Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build

Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: MOPEDCoverageEligibilityResponse

Official URL: http://example.org/StructureDefinition/MOPEDCoverageEligibilityResponse Version: 0.1.0
Draft as of 2024-11-12 ​ Responsible: Example Publisher Computable Name: MOPEDCoverageEligibilityResponse

MOPED Profil der CoverageEligibilityResponse Ressource für die Versichertenanspruchserklärung-Antwort.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CoverageEligibilityResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse CoverageEligibilityResponse resource
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... fristende 0..1 boolean "Fristende"
URL: http://example.org/StructureDefinition/moped-ext-fristende
.... vaeStatus 0..1 Coding "VAEST - Status der Versichertenanspruchserklärung"
URL: http://example.org/StructureDefinition/moped-ext-vaestatus
Binding: http://tbd.at/MOPED-VAEStatus (required)
.... verpflegskostenBeitragsbefreiung 0..1 Coding "VKBEFR – Verpflegskosten-Beitragsbefreiung"
URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Binding: http://tbd.at/MOPED-Verpflegskosten-Beitragsbefreiung (required)
.... vortageanzahlAufKostenbeitrag 0..1 unsignedInt "Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage.
URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
... patient 1..1 Reference(HL7® AT Core Patient Profile) Intended recipient of products and services
... insurance
.... coverage 1..1 Reference(MOPEDCoverage) Insurance information

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse CoverageEligibilityResponse resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... fristende 0..1 boolean "Fristende"
URL: http://example.org/StructureDefinition/moped-ext-fristende
.... vaeStatus 0..1 Coding "VAEST - Status der Versichertenanspruchserklärung"
URL: http://example.org/StructureDefinition/moped-ext-vaestatus
Binding: http://tbd.at/MOPED-VAEStatus (required)
.... verpflegskostenBeitragsbefreiung 0..1 Coding "VKBEFR – Verpflegskosten-Beitragsbefreiung"
URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Binding: http://tbd.at/MOPED-Verpflegskosten-Beitragsbefreiung (required)
.... vortageanzahlAufKostenbeitrag 0..1 unsignedInt "Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage.
URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... purpose Σ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.


... patient Σ 1..1 Reference(HL7® AT Core Patient Profile) Intended recipient of products and services
... created Σ 1..1 dateTime Response creation date
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: EligibilityOutcome (required): The outcome of the processing.

... insurer Σ 1..1 Reference(Organization) Coverage issuer

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityResponse.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.purposerequiredEligibilityResponsePurpose
http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.outcomerequiredEligibilityOutcome
http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageEligibilityResponseIf 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-5errorCoverageEligibilityResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageEligibilityResponseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse CoverageEligibilityResponse resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... fristende 0..1 boolean "Fristende"
URL: http://example.org/StructureDefinition/moped-ext-fristende
.... vaeStatus 0..1 Coding "VAEST - Status der Versichertenanspruchserklärung"
URL: http://example.org/StructureDefinition/moped-ext-vaestatus
Binding: http://tbd.at/MOPED-VAEStatus (required)
.... verpflegskostenBeitragsbefreiung 0..1 Coding "VKBEFR – Verpflegskosten-Beitragsbefreiung"
URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Binding: http://tbd.at/MOPED-Verpflegskosten-Beitragsbefreiung (required)
.... vortageanzahlAufKostenbeitrag 0..1 unsignedInt "Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage.
URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for coverage eligiblity request
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... purpose Σ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.


... patient Σ 1..1 Reference(HL7® AT Core Patient Profile) Intended recipient of products and services
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... serviced[x] 0..1 Estimated date or dates of service
.... servicedDate date
.... servicedPeriod Period
... created Σ 1..1 dateTime Response creation date
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: EligibilityOutcome (required): The outcome of the processing.

... disposition 0..1 string Disposition Message
... insurer Σ 1..1 Reference(Organization) Coverage issuer
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage Σ 1..1 Reference(MOPEDCoverage) Insurance information
.... inforce 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item C 0..* BackboneElement Benefits and authorization details
ces-1: SHALL contain a category or a billcode but not both.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category C 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.

