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 |
---|---|---|---|---|
CoverageEligibilityResponse | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
Slices for identifier | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |
identifier:All Slices | Content/Rules for all slices | |||
type | 1..1 | CodeableConcept | Description of identifier | |
coding | ||||
code | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | |
value | 1..1 | string | The value that is unique | |
identifier:UUID | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |
type | ||||
coding | ||||
code | 1..1 | code | External System generated UUID Required Pattern: UUID | |
status | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
purpose | 1..1 | code | auth-requirements | benefits | discovery | validation Required Pattern: benefits | |
patient | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | |
serviced[x] | 0..0 | |||
requestor | 0..0 | |||
request | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | |
outcome | 1..1 | code | queued | complete | error | partial Required Pattern: complete | |
disposition | 0..0 | |||
insurer | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | |
insurance | ||||
coverage | 1..1 | Reference(openIMIS Coverage) | Insurance information | |
inforce | 0..0 | |||
benefitPeriod | 1..1 | Period | When the benefits are applicable | |
start | 1..1 | dateTime | Benefit stat day | |
end | 1..1 | dateTime | Benefit end day | |
Slices for item | 1..3 | BackboneElement | Benefits and authorization details Slice: Unordered, Closed by value:category.coding.code | |
item:All Slices | Content/Rules for all slices | |||
category | 0..1 | CodeableConcept | Category Binding: Category of the item (Coverage) (required) | |
modifier | 0..0 | |||
provider | 0..0 | |||
network | 0..0 | |||
unit | 0..0 | |||
term | 0..0 | |||
authorizationRequired | 0..0 | |||
authorizationSupporting | 0..0 | |||
authorizationUrl | 0..0 | |||
item:benefit | 1..1 | BackboneElement | Coverage eligibility for policy | |
category | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefit | |
display | 1..1 | string | Representation defined by the system Fixed Value: Benefit Package | |
productOrService | 0..0 | |||
excluded | 0..0 | |||
name | 1..1 | string | Product/Item/Service code | |
description | 1..1 | string | Product/Item/Service name | |
Slices for benefit | 0..11 | BackboneElement | Benefit Summary Slice: Unordered, Closed by type:allowed[x] | |
benefit:All Slices | Content/Rules for all slices | |||
used[x] | 0..0 | |||
benefit:total | 0..6 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as total left (Coverage) (required) | |
allowed[x] | 1..1 | unsignedInt | Benefits allowed | |
benefit:amount | 0..5 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as amount left (Coverage) (required) | |
allowed[x] | 1..1 | Money | Benefits allowed Slice: Unordered, Open by type:$this | |
allowedMoney | 1..1 | Money | Benefits allowed | |
value | 1..1 | decimal | Numerical value (with implicit precision) | |
item:item | 0..1 | BackboneElement | Coverage eligibility for item | |
category | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item | |
display | 1..1 | string | Representation defined by the system Fixed Value: Item | |
productOrService | 1..1 | CodeableConcept | Item Code | |
coding | 0..0 | |||
text | 1..1 | string | Item Code | |
excluded | 1..1 | boolean | Item excluded | |
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |
benefit:All Slices | Content/Rules for all slices | |||
used[x] | 0..0 | |||
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |
allowed[x] | 0..1 | string | Benefits allowed | |
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |
item:service | 0..1 | BackboneElement | Coverage eligibility for service | |
category | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: service | |
display | 1..1 | string | Representation defined by the system Fixed Value: Service | |
productOrService | 1..1 | CodeableConcept | Service Code | |
coding | 0..0 | |||
text | 1..1 | string | Service Code | |
excluded | 1..1 | boolean | Service excluded | |
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |
allowed[x] | 0..1 | string | Benefits allowed | |
used[x] | 0..0 | |||
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |
used[x] | 0..0 | |||
preAuthRef | 0..0 | |||
form | 0..0 | |||
error | 0..0 | |||
Documentation for this format |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
CoverageEligibilityResponse | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |||||
id | Σ | 0..1 | string | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
Slices for identifier | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |||||
identifier:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | 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. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | Σ | 0..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | Σ | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
identifier:UUID | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | 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. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | Σ | 0..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | Σ | 1..1 | code | External System generated UUID Required Pattern: UUID | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
status | ?!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 | ||||
purpose | Σ | 1..1 | code | auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits | ||||
patient | Σ | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | ||||
created | Σ | 1..1 | dateTime | Response creation date | ||||
request | Σ | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | ||||
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | ||||
insurer | Σ | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | ||||
insurance | 0..* | BackboneElement | Patient insurance information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
coverage | Σ | 1..1 | Reference(openIMIS Coverage) | Insurance information | ||||
benefitPeriod | 1..1 | Period | When the benefits are applicable | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
start | ΣI | 1..1 | dateTime | Benefit stat day | ||||
end | ΣI | 1..1 | dateTime | Benefit end day | ||||
Slices for item | I | 1..3 | BackboneElement | Benefits and authorization details Slice: Unordered, Closed by value:category.coding.code | ||||
item:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Category Binding: Category of the item (Coverage) (required) | |||||
productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
excluded | 0..1 | boolean | Excluded from the plan | |||||
name | 0..1 | string | Short name for the benefit | |||||
description | 0..1 | string | Description of the benefit or services covered | |||||
benefit | 0..* | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
item:benefit | I | 1..1 | BackboneElement | Coverage eligibility for policy | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefit | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Benefit Package | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
modifier | 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. | |||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
name | 1..1 | string | Product/Item/Service code | |||||
description | 1..1 | string | Product/Item/Service name | |||||
network | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
unit | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
Slices for benefit | 0..11 | BackboneElement | Benefit Summary Slice: Unordered, Closed by type:allowed[x] | |||||
benefit:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
benefit:total | 0..6 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as total left (Coverage) (required) | |||||
allowed[x] | 1..1 | unsignedInt | Benefits allowed | |||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
benefit:amount | 0..5 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as amount left (Coverage) (required) | |||||
Slices for allowed[x] | 1..1 | Money | Benefits allowed Slice: Unordered, Closed by type:$this | |||||
allowed[x]:allowedMoney | 1..1 | Money | Benefits allowed | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
currency | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
authorizationRequired | 0..1 | boolean | Authorization required flag | |||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | |||||
item:item | I | 0..1 | BackboneElement | Coverage eligibility for item | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Item | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
productOrService | 1..1 | CodeableConcept | Item Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
text | Σ | 1..1 | string | Item Code | ||||
modifier | 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. | |||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
excluded | 1..1 | boolean | Item excluded | |||||
name | 0..1 | string | Short name for the benefit | |||||
description | 0..1 | string | Description of the benefit or services covered | |||||
network | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
unit | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |||||
benefit:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | string | Benefits allowed | |||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
authorizationRequired | 0..1 | boolean | Authorization required flag | |||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | |||||
item:service | I | 0..1 | BackboneElement | Coverage eligibility for service | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: service | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Service | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
productOrService | 1..1 | CodeableConcept | Service Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
text | Σ | 1..1 | string | Service Code | ||||
modifier | 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. | |||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
excluded | 1..1 | boolean | Service excluded | |||||
name | 0..1 | string | Short name for the benefit | |||||
description | 0..1 | string | Description of the benefit or services covered | |||||
network | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
unit | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |||||
benefit:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | string | Benefits allowed | |||||
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |||||
authorizationRequired | 0..1 | boolean | Authorization required flag | |||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | |||||
Documentation for this format |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
CoverageEligibilityResponse | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
Documentation for this format |
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 |
---|---|---|---|---|
CoverageEligibilityResponse | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
Slices for identifier | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |
identifier:All Slices | Content/Rules for all slices | |||
type | 1..1 | CodeableConcept | Description of identifier | |
coding | ||||
code | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | |
value | 1..1 | string | The value that is unique | |
identifier:UUID | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |
type | ||||
coding | ||||
code | 1..1 | code | External System generated UUID Required Pattern: UUID | |
status | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
purpose | 1..1 | code | auth-requirements | benefits | discovery | validation Required Pattern: benefits | |
patient | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | |
serviced[x] | 0..0 | |||
requestor | 0..0 | |||
request | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | |
outcome | 1..1 | code | queued | complete | error | partial Required Pattern: complete | |
disposition | 0..0 | |||
insurer | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | |
insurance | ||||
coverage | 1..1 | Reference(openIMIS Coverage) | Insurance information | |
inforce | 0..0 | |||
benefitPeriod | 1..1 | Period | When the benefits are applicable | |
start | 1..1 | dateTime | Benefit stat day | |
end | 1..1 | dateTime | Benefit end day | |
Slices for item | 1..3 | BackboneElement | Benefits and authorization details Slice: Unordered, Closed by value:category.coding.code | |
item:All Slices | Content/Rules for all slices | |||
category | 0..1 | CodeableConcept | Category Binding: Category of the item (Coverage) (required) | |
modifier | 0..0 | |||
provider | 0..0 | |||
network | 0..0 | |||
unit | 0..0 | |||
term | 0..0 | |||
authorizationRequired | 0..0 | |||
authorizationSupporting | 0..0 | |||
authorizationUrl | 0..0 | |||
item:benefit | 1..1 | BackboneElement | Coverage eligibility for policy | |
category | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefit | |
display | 1..1 | string | Representation defined by the system Fixed Value: Benefit Package | |
