for item
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: item
....... display1..1stringRepresentation defined by the system
Fixed Value: Item
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... provider 0..1Reference(Practitioner | PractitionerRole)Perfoming practitioner
..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... facility 0..1Reference(Location | Organization)Servicing facility
..... diagnosis 0..*BackboneElementApplicable diagnosis
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... diagnosis[x] 0..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

....... diagnosisCodeableConceptCodeableConcept
....... diagnosisReferenceReference(Condition)
..... detail 0..*Reference(Resource)Product or service details
.... item:service 0..1BackboneElementItem to be evaluated for eligibiity
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... supportingInfoSequence 0..*positiveIntApplicable exception or supporting information
..... category 0..1CodeableConceptCoverage eligibility for service
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: service
....... display1..1stringRepresentation defined by the system
Fixed Value: Service
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... provider 0..1Reference(Practitioner | PractitionerRole)Perfoming practitioner
..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... facility 0..1Reference(Location | Organization)Servicing facility
..... diagnosis 0..*BackboneElementApplicable diagnosis
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... diagnosis[x] 0..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

....... diagnosisCodeableConceptCodeableConcept
....... diagnosisReferenceReference(Condition)
..... detail 0..*Reference(Resource)Product or service details

doco Documentation for this format

This structure is derived from CoverageEligibilityRequest

Summary

Mandatory: 4 elements (3 nested mandatory elements)
Prohibited: 16 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element CoverageEligibilityRequest.identifier is sliced based on the value of value:type.coding.code (Closed)
  • The element CoverageEligibilityRequest.item is sliced based on the value of value:category.coding.code (Closed)

Differential View

This structure is derived from CoverageEligibilityRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... Slices for identifier 1..1IdentifierBusiness Identifier for coverage eligiblity request
Slice: Unordered, Closed by value:type.coding.code
.... identifier:All Slices Content/Rules for all slices
..... type 1..1CodeableConceptDescription of identifier
...... coding
....... code 0..1codeSymbol in syntax defined by the system
Binding: openIMIS Identifiers Value Set (required)
..... value 1..1stringThe value that is unique
.... identifier:UUID 1..1IdentifierBusiness Identifier for coverage eligiblity request
..... type
...... coding
....... code 1..1codeExternal System generated UUID
Required Pattern: UUID
... status 1..1codeactive | cancelled | draft | entered-in-error
Required Pattern: active
... priority 0..0
... patient 1..1Reference(openIMIS Patient)Intended recipient of products and services
... serviced[x] 0..0
... enterer 0..0
... provider 0..0
... insurer 1..1Reference(openIMIS Insurance Organization)Coverage issuer
... facility 0..0
... supportingInfo 0..0
... insurance 0..0
... Slices for item 0..2BackboneElementItem to be evaluated for eligibiity
Slice: Unordered, Closed by value:category.coding.code
.... item:All Slices Content/Rules for all slices
..... supportingInfoSequence 0..0
..... category 0..1CodeableConceptCategory
Binding: Category of the item (Coverage) (required)
..... productOrService 1..1CodeableConceptItem Code
...... coding 0..0
...... text 1..1stringItem/Service Code
..... modifier 0..0
..... provider 0..0
..... quantity 0..0
..... unitPrice 0..0
..... facility 0..0
..... diagnosis 0..0
..... detail 0..0
.... item:item 0..1BackboneElementItem to be evaluated for eligibiity
..... category 0..1CodeableConceptCoverage eligibility for item
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: item
....... display1..1stringRepresentation defined by the system
Fixed Value: Item
.... item:service 0..1BackboneElementItem to be evaluated for eligibiity
..... category 0..1CodeableConceptCoverage eligibility for service
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: service
....... display1..1stringRepresentation defined by the system
Fixed Value: Service

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier 1..1IdentifierBusiness Identifier for coverage eligiblity request
Slice: Unordered, Closed by value:type.coding.code
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ0..*CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ0..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ0..1codeSymbol in syntax defined by the system
Binding: openIMIS Identifiers Value Set (required)
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:UUID 1..1IdentifierBusiness Identifier for coverage eligiblity request
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ0..*CodingCode defined by a terminology system
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ0..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ1..1codeExternal System generated UUID
Required Pattern: UUID
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Required Pattern: active
... purpose Σ1..1codeauth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.



