{
"description": "Israel Core proposed constraints and extensions on the CoverageEligibilityResponse Resource",
"_filename": "StructureDefinition-il-core-coverage-eligibility-response.json",
"package_name": "il.core.fhir.r4",
"date": "2024-04-07",
"derivation": "constraint",
"publisher": "Israel Core Team",
"fhirVersion": "4.0.1",
"name": "ILCoreCoverageEligibilityResponse",
"mapping": [ {
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Pattern",
"identity": "workflow"
}, {
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern Mapping",
"identity": "w5"
}, {
"uri": "http://www.cda-adc.ca/en/services/cdanet/",
"name": "Canadian Dental Association eclaims standard",
"identity": "cdanetv4"
}, {
"uri": "http://hl7.org/v3",
"name": "RIM Mapping",
"identity": "rim"
} ],
"abstract": false,
"type": "CoverageEligibilityResponse",
"experimental": null,
"resourceType": "StructureDefinition",
"title": "ILCore CoverageEligibilityResponse Profile",
"package_version": "0.15.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "draft"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0
} ],
"snapshot": {
"element": [ {
"constraint": [ {
"key": "dom-2",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"xpath": "not(parent::f:contained and f:contained)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.contained.empty()"
}, {
"key": "dom-3",
"human": "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",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "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()"
}, {
"key": "dom-4",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
}, {
"key": "dom-5",
"human": "If a resource is contained in another resource, it SHALL NOT have a security label",
"xpath": "not(exists(f:contained/*/f:meta/f:security))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.meta.security.empty()"
}, {
"key": "dom-6",
"human": "A resource should have narrative for robust management",
"xpath": "exists(f:text/h:div)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "warning",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
} ],
"expression": "text.`div`.exists()"
} ],
"path": "CoverageEligibilityResponse",
"min": 0,
"definition": "Israel Core proposed constraints and extensions on the CoverageEligibilityResponse resource profile.",
"isModifier": false,
"short": "ILCore CoverageEligibilityResponse Profile",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "Event",
"identity": "workflow"
} ],
"max": "*",
"id": "CoverageEligibilityResponse",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse"
},
"isSummary": false
}, {
"path": "CoverageEligibilityResponse.id",
"min": 0,
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"isModifier": false,
"short": "Logical id of this artifact",
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.id",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.meta",
"min": 0,
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"isModifier": false,
"short": "Metadata about the resource",
"type": [ {
"code": "Meta"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.meta",
"base": {
"max": "1",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.implicitRules",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.implicitRules"
},
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"isModifier": false,
"short": "Language of the resource content",
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/languages",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language."
},
"max": "1",
"id": "CoverageEligibilityResponse.language",
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"base": {
"max": "1",
"min": 0,
"path": "Resource.language"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"isModifier": false,
"short": "Text summary of the resource, for human interpretation",
"mapping": [ {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"id": "CoverageEligibilityResponse.text",
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"base": {
"max": "1",
"min": 0,
"path": "DomainResource.text"
},
"isSummary": false
}, {
"path": "CoverageEligibilityResponse.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"isModifier": false,
"short": "Contained, inline Resources",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"id": "CoverageEligibilityResponse.contained",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "CoverageEligibilityResponse.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "CoverageEligibilityResponse.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.identifier",
"requirements": "Allows coverage eligibility requests to be distinguished and referenced.",
"min": 0,
"definition": "A unique identifier assigned to this coverage eligiblity request.",
"isModifier": false,
"short": "Business Identifier for coverage eligiblity request",
"mapping": [ {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "FiveWs.identifier",
"identity": "w5"
} ],
"type": [ {
"code": "Identifier"
} ],
"max": "*",
"id": "CoverageEligibilityResponse.identifier",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.identifier"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.status",
"requirements": "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.",
"min": 1,
"definition": "The status of the resource instance.",
"isModifier": true,
"short": "active | cancelled | draft | entered-in-error",
"mapping": [ {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "FiveWs.status",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/fm-status|4.0.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "EligibilityResponseStatus"
} ],
"description": "A code specifying the state of the resource instance."
},
"max": "1",
"id": "CoverageEligibilityResponse.status",
"comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.status"
},
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.purpose",
"requirements": "To indicate the processing actions requested.",
"min": 1,
"definition": "Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified.",
"isModifier": false,
"short": "auth-requirements | benefits | discovery | validation",
"mapping": [ {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|4.0.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "EligibilityResponsePurpose"
} ],
"description": "A code specifying the types of information being requested."