productOrService | 0..0 | |||
excluded | 0..0 | |||
name | 1..1 | string | Product/Item/Service code | |
description | 1..1 | string | Product/Item/Service name | |
Slices for benefit | 0..11 | BackboneElement | Benefit Summary Slice: Unordered, Closed by type:allowed[x] | |
benefit:All Slices | Content/Rules for all slices | |||
used[x] | 0..0 | |||
benefit:total | 0..6 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as total left (Coverage) (required) | |
allowed[x] | 1..1 | unsignedInt | Benefits allowed | |
benefit:amount | 0..5 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as amount left (Coverage) (required) | |
allowed[x] | 1..1 | Money | Benefits allowed Slice: Unordered, Open by type:$this | |
allowedMoney | 1..1 | Money | Benefits allowed | |
value | 1..1 | decimal | Numerical value (with implicit precision) | |
item:item | 0..1 | BackboneElement | Coverage eligibility for item | |
category | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item | |
display | 1..1 | string | Representation defined by the system Fixed Value: Item | |
productOrService | 1..1 | CodeableConcept | Item Code | |
coding | 0..0 | |||
text | 1..1 | string | Item Code | |
excluded | 1..1 | boolean | Item excluded | |
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |
benefit:All Slices | Content/Rules for all slices | |||
used[x] | 0..0 | |||
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |
allowed[x] | 0..1 | string | Benefits allowed | |
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |
item:service | 0..1 | BackboneElement | Coverage eligibility for service | |
category | 0..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: service | |
display | 1..1 | string | Representation defined by the system Fixed Value: Service | |
productOrService | 1..1 | CodeableConcept | Service Code | |
coding | 0..0 | |||
text | 1..1 | string | Service Code | |
excluded | 1..1 | boolean | Service excluded | |
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |
allowed[x] | 0..1 | string | Benefits allowed | |
used[x] | 0..0 | |||
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |
type | 1..1 | CodeableConcept | Benefit classification Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |
used[x] | 0..0 | |||
preAuthRef | 0..0 | |||
form | 0..0 | |||
error | 0..0 | |||
Documentation for this format |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
CoverageEligibilityResponse | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |||||
id | Σ | 0..1 | string | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
Slices for identifier | 1..1 | Identifier | Business Identifier for coverage eligiblity request Slice: Unordered, Closed by value:type.coding.code | |||||
identifier:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | 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. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | Σ | 0..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | Σ | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
identifier:UUID | 1..1 | Identifier | Business Identifier for coverage eligiblity request | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | 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. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | Σ | 0..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | Σ | 1..1 | code | External System generated UUID Required Pattern: UUID | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
status | ?!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 | ||||
purpose | Σ | 1..1 | code | auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits | ||||
patient | Σ | 1..1 | Reference(openIMIS Patient) | Intended recipient of products and services | ||||
created | Σ | 1..1 | dateTime | Response creation date | ||||
request | Σ | 1..1 | Reference(openIMIS CoverageEligibilityRequest) | Eligibility request reference | ||||
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. Required Pattern: complete | ||||
insurer | Σ | 1..1 | Reference(openIMIS Insurance Organization) | Coverage issuer | ||||
insurance | 0..* | BackboneElement | Patient insurance information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
coverage | Σ | 1..1 | Reference(openIMIS Coverage) | Insurance information | ||||
benefitPeriod | 1..1 | Period | When the benefits are applicable | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
start | ΣI | 1..1 | dateTime | Benefit stat day | ||||
end | ΣI | 1..1 | dateTime | Benefit end day | ||||
Slices for item | I | 1..3 | BackboneElement | Benefits and authorization details Slice: Unordered, Closed by value:category.coding.code | ||||
item:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Category Binding: Category of the item (Coverage) (required) | |||||
productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
excluded | 0..1 | boolean | Excluded from the plan | |||||
name | 0..1 | string | Short name for the benefit | |||||
description | 0..1 | string | Description of the benefit or services covered | |||||
benefit | 0..* | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
item:benefit | I | 1..1 | BackboneElement | Coverage eligibility for policy | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefit | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Benefit Package | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
modifier | 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. | |||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
name | 1..1 | string | Product/Item/Service code | |||||
description | 1..1 | string | Product/Item/Service name | |||||
network | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
unit | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
Slices for benefit | 0..11 | BackboneElement | Benefit Summary Slice: Unordered, Closed by type:allowed[x] | |||||
benefit:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
benefit:total | 0..6 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as total left (Coverage) (required) | |||||
allowed[x] | 1..1 | unsignedInt | Benefits allowed | |||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
benefit:amount | 0..5 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: Type of benefit as amount left (Coverage) (required) | |||||
Slices for allowed[x] | 1..1 | Money | Benefits allowed Slice: Unordered, Closed by type:$this | |||||
allowed[x]:allowedMoney | 1..1 | Money | Benefits allowed | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
