Universal API Implementation Guide
1.1.20 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Official URL: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request | Version: 1.1.20 | |||
Active as of 2020-12-11 | Computable Name: UapiCoverageEligibilityRequest |
This profile constrains the CoverageEligibilityRequest resource to be used in sharing service request results in UAPI
Usages:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |
![]() ![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | UAPI CoverageEligibilityRequest ServiceRequestType URL: https://fhir.developer.gene.com/StructureDefinition/SRType Binding: UAPI Value Set - Service Request Type (required) | |
![]() ![]() ![]() ![]() |
1..* | CodeableConcept | UAPI CoverageEligibilityRequest Product URL: https://fhir.developer.gene.com/StructureDefinition/Product Binding: UAPI Value Set - Product Name (required) | |
![]() ![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Intended recipient of products and services |
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Organization) | Coverage issuer |
![]() |
Path | Conformance | ValueSet | URI |
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard | |
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.3.0 From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | CoverageEligibilityRequest | 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | CoverageEligibilityRequest | 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 | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from CoverageEligibilityRequest
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
CoverageEligibilityRequest | |||
![]() ![]() ![]() |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | UAPI CoverageEligibilityRequest ServiceRequestType URL: https://fhir.developer.gene.com/StructureDefinition/SRType Binding: UAPI Value Set - Service Request Type (required) | |
![]() ![]() ![]() ![]() |
1..* | CodeableConcept | UAPI CoverageEligibilityRequest Product URL: https://fhir.developer.gene.com/StructureDefinition/Product Binding: UAPI Value Set - Product Name (required) | |
![]() |
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |||||
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): IETF language tag
| |||||
![]() ![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
![]() ![]() ![]() |
0..* | Resource | Contained, inline Resources Constraints: dom-r4b | |||||
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1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
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0..1 | CodeableConcept | UAPI CoverageEligibilityRequest ServiceRequestType URL: https://fhir.developer.gene.com/StructureDefinition/SRType Binding: UAPI Value Set - Service Request Type (required) | |||||
![]() ![]() ![]() ![]() |
1..* | CodeableConcept | UAPI CoverageEligibilityRequest Product URL: https://fhir.developer.gene.com/StructureDefinition/Product Binding: UAPI Value Set - Product Name (required) | |||||
![]() ![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() |
0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
![]() ![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. | ||||
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Intended recipient of products and services | ||||
![]() ![]() ![]() |
0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() ![]() |
Period | |||||||
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Creation date | ||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Author | |||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |||||
![]() ![]() ![]() |
Σ | 1..1 | Reference(Organization) | Coverage issuer | ||||
![]() ![]() ![]() |
0..1 | Reference(Location) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() |
1..1 | Reference(Resource) | Data to be provided | |||||
![]() ![]() ![]() ![]() |
0..1 | boolean | Applies to all items | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | boolean | Applicable coverage | |||||
![]() ![]() ![]() ![]() |
1..1 | Reference(Coverage) | Insurance information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable exception or supporting information | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Perfoming practitioner | |||||
![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() |
0..1 | Reference(Location | Organization) | Servicing facility | |||||
![]() ![]() ![]() ![]() |
0..* | BackboneElement | Applicable diagnosis | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() ![]() |
0..* | Reference(Resource) | Product or service details | |||||
![]() |
Path | Conformance | ValueSet | URI | |||
CoverageEligibilityRequest.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languages From the FHIR Standard
| ||||
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard | ||||
CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard | ||||
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.3.0 From the FHIR Standard | ||||
CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard | ||||
CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | ||||
CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard | ||||
CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | CoverageEligibilityRequest | 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | CoverageEligibilityRequest | 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 | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management : text.`div`.exists() | |
dom-r4b | warning | CoverageEligibilityRequest.contained | Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems : ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic) | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from CoverageEligibilityRequest
Key Elements View
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |
![]() ![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | UAPI CoverageEligibilityRequest ServiceRequestType URL: https://fhir.developer.gene.com/StructureDefinition/SRType Binding: UAPI Value Set - Service Request Type (required) | |
![]() ![]() ![]() ![]() |
1..* | CodeableConcept | UAPI CoverageEligibilityRequest Product URL: https://fhir.developer.gene.com/StructureDefinition/Product Binding: UAPI Value Set - Product Name (required) | |
![]() ![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Intended recipient of products and services |
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Organization) | Coverage issuer |
![]() |
Path | Conformance | ValueSet | URI |
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard | |
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.3.0 From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | CoverageEligibilityRequest | 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | CoverageEligibilityRequest | 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 | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Differential View
This structure is derived from CoverageEligibilityRequest
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
CoverageEligibilityRequest | |||
![]() ![]() ![]() |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | UAPI CoverageEligibilityRequest ServiceRequestType URL: https://fhir.developer.gene.com/StructureDefinition/SRType Binding: UAPI Value Set - Service Request Type (required) | |
![]() ![]() ![]() ![]() |
1..* | CodeableConcept | UAPI CoverageEligibilityRequest Product URL: https://fhir.developer.gene.com/StructureDefinition/Product Binding: UAPI Value Set - Product Name (required) | |
![]() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |||||
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): IETF language tag
| |||||
![]() ![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
![]() ![]() ![]() |
0..* | Resource | Contained, inline Resources Constraints: dom-r4b | |||||
![]() ![]() ![]() |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | UAPI CoverageEligibilityRequest ServiceRequestType URL: https://fhir.developer.gene.com/StructureDefinition/SRType Binding: UAPI Value Set - Service Request Type (required) | |||||
![]() ![]() ![]() ![]() |
1..* | CodeableConcept | UAPI CoverageEligibilityRequest Product URL: https://fhir.developer.gene.com/StructureDefinition/Product Binding: UAPI Value Set - Product Name (required) | |||||
![]() ![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() |
0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
![]() ![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. | ||||
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Intended recipient of products and services | ||||
![]() ![]() ![]() |
0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() ![]() |
Period | |||||||
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Creation date | ||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Author | |||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |||||
![]() ![]() ![]() |
Σ | 1..1 | Reference(Organization) | Coverage issuer | ||||
![]() ![]() ![]() |
0..1 | Reference(Location) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() |
1..1 | Reference(Resource) | Data to be provided | |||||
![]() ![]() ![]() ![]() |
0..1 | boolean | Applies to all items | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | boolean | Applicable coverage | |||||
![]() ![]() ![]() ![]() |
1..1 | Reference(Coverage) | Insurance information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable exception or supporting information | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Perfoming practitioner | |||||
![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() |
0..1 | Reference(Location | Organization) | Servicing facility | |||||
![]() ![]() ![]() ![]() |
0..* | BackboneElement | Applicable diagnosis | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() ![]() |
0..* | Reference(Resource) | Product or service details | |||||
![]() |
Path | Conformance | ValueSet | URI | |||
CoverageEligibilityRequest.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languages From the FHIR Standard
| ||||
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.3.0 From the FHIR Standard | ||||
CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard | ||||
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.3.0 From the FHIR Standard | ||||
CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard | ||||
CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | ||||
CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard | ||||
CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | CoverageEligibilityRequest | 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | CoverageEligibilityRequest | 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 | CoverageEligibilityRequest | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | CoverageEligibilityRequest | A resource should have narrative for robust management : text.`div`.exists() | |
dom-r4b | warning | CoverageEligibilityRequest.contained | Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems : ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic) | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from CoverageEligibilityRequest
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