..... productOrService C 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... provider 0..1 Reference(Practitioner | PractitionerRole) Performing practitioner
..... excluded 0..1 boolean Excluded from the plan
..... name 0..1 string Short name for the benefit
..... description 0..1 string Description of the benefit or services covered
..... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.

..... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.

..... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.

..... benefit 0..* BackboneElement Benefit Summary
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.

...... allowed[x] 0..1 Benefits allowed
....... allowedUnsignedInt unsignedInt
....... allowedString string
....... allowedMoney Money
...... used[x] 0..1 Benefits used
....... usedUnsignedInt unsignedInt
....... usedString string
....... usedMoney Money
..... authorizationRequired 0..1 boolean Authorization required flag
..... authorizationSupporting 0..* CodeableConcept Type of required supporting materials
Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.


..... authorizationUrl 0..1 uri Preauthorization requirements endpoint
... preAuthRef 0..1 string Preauthorization reference
... form 0..1 CodeableConcept Printed form identifier
Binding: FormCodes (example): The forms codes.

... error 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Error code detailing processing issues
Binding: AdjudicationErrorCodes (example): The error codes for adjudication processing.

.... expression Σ 0..* string FHIRPath of element(s) related to issue

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityResponse.languagerequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.purposerequiredEligibilityResponsePurpose
http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.event.typeexampleDatesTypeCodes
http://hl7.org/fhir/ValueSet/datestype
from the FHIR Standard
CoverageEligibilityResponse.outcomerequiredEligibilityOutcome
http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.networkexampleNetworkTypeCodes
http://hl7.org/fhir/ValueSet/benefit-network
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unitexampleUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.termexampleBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.typeexampleBenefitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-type
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.authorizationSupportingexampleCoverageEligibilityResponseAuthSupportCodes
http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support
from the FHIR Standard
CoverageEligibilityResponse.formexampleFormCodes
http://hl7.org/fhir/ValueSet/forms
from the FHIR Standard
CoverageEligibilityResponse.error.codeexampleAdjudicationErrorCodes
http://hl7.org/fhir/ValueSet/adjudication-error
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ces-1errorCoverageEligibilityResponse.insurance.itemSHALL contain a category or a billcode but not both.
: category.exists() xor productOrService.exists()
dom-2errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageEligibilityResponseIf 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-5errorCoverageEligibilityResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageEligibilityResponseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from CoverageEligibilityResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse CoverageEligibilityResponse resource
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... fristende 0..1 boolean "Fristende"
URL: http://example.org/StructureDefinition/moped-ext-fristende
.... vaeStatus 0..1 Coding "VAEST - Status der Versichertenanspruchserklärung"
URL: http://example.org/StructureDefinition/moped-ext-vaestatus
Binding: http://tbd.at/MOPED-VAEStatus (required)
.... verpflegskostenBeitragsbefreiung 0..1 Coding "VKBEFR – Verpflegskosten-Beitragsbefreiung"
URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Binding: http://tbd.at/MOPED-Verpflegskosten-Beitragsbefreiung (required)
.... vortageanzahlAufKostenbeitrag 0..1 unsignedInt "Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage.
URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
... patient 1..1 Reference(HL7® AT Core Patient Profile) Intended recipient of products and services
... insurance
.... coverage 1..1 Reference(MOPEDCoverage) Insurance information

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse CoverageEligibilityResponse resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... fristende 0..1 boolean "Fristende"
URL: http://example.org/StructureDefinition/moped-ext-fristende
.... vaeStatus 0..1 Coding "VAEST - Status der Versichertenanspruchserklärung"
URL: http://example.org/StructureDefinition/moped-ext-vaestatus
Binding: http://tbd.at/MOPED-VAEStatus (required)
.... verpflegskostenBeitragsbefreiung 0..1 Coding "VKBEFR – Verpflegskosten-Beitragsbefreiung"
URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Binding: http://tbd.at/MOPED-Verpflegskosten-Beitragsbefreiung (required)
.... vortageanzahlAufKostenbeitrag 0..1 unsignedInt "Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage.
URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... purpose Σ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.


... patient Σ 1..1 Reference(HL7® AT Core Patient Profile) Intended recipient of products and services
... created Σ 1..1 dateTime Response creation date
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: EligibilityOutcome (required): The outcome of the processing.

... insurer Σ 1..1 Reference(Organization) Coverage issuer

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityResponse.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.purposerequiredEligibilityResponsePurpose
http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.outcomerequiredEligibilityOutcome
http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageEligibilityResponseIf 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-5errorCoverageEligibilityResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageEligibilityResponseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse CoverageEligibilityResponse resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... fristende 0..1 boolean "Fristende"
URL: http://example.org/StructureDefinition/moped-ext-fristende
.... vaeStatus 0..1 Coding "VAEST - Status der Versichertenanspruchserklärung"
URL: http://example.org/StructureDefinition/moped-ext-vaestatus
Binding: http://tbd.at/MOPED-VAEStatus (required)
.... verpflegskostenBeitragsbefreiung 0..1 Coding "VKBEFR – Verpflegskosten-Beitragsbefreiung"
URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Binding: http://tbd.at/MOPED-Verpflegskosten-Beitragsbefreiung (required)
.... vortageanzahlAufKostenbeitrag 0..1 unsignedInt "Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage.
URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for coverage eligiblity request
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... purpose Σ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.


... patient Σ 1..1 Reference(HL7® AT Core Patient Profile) Intended recipient of products and services
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... serviced[x] 0..1 Estimated date or dates of service
.... servicedDate date
.... servicedPeriod Period
... created Σ 1..1 dateTime Response creation date
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: EligibilityOutcome (required): The outcome of the processing.

... disposition 0..1 string Disposition Message
... insurer Σ 1..1 Reference(Organization) Coverage issuer
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage Σ 1..1 Reference(MOPEDCoverage) Insurance information
.... inforce 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item C 0..* BackboneElement Benefits and authorization details
ces-1: SHALL contain a category or a billcode but not both.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category C 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.

..... productOrService C 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... provider 0..1 Reference(Practitioner | PractitionerRole) Performing practitioner
..... excluded 0..1 boolean Excluded from the plan
..... name 0..1 string Short name for the benefit
..... description 0..1 string Description of the benefit or services covered
..... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.

..... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.

..... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.

..... benefit 0..* BackboneElement Benefit Summary
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.

...... allowed[x] 0..1 Benefits allowed
....... allowedUnsignedInt unsignedInt
....... allowedString string
....... allowedMoney Money
...... used[x] 0..1 Benefits used
....... usedUnsignedInt unsignedInt
....... usedString string
....... usedMoney Money
..... authorizationRequired 0..1 boolean Authorization required flag
..... authorizationSupporting 0..* CodeableConcept Type of required supporting materials
Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.


..... authorizationUrl 0..1 uri Preauthorization requirements endpoint
... preAuthRef 0..1 string Preauthorization reference
... form 0..1 CodeableConcept Printed form identifier
Binding: FormCodes (example): The forms codes.

... error 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Error code detailing processing issues
Binding: AdjudicationErrorCodes (example): The error codes for adjudication processing.

.... expression Σ 0..* string FHIRPath of element(s) related to issue

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityResponse.languagerequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.purposerequiredEligibilityResponsePurpose
http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.event.typeexampleDatesTypeCodes
http://hl7.org/fhir/ValueSet/datestype
from the FHIR Standard
CoverageEligibilityResponse.outcomerequiredEligibilityOutcome
http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.networkexampleNetworkTypeCodes
http://hl7.org/fhir/ValueSet/benefit-network
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unitexampleUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.termexampleBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.typeexampleBenefitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-type
from the FHIR Standard
CoverageEligibilityResponse.insurance.item.authorizationSupportingexampleCoverageEligibilityResponseAuthSupportCodes
http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support
from the FHIR Standard
CoverageEligibilityResponse.formexampleFormCodes
http://hl7.org/fhir/ValueSet/forms
from the FHIR Standard
CoverageEligibilityResponse.error.codeexampleAdjudicationErrorCodes
http://hl7.org/fhir/ValueSet/adjudication-error
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ces-1errorCoverageEligibilityResponse.insurance.itemSHALL contain a category or a billcode but not both.
: category.exists() xor productOrService.exists()
dom-2errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageEligibilityResponseIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageEligibilityResponseIf 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-5errorCoverageEligibilityResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageEligibilityResponseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

 

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