currency | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
authorizationRequired | 0..1 | boolean | Authorization required flag | |||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | |||||
item:item | I | 0..1 | BackboneElement | Coverage eligibility for item | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Item | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
productOrService | 1..1 | CodeableConcept | Item Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
text | Σ | 1..1 | string | Item Code | ||||
modifier | 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. | |||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
excluded | 1..1 | boolean | Item excluded | |||||
name | 0..1 | string | Short name for the benefit | |||||
description | 0..1 | string | Description of the benefit or services covered | |||||
network | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
unit | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |||||
benefit:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | string | Benefits allowed | |||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
authorizationRequired | 0..1 | boolean | Authorization required flag | |||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | |||||
item:service | I | 0..1 | BackboneElement | Coverage eligibility for service | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-category | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: service | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Service | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
productOrService | 1..1 | CodeableConcept | Service Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
text | Σ | 1..1 | string | Service Code | ||||
modifier | 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. | |||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
excluded | 1..1 | boolean | Service excluded | |||||
name | 0..1 | string | Short name for the benefit | |||||
description | 0..1 | string | Description of the benefit or services covered | |||||
network | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
unit | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
Slices for benefit | 0..2 | BackboneElement | Benefit Summary Slice: Unordered, Closed by value:type.coding.code | |||||
benefit:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
allowed[x] | 0..1 | Benefits allowed | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
used[x] | 0..1 | Benefits used | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedString | string | |||||||
usedMoney | Money | |||||||
benefit:minDate | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: min_date_item | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Mininum date | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | string | Benefits allowed | |||||
benefit:itemLeft | 0..1 | BackboneElement | Benefit Summary | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/coverage-item-benefit-type | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: item_left | |||||
display | 1..1 | string | Representation defined by the system Fixed Value: Items left | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
allowed[x] | 0..1 | unsignedInt | Benefits allowed | |||||
authorizationRequired | 0..1 | boolean | Authorization required flag | |||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | |||||
Documentation for this format |
Other representations of profile: CSV, Excel, Schematron
Path | Conformance | ValueSet / Code |
CoverageEligibilityResponse.language | preferred | CommonLanguages Max Binding: AllLanguages |
CoverageEligibilityResponse.identifier.use | required | IdentifierUse |
CoverageEligibilityResponse.identifier.type | extensible | Identifier Type Codes |
CoverageEligibilityResponse.identifier.type.coding.code | required | OpenIMISIdentifierVS |
CoverageEligibilityResponse.identifier:UUID.use | required | IdentifierUse |
CoverageEligibilityResponse.identifier:UUID.type | extensible | Identifier Type Codes |
CoverageEligibilityResponse.status | required | Pattern: active |
CoverageEligibilityResponse.purpose | required | Pattern: benefits |
CoverageEligibilityResponse.outcome | required | Pattern: complete |
CoverageEligibilityResponse.insurance.item.category | required | CoverageItemCategoryVS |
CoverageEligibilityResponse.insurance.item.productOrService | example | USCLSCodes |
CoverageEligibilityResponse.insurance.item.benefit.type | example | BenefitTypeCodes |
CoverageEligibilityResponse.insurance.item:benefit.category | example | Pattern: benefit("Benefit Package") |
CoverageEligibilityResponse.insurance.item:benefit.modifier | example | ModifierTypeCodes |
CoverageEligibilityResponse.insurance.item:benefit.network | example | NetworkTypeCodes |
CoverageEligibilityResponse.insurance.item:benefit.unit | example | UnitTypeCodes |
CoverageEligibilityResponse.insurance.item:benefit.term | example | BenefitTermCodes |
CoverageEligibilityResponse.insurance.item:benefit.benefit.type | example | BenefitTypeCodes |
CoverageEligibilityResponse.insurance.item:benefit.benefit:total.type | required | CoverageItemBenefitTypeTotalLeftVS |
CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.type | required | CoverageItemBenefitTypeAmountLeftVS |
CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x]:allowedMoney.currency | required | Currencies |
CoverageEligibilityResponse.insurance.item:benefit.authorizationSupporting | example | CoverageEligibilityResponseAuthSupportCodes |
CoverageEligibilityResponse.insurance.item:item.category | example | Pattern: item("Item") |
CoverageEligibilityResponse.insurance.item:item.productOrService | example | USCLSCodes |
CoverageEligibilityResponse.insurance.item:item.modifier | example | ModifierTypeCodes |
CoverageEligibilityResponse.insurance.item:item.network | example | NetworkTypeCodes |
CoverageEligibilityResponse.insurance.item:item.unit | example | UnitTypeCodes |
CoverageEligibilityResponse.insurance.item:item.term | example | BenefitTermCodes |
CoverageEligibilityResponse.insurance.item:item.benefit.type | example | BenefitTypeCodes |
CoverageEligibilityResponse.insurance.item:item.benefit:minDate.type | example | Pattern: min_date_item("Mininum date") |
CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.type | example | Pattern: item_left("Items left") |
CoverageEligibilityResponse.insurance.item:item.authorizationSupporting | example | CoverageEligibilityResponseAuthSupportCodes |
CoverageEligibilityResponse.insurance.item:service.category | example | Pattern: service("Service") |