},
"max": "*",
"id": "CoverageEligibilityResponse.purpose",
"base": {
"max": "*",
"min": 1,
"path": "CoverageEligibilityResponse.purpose"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.patient",
"requirements": "Required to provide context and coverage validation.",
"min": 1,
"definition": "The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.",
"isModifier": false,
"short": "Intended recipient of products and services",
"mapping": [ {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "FiveWs.subject[x]",
"identity": "w5"
}, {
"map": "C06,C07,C08, C05, C04",
"identity": "cdanetv4"
}, {
"map": "FiveWs.subject",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-patient" ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.patient",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.patient"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.serviced[x]",
"requirements": "Required to provide time context for the request.",
"min": 0,
"definition": "The date or dates when the enclosed suite of services were performed or completed.",
"isModifier": false,
"short": "Estimated date or dates of service",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
}, {
"map": "F09",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.serviced[x]",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.serviced[x]"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.created",
"requirements": "Need to record a timestamp for use by both the recipient and the issuer.",
"min": 1,
"definition": "The date this resource was created.",
"isModifier": false,
"short": "Response creation date",
"mapping": [ {
"map": "FiveWs.recorded",
"identity": "w5"
} ],
"type": [ {
"code": "dateTime"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.created",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.created"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.requestor",
"min": 0,
"definition": "The provider which is responsible for the request.",
"isModifier": false,
"short": "Party responsible for the request",
"mapping": [ {
"map": "FiveWs.source",
"identity": "w5"
}, {
"map": "B01",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner", "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner-role", "http://fhir.health.gov.il/StructureDefinition/il-core-organization" ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.requestor",
"comment": "Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.requestor"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.request",
"requirements": "Needed to allow the response to be linked to the request.",
"min": 1,
"definition": "Reference to the original request resource.",
"isModifier": false,
"short": "Eligibility request reference",
"mapping": [ {
"map": "Event.basedOn",
"identity": "workflow"
}, {
"map": "FiveWs.why[x]",
"identity": "w5"
}, {
"map": "A02|G01",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-coverage-eligibility-request" ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.request",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.request"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.outcome",
"requirements": "To advise the requestor of an overall processing outcome.",
"min": 1,
"definition": "The outcome of the request processing.",
"isModifier": false,
"short": "queued | complete | error | partial",
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The outcome of the processing."
},
"max": "1",
"id": "CoverageEligibilityResponse.outcome",
"comment": "The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.outcome"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.disposition",
"requirements": "Provided for user display.",
"min": 0,
"definition": "A human readable description of the status of the adjudication.",
"isModifier": false,
"short": "Disposition Message",
"mapping": [ {
"map": "Event.note",
"identity": "workflow"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.disposition",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.disposition"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurer",
"requirements": "Need to identify the author.",
"min": 1,
"definition": "The Insurer who issued the coverage in question and is the author of the response.",
"isModifier": false,
"short": "Coverage issuer",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-organization" ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurer",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.insurer"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance",
"requirements": "There must be at least one coverage for which eligibility is requested.",
"min": 0,
"definition": "Financial instruments for reimbursement for the health care products and services.",
"isModifier": false,
"short": "Patient insurance information",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "380;0"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Insurance"
} ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance",
"comment": "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.insurance"
},
"isSummary": false
}, {
"path": "CoverageEligibilityResponse.insurance.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.insurance.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.insurance.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored even if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.coverage",
"requirements": "Required to allow the adjudicator to locate the correct policy and history within their information system.",
"min": 1,
"definition": "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.",
"isModifier": false,
"short": "Insurance information",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.coverage",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.insurance.coverage"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.inforce",
"requirements": "Needed to convey the answer to the eligibility validation request.",
"min": 0,
"definition": "Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.",
"isModifier": false,
"short": "Coverage inforce indicator",
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.inforce",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.inforce"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.benefitPeriod",
"requirements": "Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.",
"min": 0,
"definition": "The term of the benefits documented in this response.",
"isModifier": false,
"short": "When the benefits are applicable",
"type": [ {
"code": "Period"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.benefitPeriod",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.benefitPeriod"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ces-1",
"human": "SHALL contain a category or a billcode but not both.",
"xpath": "exists(f:category) or exists(f:productOrService)",
"severity": "error",
"expression": "category.exists() xor productOrService.exists()"
}, {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item",
"min": 0,
"definition": "Benefits and optionally current balances, and authorization details by category or service.",
"isModifier": false,
"short": "Benefits and authorization details",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "340;120"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Items"
} ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item"
},
"isSummary": false
}, {
"path": "CoverageEligibilityResponse.insurance.item.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.insurance.item.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.insurance.item.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored even if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.category",
"requirements": "Needed to convey the category of service or product for which eligibility is sought.",
"min": 0,
"definition": "Code to identify the general type of benefits under which products and services are provided.",
"isModifier": false,
"short": "Benefit classification",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision etc."
},
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.category",
"comment": "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.category"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.productOrService",
"requirements": "Needed to convey the actual service or product for which eligibility is sought.",
"min": 0,
"definition": "This contains the product, service, drug or other billing code for the item.",
"isModifier": false,
"short": "Billing, service, product, or drug code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"alias": [ "Drug Code", "Bill Code", "Service Code" ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.productOrService",
"comment": "Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI).",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.productOrService"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.modifier",
"requirements": "To support provision of the item or to charge an elevated fee.",
"min": 0,
"definition": "Item typification or modifiers codes to convey additional context for the product or service.",
"isModifier": false,
"short": "Product or service billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.modifier",
"comment": "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.modifier"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.provider",
"requirements": "Needed to convey the eligible provider.",
"min": 0,
"definition": "The practitioner who is eligible for the provision of the product or service.",
"isModifier": false,
"short": "Performing practitioner",
"mapping": [ {
"map": "FiveWs.source",
"identity": "w5"
}, {
"map": "B01",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner", "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner-role" ]
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.provider",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.provider"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.excluded",
"requirements": "Needed to identify items that are specifically excluded from the coverage.",
"min": 0,
"definition": "True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.",
"isModifier": false,
"short": "Excluded from the plan",
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.excluded",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.excluded"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.name",
"requirements": "Required to align with other plan names.",
"min": 0,
"definition": "A short name or tag for the benefit.",
"isModifier": false,
"short": "Short name for the benefit",
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.name",
"comment": "For example: MED01, or DENT2.",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.name"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.description",
"requirements": "Needed for human readable reference.",
"min": 0,
"definition": "A richer description of the benefit or services covered.",
"isModifier": false,
"short": "Description of the benefit or services covered",
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.description",
"comment": "For example 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.description"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.network",
"requirements": "Needed as in or out of network providers are treated differently under the coverage.",
"min": 0,
"definition": "Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.",
"isModifier": false,
"short": "In or out of network",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-network",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitNetwork"
} ],
"description": "Code to classify in or out of network services."
},
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.network",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.network"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.unit",
"requirements": "Needed for the understanding of the benefits.",
"min": 0,
"definition": "Indicates if the benefits apply to an individual or to the family.",
"isModifier": false,
"short": "Individual or family",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-unit",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitUnit"
} ],
"description": "Unit covered/serviced - individual or family."
},
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.unit",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.unit"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.term",
"requirements": "Needed for the understanding of the benefits.",
"min": 0,
"definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.",
"isModifier": false,
"short": "Annual or lifetime",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-term",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitTerm"
} ],
"description": "Coverage unit - annual, lifetime."
},
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.term",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.term"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.benefit",
"min": 0,
"definition": "Benefits used to date.",
"isModifier": false,
"short": "Benefit Summary",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "340;320"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefit"
} ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.benefit",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.benefit"
},
"isSummary": false
}, {
"path": "CoverageEligibilityResponse.insurance.item.benefit.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.benefit.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.insurance.item.benefit.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.benefit.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.insurance.item.benefit.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored even if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.benefit.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.benefit.type",
"requirements": "Needed to convey the nature of the benefit.",
"min": 1,
"definition": "Classification of benefit being provided.",
"isModifier": false,
"short": "Benefit classification",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitType"
} ],
"description": "Deductable, visits, co-pay, etc."
},
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.benefit.type",
"comment": "For example: deductible, visits, benefit amount.",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.insurance.item.benefit.type"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.benefit.allowed[x]",
"requirements": "Needed to convey the benefits offered under the coverage.",
"min": 0,
"definition": "The quantity of the benefit which is permitted under the coverage.",
"isModifier": false,
"short": "Benefits allowed",
"type": [ {
"code": "unsignedInt"
}, {
"code": "string"
}, {
"code": "Money"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.benefit.allowed[x]",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.benefit.allowed[x]"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.benefit.used[x]",
"requirements": "Needed to convey the benefits consumed to date.",
"min": 0,
"definition": "The quantity of the benefit which have been consumed to date.",
"isModifier": false,
"short": "Benefits used",
"type": [ {
"code": "unsignedInt"
}, {
"code": "string"
}, {
"code": "Money"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.benefit.used[x]",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.benefit.used[x]"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.authorizationRequired",
"requirements": "Needed to convey that preauthorization is required.",
"min": 0,
"definition": "A boolean flag indicating whether a preauthorization is required prior to actual service delivery.",
"isModifier": false,
"short": "Authorization required flag",
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.authorizationRequired",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.authorizationRequired"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.authorizationSupporting",
"requirements": "Needed to inform the provider of collateral materials or actions needed for preauthorization.",
"min": 0,
"definition": "Codes or comments regarding information or actions associated with the preauthorization.",
"isModifier": false,
"short": "Type of required supporting materials",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AuthSupporting"
} ],
"description": "Type of supporting information to provide with a preauthorization."
},
"max": "*",
"id": "CoverageEligibilityResponse.insurance.item.authorizationSupporting",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.authorizationSupporting"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.insurance.item.authorizationUrl",
"requirements": "Needed to enable insurers to advise providers of informative information.",
"min": 0,
"definition": "A web location for obtaining requirements or descriptive information regarding the preauthorization.",
"isModifier": false,
"short": "Preauthorization requirements endpoint",
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.insurance.item.authorizationUrl",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.insurance.item.authorizationUrl"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.preAuthRef",
"requirements": "To provide any preauthorization reference for provider use.",
"min": 0,
"definition": "A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.",
"isModifier": false,
"short": "Preauthorization reference",
"mapping": [ {
"map": "F03",
"identity": "cdanetv4"
}, {
"map": "23",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "CoverageEligibilityResponse.preAuthRef",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.preAuthRef"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.form",
"requirements": "Needed to specify the specific form used for producing output for this response.",
"min": 0,
"definition": "A code for the form to be used for printing the content.",
"isModifier": false,
"short": "Printed form identifier",
"mapping": [ {
"map": "G42",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/forms",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The forms codes."
},
"max": "1",
"id": "CoverageEligibilityResponse.form",
"comment": "May be needed to identify specific jurisdictional forms.",
"base": {
"max": "1",
"min": 0,
"path": "CoverageEligibilityResponse.form"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.error",
"requirements": "Need to communicate processing issues to the requestor.",
"min": 0,
"definition": "Errors encountered during the processing of the request.",
"isModifier": false,
"short": "Processing errors",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Errors"
} ],
"max": "*",
"id": "CoverageEligibilityResponse.error",
"base": {
"max": "*",
"min": 0,
"path": "CoverageEligibilityResponse.error"
},
"isSummary": false
}, {
"path": "CoverageEligibilityResponse.error.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "CoverageEligibilityResponse.error.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.error.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "CoverageEligibilityResponse.error.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "CoverageEligibilityResponse.error.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored even if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "CoverageEligibilityResponse.error.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "CoverageEligibilityResponse.error.code",
"requirements": "Required to convey processing errors.",
"min": 1,
"definition": "An error code,from a specified code system, which details why the eligibility check could not be performed.",
"isModifier": false,
"short": "Error code detailing processing issues",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication-error",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationError"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The error codes for adjudication processing."
},
"max": "1",
"id": "CoverageEligibilityResponse.error.code",
"base": {
"max": "1",
"min": 1,
"path": "CoverageEligibilityResponse.error.code"
},
"isSummary": false
} ]
},
"status": "draft",
"id": "82c7441a-cfd0-4b14-901d-9702544ebf1d",
"kind": "resource",
"url": "http://fhir.health.gov.il/StructureDefinition/il-core-coverage-eligibility-response",
"version": "0.15.1",
"differential": {
"element": [ {
"id": "CoverageEligibilityResponse",
"path": "CoverageEligibilityResponse",
"short": "ILCore CoverageEligibilityResponse Profile",
"definition": "Israel Core proposed constraints and extensions on the CoverageEligibilityResponse resource profile."
}, {
"id": "CoverageEligibilityResponse.patient",
"path": "CoverageEligibilityResponse.patient",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-patient" ]
} ]
}, {
"id": "CoverageEligibilityResponse.requestor",
"path": "CoverageEligibilityResponse.requestor",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner", "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner-role", "http://fhir.health.gov.il/StructureDefinition/il-core-organization" ]
} ]
}, {
"id": "CoverageEligibilityResponse.request",
"path": "CoverageEligibilityResponse.request",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-coverage-eligibility-request" ]
} ]
}, {
"id": "CoverageEligibilityResponse.insurer",
"path": "CoverageEligibilityResponse.insurer",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-organization" ]
} ]
}, {
"id": "CoverageEligibilityResponse.insurance.item.provider",
"path": "CoverageEligibilityResponse.insurance.item.provider",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner", "http://fhir.health.gov.il/StructureDefinition/il-core-practitioner-role" ]
} ]
} ]
},
"contact": [ {
"telecom": [ {
"value": "tal.primak@moh.gov.il",
"system": "email"
} ]
} ],
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse"
}