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
Official URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/openimis-coverage-eligibility-response | Version: 1.0.0 | |||
Active as of 2022-05-31 | Responsible: openIMIS Initiative | Computable Name: OpenIMISCoverageEligibilityResponse |
Defines a CoverageEligibilityResponse for openIMIS to get the enquire information for an Insuree.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from CoverageEligibilityResponse
Summary
Mandatory: 4 elements (18 nested mandatory elements)
Prohibited: 23 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
This structure is derived from CoverageEligibilityResponse
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
![]() ![]() ![]() | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Description of identifier | |
![]() ![]() ![]() ![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | |
![]() ![]() ![]() ![]() ![]() | 1..1 | string | The value that is unique | |
![]() ![]() ![]() ![]() | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |
![]() ![]() ![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | External System generated UUID Required Pattern: UUID | |
![]() ![]() ![]() | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
![]() ![]() ![]() | 1..1 | code | auth-requirements | benefits | discovery | validation Required Pattern: benefits | |
![]() ![]() ![]() | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | |
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | |
![]() ![]() ![]() | 1..1 | code | queued | complete | error | partial Required Pattern: complete | |
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | 1..1 | Reference(openIMIS Coverage) | Insurance information | |
![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() | 1..1 | Period | When the benefits are applicable | |
![]() ![]() ![]() ![]() ![]() | 1..1 | dateTime | Benefit stat day | |
![]() ![]() ![]() ![]() ![]() | 1..1 | dateTime | Benefit end day | |
![]() ![]() ![]() ![]() | 1..3 | BackboneElement | Benefits and authorization details Slice: Unordered, Closed by value:category.coding.code | |
![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Category Binding: Category of the item (Coverage) (required) | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() | 1..1 | BackboneElement | Coverage eligibility for policy | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefit | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Benefit Package | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Product/Item/Service code | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Product/Item/Service name | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..11 | BackboneElement | Benefit Summary Slice: Unordered, Closed by type:allowed[x] | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..6 | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as total left (Coverage) (required) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | unsignedInt | Benefits allowed | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..5 | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as amount left (Coverage) (required) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | Money | Benefits allowed Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | Money | Benefits allowed | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | decimal | Numerical value (with implicit precision) | |
![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Coverage eligibility for item | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Item | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Item Code | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Item Code | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | boolean | Item excluded | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Benefits allowed | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Items left | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | unsignedInt | Benefits allowed | |
![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Coverage eligibility for service | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: service | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Service | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Service Code | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Service Code | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | boolean | Service excluded | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Benefits allowed | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Items left | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | unsignedInt | Benefits allowed | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 0..0 | |||
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |||||
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |||||
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Description 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. | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..* | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | uri | Identity of the terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() ![]() ![]() | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Description 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. | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..* | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | uri | Identity of the terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | code | External System generated UUID Required Pattern: UUID | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
![]() ![]() ![]() | Σ | 1..1 | code | auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | ||||
![]() ![]() ![]() | Σ | 1..1 | dateTime | Response creation date | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | ||||
![]() ![]() ![]() | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | ||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | Σ | 1..1 | Reference(openIMIS Coverage) | Insurance information | ||||
![]() ![]() ![]() ![]() | 1..1 | Period | When the benefits are applicable | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | dateTime | Benefit stat day | ||||
![]() ![]() ![]() ![]() ![]() | ΣI | 1..1 | dateTime | Benefit end day | ||||
![]() ![]() ![]() ![]() | I | 1..3 | BackboneElement | Benefits and authorization details Slice: Unordered, Closed by value:category.coding.code | ||||
![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Category Binding: Category of the item (Coverage) (required) | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Excluded from the plan | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Short name for the benefit | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Description of the benefit or services covered | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() | I | 1..1 | BackboneElement | Coverage eligibility for policy | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefit | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Benefit Package | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Product/Item/Service code | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Product/Item/Service name | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..11 | BackboneElement | Benefit Summary Slice: Unordered, Closed by type:allowed[x] | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..6 | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as total left (Coverage) (required) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | unsignedInt | Benefits allowed | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..5 | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as amount left (Coverage) (required) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | Money | Benefits allowed Slice: Unordered, Closed by type:$this | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | Money | Benefits allowed | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Authorization required flag | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Preauthorization requirements endpoint | |||||
![]() ![]() ![]() ![]() ![]() | I | 0..1 | BackboneElement | Coverage eligibility for item | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Item | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Item Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | string | Item Code | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | boolean | Item excluded | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Short name for the benefit | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Description of the benefit or services covered | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Benefits allowed | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Items left | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | unsignedInt | Benefits allowed | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Authorization required flag | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Preauthorization requirements endpoint | |||||
![]() ![]() ![]() ![]() ![]() | I | 0..1 | BackboneElement | Coverage eligibility for service | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: service | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Service | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Service Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | string | Service Code | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | boolean | Service excluded | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Short name for the benefit | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Description of the benefit or services covered | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Benefits allowed | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | BackboneElement | Benefit Summary | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | string | Representation defined by the system Fixed Value: Items left | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | unsignedInt | Benefits allowed | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Authorization required flag | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Preauthorization requirements endpoint | |||||
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
![]() |
This structure is derived from CoverageEligibilityResponse
Summary
Mandatory: 4 elements (18 nested mandatory elements)
Prohibited: 23 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from CoverageEligibilityResponse
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
![]() ![]() ![]() | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Description of identifier | |
![]() ![]() ![]() ![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | |
![]() ![]() ![]() ![]() ![]() | 1..1 | string | The value that is unique | |
![]() ![]() ![]() ![]() | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |
![]() ![]() ![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | External System generated UUID Required Pattern: UUID | |
![]() ![]() ![]() | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
![]() ![]() ![]() | 1..1 | code | auth-requirements | benefits | discovery | validation Required Pattern: benefits | |
![]() ![]() ![]() | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | |
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | |
![]() ![]() ![]() | 1..1 | code | queued | complete | error | partial Required Pattern: complete | |
![]() ![]() ![]() | 0..0 | |||
![]() ![]() ![]() | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | |
![]() ![]() |