CoverageEligibilityResponse.insurance.item:service.productOrService | example | USCLSCodes |
CoverageEligibilityResponse.insurance.item:service.modifier | example | ModifierTypeCodes |
CoverageEligibilityResponse.insurance.item:service.network | example | NetworkTypeCodes |
CoverageEligibilityResponse.insurance.item:service.unit | example | UnitTypeCodes |
CoverageEligibilityResponse.insurance.item:service.term | example | BenefitTermCodes |
CoverageEligibilityResponse.insurance.item:service.benefit.type | example | BenefitTypeCodes |
CoverageEligibilityResponse.insurance.item:service.benefit:minDate.type | example | Pattern: min_date_item("Mininum date") |
CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.type | example | Pattern: item_left("Items left") |
CoverageEligibilityResponse.insurance.item:service.authorizationSupporting | example | CoverageEligibilityResponseAuthSupportCodes |
CoverageEligibilityResponse.error.code | example | Adjudication Error Codes |
Id | Grade | Path | Details | Requirements |
dom-2 | error | CoverageEligibilityResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | CoverageEligibilityResponse | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : 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-4 | error | CoverageEligibilityResponse | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | CoverageEligibilityResponse | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | Best Practice | CoverageEligibilityResponse | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | CoverageEligibilityResponse.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.identifier.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.identifier.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.identifier.type.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.identifier:UUID.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.identifier:UUID.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.identifier:UUID.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.purpose | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.patient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.created | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.request | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.outcome | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.coverage | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.benefitPeriod | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.benefitPeriod.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.benefitPeriod.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.benefitPeriod.start | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.benefitPeriod.end | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ces-1 | error | CoverageEligibilityResponse.insurance.item | SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.excluded | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.name | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.benefit.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.benefit.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ces-1 | error | CoverageEligibilityResponse.insurance.item:benefit | SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.name | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.network | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.unit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.term | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:total.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x]:allowedMoney | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x]:allowedMoney.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x]:allowedMoney.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x]:allowedMoney.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.allowed[x]:allowedMoney.currency | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.benefit:amount.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.authorizationRequired | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.authorizationSupporting | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:benefit.authorizationUrl | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ces-1 | error | CoverageEligibilityResponse.insurance.item:item | SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.productOrService.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.productOrService.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.productOrService.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.excluded | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.name | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.network | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.unit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.term | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:minDate.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.benefit:itemLeft.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.authorizationRequired | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.authorizationSupporting | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:item.authorizationUrl | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ces-1 | error | CoverageEligibilityResponse.insurance.item:service | SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.productOrService.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.productOrService.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.productOrService.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.excluded | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.name | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.network | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.unit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.term | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:minDate.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.benefit:itemLeft.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.authorizationRequired | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.authorizationSupporting | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item:service.authorizationUrl | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.error.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.error.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.error.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.error.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.error.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |