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 - Detailed Descriptions

Draft as of 2024-10-29

Definitions for the MOPEDCoverageEligibilityResponse resource profile.

Guidance on how to interpret the contents of this table can be found here

0. CoverageEligibilityResponse
2. CoverageEligibilityResponse.extension
SlicingThis element introduces a set of slices on CoverageEligibilityResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. CoverageEligibilityResponse.extension:EndOfEligibility
    Slice NameEndOfEligibility
    Control0..1
    TypeExtension(EndOfEligibility) (Extension Type: boolean)
    6. CoverageEligibilityResponse.extension:VAEStatus
    Slice NameVAEStatus
    Control0..1
    TypeExtension(VAEStatus) (Extension Type: Coding)
    8. CoverageEligibilityResponse.extension:MealCostExcemption
    Slice NameMealCostExcemption
    Control0..1
    TypeExtension(MealCostExcemption) (Extension Type: Coding)
    10. CoverageEligibilityResponse.extension:NumberOfPreviouslyPaidDays
    Slice NameNumberOfPreviouslyPaidDays
    Control0..1
    TypeExtension(Vortageanzahl auf Kostenbeitrag) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta)
    12. CoverageEligibilityResponse.patient
    TypeReference(HL7® AT Core Patient Profile)
    14. CoverageEligibilityResponse.insurance
    16. CoverageEligibilityResponse.insurance.coverage
    TypeReference(SVCCoverage)

    Guidance on how to interpret the contents of this table can be found here

    0. CoverageEligibilityResponse
    Definition

    This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.

    ShortCoverageEligibilityResponse resource
    Control0..*
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    2. CoverageEligibilityResponse.implicitRules
    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.

    ShortA set of rules under which this content was created
    Comments

    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 its narrative along with other profiles, value sets, etc.

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. CoverageEligibilityResponse.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

    ShortContained, inline Resources
    Comments

    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.

    Control0..*
    This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
    TypeResource
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesinline resources, anonymous resources, contained resources
    6. CoverageEligibilityResponse.extension
    Definition

    An Extension


    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 managable, 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.

    ShortExtensionAdditional content defined by implementations
    Comments

    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.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on CoverageEligibilityResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 8. CoverageEligibilityResponse.extension:EndOfEligibility
      Slice NameEndOfEligibility
      Definition

      "Fristende"

      Short"Fristende"
      Control0..1
      TypeExtension(EndOfEligibility) (Extension Type: boolean)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      10. CoverageEligibilityResponse.extension:VAEStatus
      Slice NameVAEStatus
      Definition

      "VAEST - Status der Versichertenanspruchserklärung"

      Short"VAEST - Status der Versichertenanspruchserklärung"
      Control0..1
      TypeExtension(VAEStatus) (Extension Type: Coding)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      12. CoverageEligibilityResponse.extension:MealCostExcemption
      Slice NameMealCostExcemption
      Definition

      "VKBEFR – Verpflegskosten-Beitragsbefreiung"

      Short"VKBEFR – Verpflegskosten-Beitragsbefreiung"
      Control0..1
      TypeExtension(MealCostExcemption) (Extension Type: Coding)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      14. CoverageEligibilityResponse.extension:NumberOfPreviouslyPaidDays
      Slice NameNumberOfPreviouslyPaidDays
      Definition

      "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.

      Short"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.
      Control0..1
      TypeExtension(Vortageanzahl auf Kostenbeitrag) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. CoverageEligibilityResponse.modifierExtension
      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 managable, 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.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Must Supportfalse
      Summarytrue
      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.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. CoverageEligibilityResponse.status
      Definition

      The status of the resource instance.

      Shortactive | cancelled | draft | entered-in-error
      Comments

      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0
      (required to http://hl7.org/fhir/ValueSet/fm-status|5.0.0)

      A code specifying the state of the resource instance.

      Typecode
      Is Modifiertrue because 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      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'.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. CoverageEligibilityResponse.purpose
      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.

      Shortauth-requirements | benefits | discovery | validation
      Control1..*
      BindingThe codes SHALL be taken from EligibilityResponsePurposehttp://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0
      (required to http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0)

      A code specifying the types of information being requested.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      To indicate the processing actions requested.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. CoverageEligibilityResponse.patient
      Definition

      The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.

      ShortIntended recipient of products and services
      Control1..1
      TypeReference(HL7® AT Core Patient Profile, Patient)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Required to provide context and coverage validation.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. CoverageEligibilityResponse.created
      Definition

      The date this resource was created.

      ShortResponse creation date
      Control1..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      Need to record a timestamp for use by both the recipient and the issuer.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. CoverageEligibilityResponse.request
      Definition

      Reference to the original request resource.

      ShortEligibility request reference
      Control1..1
      TypeReference(CoverageEligibilityRequest)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Needed to allow the response to be linked to the request.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. CoverageEligibilityResponse.outcome
      Definition

      The outcome of the request processing.

      Shortqueued | complete | error | partial
      Comments

      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).

      Control1..1
      BindingThe codes SHALL be taken from EligibilityOutcomehttp://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0
      (required to http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0)

      The outcome of the processing.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      To advise the requestor of an overall processing outcome.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. CoverageEligibilityResponse.insurer
      Definition

      The Insurer who issued the coverage in question and is the author of the response.

      ShortCoverage issuer
      Control1..1
      TypeReference(Organization)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Need to identify the author.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. CoverageEligibilityResponse
      Definition

      This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.

      ShortCoverageEligibilityResponse resource
      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. CoverageEligibilityResponse.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      4. CoverageEligibilityResponse.meta
      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.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. CoverageEligibilityResponse.implicitRules
      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.

      ShortA set of rules under which this content was created
      Comments

      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 its narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. CoverageEligibilityResponse.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      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).

      Control0..1
      BindingThe codes SHALL be taken from AllLanguages
      (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

      IETF language tag for a human language

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. CoverageEligibilityResponse.text
      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.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have a 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.

      Control0..1
      This element is affected by the following invariants: dom-6
      TypeNarrative
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. CoverageEligibilityResponse.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

      ShortContained, inline Resources
      Comments

      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.

      Control0..*
      This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. CoverageEligibilityResponse.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on CoverageEligibilityResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. CoverageEligibilityResponse.extension:EndOfEligibility
        Slice NameEndOfEligibility
        Definition

        "Fristende"

        Short"Fristende"
        Control0..1
        TypeExtension(EndOfEligibility) (Extension Type: boolean)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. CoverageEligibilityResponse.extension:VAEStatus
        Slice NameVAEStatus
        Definition

        "VAEST - Status der Versichertenanspruchserklärung"

        Short"VAEST - Status der Versichertenanspruchserklärung"
        Control0..1
        TypeExtension(VAEStatus) (Extension Type: Coding)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. CoverageEligibilityResponse.extension:MealCostExcemption
        Slice NameMealCostExcemption
        Definition

        "VKBEFR – Verpflegskosten-Beitragsbefreiung"

        Short"VKBEFR – Verpflegskosten-Beitragsbefreiung"
        Control0..1
        TypeExtension(MealCostExcemption) (Extension Type: Coding)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        22. CoverageEligibilityResponse.extension:NumberOfPreviouslyPaidDays
        Slice NameNumberOfPreviouslyPaidDays
        Definition

        "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.

        Short"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.
        Control0..1
        TypeExtension(Vortageanzahl auf Kostenbeitrag) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        24. CoverageEligibilityResponse.modifierExtension
        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 managable, 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Must Supportfalse
        Summarytrue
        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.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        26. CoverageEligibilityResponse.identifier
        Definition

        A unique identifier assigned to this coverage eligiblity request.

        ShortBusiness Identifier for coverage eligiblity request
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Allows coverage eligibility requests to be distinguished and referenced.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. CoverageEligibilityResponse.status
        Definition

        The status of the resource instance.

        Shortactive | cancelled | draft | entered-in-error
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from FinancialResourceStatusCodes
        (required to http://hl7.org/fhir/ValueSet/fm-status|5.0.0)

        A code specifying the state of the resource instance.

        Typecode
        Is Modifiertrue because 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
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        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'.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. CoverageEligibilityResponse.purpose
        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.

        Shortauth-requirements | benefits | discovery | validation
        Control1..*
        BindingThe codes SHALL be taken from EligibilityResponsePurpose
        (required to http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0)

        A code specifying the types of information being requested.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        To indicate the processing actions requested.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. CoverageEligibilityResponse.patient
        Definition

        The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.

        ShortIntended recipient of products and services
        Control1..1
        TypeReference(HL7® AT Core Patient Profile)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Required to provide context and coverage validation.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. CoverageEligibilityResponse.event
        Definition

        Information code for an event with a corresponding date or period.

