description: This profile sets minimum expectations for  CoverageEligibilityRequest to provide patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.
package_name: ndhm.in
derivation: constraint
name: CoverageEligibilityRequest
type: CoverageEligibilityRequest
elements:
  patient:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient']
    index: 3
  insurance:
    mustSupport: true
    index: 10
    elements:
      coverage:
        type: Reference
        mustSupport: true
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage']
        index: 11
  facility: {index: 8}
  enterer:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 5
  supportingInfo: {mustSupport: true, index: 9}
  purpose: {mustSupport: true, index: 2}
  item:
    mustSupport: true
    index: 12
    elements:
      category:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
        index: 13
        elements:
          coding:
            elements:
              system: {index: 14}
              code: {index: 15}
              display: {index: 16}
            required: [display, system, code]
      productOrService:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
        mustSupport: true
        index: 17
        elements:
          coding:
            elements:
              system: {index: 18}
              code: {index: 19}
              display: {index: 20}
            required: [display, system, code]
      provider:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
        index: 21
      facility:
        type: Reference
        refers: ['http://hl7.org/fhir/StructureDefinition/Location', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
        index: 22
      diagnosis:
        mustSupport: true
        index: 23
        elements:
          diagnosis:
            choices: [diagnosisCodeableConcept, diagnosisReference]
            index: 25
          diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 26}
          diagnosisReference:
            type: Reference
            choiceOf: diagnosis
            refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition']
            index: 27
      detail: {index: 28}
    required: [productOrService]
  created: {index: 4}
  insurer:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 7
  priority: {index: 1}
  identifier: {mustSupport: true, index: 0}
  provider:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 6
package_version: 5.0.0
class: profile
kind: resource
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityRequest
base: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest
version: 5.0.0
required: [priority, provider, enterer, insurance, identifier, facility]