Required Pattern: benefits
... patient Σ1..1Reference(openIMIS Patient)Intended recipient of products and services
... created Σ1..1dateTimeCreation date
... insurer Σ1..1Reference(openIMIS Insurance Organization)Coverage issuer
... Slices for item 0..2BackboneElementItem to be evaluated for eligibiity
Slice: Unordered, Closed by value:category.coding.code
.... item:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 0..1CodeableConceptCategory
Binding: Category of the item (Coverage) (required)
..... productOrService 1..1CodeableConceptItem Code
Binding: USCLSCodes (example): Allowable service and product codes.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... text Σ1..1stringItem/Service Code
.... item:item 0..1BackboneElementItem to be evaluated for eligibiity
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... supportingInfoSequence 0..*positiveIntApplicable exception or supporting information
..... category 0..1CodeableConceptCoverage eligibility for item
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: item
....... display1..1stringRepresentation defined by the system
Fixed Value: Item
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... provider 0..1Reference(Practitioner | PractitionerRole)Perfoming practitioner
..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... facility 0..1Reference(Location | Organization)Servicing facility
..... diagnosis 0..*BackboneElementApplicable diagnosis
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... diagnosis[x] 0..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

....... diagnosisCodeableConceptCodeableConcept
....... diagnosisReferenceReference(Condition)
..... detail 0..*Reference(Resource)Product or service details
.... item:service 0..1BackboneElementItem to be evaluated for eligibiity
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... supportingInfoSequence 0..*positiveIntApplicable exception or supporting information
..... category 0..1CodeableConceptCoverage eligibility for service
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: service
....... display1..1stringRepresentation defined by the system
Fixed Value: Service
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... provider 0..1Reference(Practitioner | PractitionerRole)Perfoming practitioner
..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... facility 0..1Reference(Location | Organization)Servicing facility
..... diagnosis 0..*BackboneElementApplicable diagnosis
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... diagnosis[x] 0..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

....... diagnosisCodeableConceptCodeableConcept
....... diagnosisReferenceReference(Condition)
..... detail 0..*Reference(Resource)Product or service details

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
CoverageEligibilityRequest.languagepreferredCommonLanguages
Max Binding: AllLanguages
CoverageEligibilityRequest.identifier.userequiredIdentifierUse
CoverageEligibilityRequest.identifier.typeextensibleIdentifier Type Codes
CoverageEligibilityRequest.identifier.type.coding.coderequiredOpenIMISIdentifierVS
CoverageEligibilityRequest.identifier:UUID.userequiredIdentifierUse
CoverageEligibilityRequest.identifier:UUID.typeextensibleIdentifier Type Codes
CoverageEligibilityRequest.statusrequiredPattern: active
CoverageEligibilityRequest.purposerequiredPattern: benefits
CoverageEligibilityRequest.item.categoryrequiredCoverageItemCategoryVS
CoverageEligibilityRequest.item.productOrServiceexampleUSCLSCodes
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]exampleICD-10Codes
CoverageEligibilityRequest.item:item.categoryexamplePattern: item("Item")
CoverageEligibilityRequest.item:item.productOrServiceexampleUSCLSCodes
CoverageEligibilityRequest.item:item.modifierexampleModifierTypeCodes
CoverageEligibilityRequest.item:item.diagnosis.diagnosis[x]exampleICD-10Codes
CoverageEligibilityRequest.item:service.categoryexamplePattern: service("Service")
CoverageEligibilityRequest.item:service.productOrServiceexampleUSCLSCodes
CoverageEligibilityRequest.item:service.modifierexampleModifierTypeCodes
CoverageEligibilityRequest.item:service.diagnosis.diagnosis[x]exampleICD-10Codes

Constraints

IdGradePathDetailsRequirements
dom-2errorCoverageEligibilityRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageEligibilityRequestIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageEligibilityRequestIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageEligibilityRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6Best PracticeCoverageEligibilityRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1errorCoverageEligibilityRequest.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.identifier.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifier.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.identifier.type.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifier.type.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.identifier.type.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifier.type.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.type.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier.assignerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUIDAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.identifier:UUID.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifier:UUID.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.identifier:UUID.type.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.type.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.identifier:UUID.assignerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.purposeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.patientAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.createdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.insurerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.supportingInfo.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.supportingInfo.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.supportingInfo.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.supportingInfo.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.supportingInfo.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.supportingInfo.informationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.supportingInfo.appliesToAllAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.insurance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.insurance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.insurance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.insurance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.insurance.focalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.insurance.coverageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.insurance.businessArrangementAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item.productOrService.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item.productOrService.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item.productOrService.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:item.supportingInfoSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.facilityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.diagnosisAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:item.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:item.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:item.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:item.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:item.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:serviceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:service.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:service.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:service.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:service.supportingInfoSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.facilityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.diagnosisAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:service.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:service.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorCoverageEligibilityRequest.item:service.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorCoverageEligibilityRequest.item:service.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorCoverageEligibilityRequest.item:service.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())