        ShortEvent information
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. CoverageEligibilityResponse.event.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        38. CoverageEligibilityResponse.event.extension
        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 managable, 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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        40. CoverageEligibilityResponse.event.modifierExtension
        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 managable, 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        42. CoverageEligibilityResponse.event.type
        Definition

        A coded event such as when a service is expected or a card printed.

        ShortSpecific event
        Control1..1
        BindingFor example codes, see DatesTypeCodes
        (example to http://hl7.org/fhir/ValueSet/datestype)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. CoverageEligibilityResponse.event.when[x]
        Definition

        A date or period in the past or future indicating when the event occurred or is expectd to occur.

        ShortOccurance date or period
        Control1..1
        TypeChoice of: dateTime, Period
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. CoverageEligibilityResponse.serviced[x]
        Definition

        The date or dates when the enclosed suite of services were performed or completed.

        ShortEstimated date or dates of service
        Control0..1
        TypeChoice of: date, Period
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Required to provide time context for the request.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. CoverageEligibilityResponse.created
        Definition

        The date this resource was created.

        ShortResponse creation date
        Control1..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Need to record a timestamp for use by both the recipient and the issuer.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. CoverageEligibilityResponse.requestor
        Definition

        The provider which is responsible for the request.

        ShortParty responsible for the request
        Comments

        This party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.

        Control0..1
        TypeReference(Practitioner, PractitionerRole, Organization)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. CoverageEligibilityResponse.request
        Definition

        Reference to the original request resource.

        ShortEligibility request reference
        Control1..1
        TypeReference(CoverageEligibilityRequest)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Needed to allow the response to be linked to the request.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. CoverageEligibilityResponse.outcome
        Definition

        The outcome of the request processing.

        Shortqueued | complete | error | partial
        Comments

        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).

        Control1..1
        BindingThe codes SHALL be taken from EligibilityOutcome
        (required to http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0)

        The outcome of the processing.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        To advise the requestor of an overall processing outcome.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. CoverageEligibilityResponse.disposition
        Definition

        A human readable description of the status of the adjudication.

        ShortDisposition Message
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Provided for user display.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. CoverageEligibilityResponse.insurer
        Definition

        The Insurer who issued the coverage in question and is the author of the response.

        ShortCoverage issuer
        Control1..1
        TypeReference(Organization)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Need to identify the author.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. CoverageEligibilityResponse.insurance
        Definition

        Financial instruments for reimbursement for the health care products and services.

        ShortPatient insurance information
        Comments

        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.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        There must be at least one coverage for which eligibility is requested.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. CoverageEligibilityResponse.insurance.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        64. CoverageEligibilityResponse.insurance.extension
        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 managable, 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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        66. CoverageEligibilityResponse.insurance.modifierExtension
        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 managable, 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        68. CoverageEligibilityResponse.insurance.coverage
        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.

        ShortInsurance information
        Control1..1
        TypeReference(SVCCoverage)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Required to allow the adjudicator to locate the correct policy and history within their information system.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. CoverageEligibilityResponse.insurance.inforce
        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.

        ShortCoverage inforce indicator
        Control0..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the answer to the eligibility validation request.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. CoverageEligibilityResponse.insurance.benefitPeriod
        Definition

        The term of the benefits documented in this response.

        ShortWhen the benefits are applicable
        Control0..1
        TypePeriod
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. CoverageEligibilityResponse.insurance.item
        Definition

        Benefits and optionally current balances, and authorization details by category or service.

        ShortBenefits and authorization details
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsces-1: SHALL contain a category or a billcode but not both. (category.exists() xor productOrService.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. CoverageEligibilityResponse.insurance.item.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        78. CoverageEligibilityResponse.insurance.item.extension
        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 managable, 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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        80. CoverageEligibilityResponse.insurance.item.modifierExtension
        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 managable, 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        82. CoverageEligibilityResponse.insurance.item.category
        Definition

        Code to identify the general type of benefits under which products and services are provided.

        ShortBenefit classification
        Comments

        Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

        Control0..1
        This element is affected by the following invariants: ces-1
        BindingFor example codes, see BenefitCategoryCodes
        (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

        Benefit categories such as: oral, medical, vision etc.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the category of service or product for which eligibility is sought.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        84. CoverageEligibilityResponse.insurance.item.productOrService
        Definition

        This contains the product, service, drug or other billing code for the item.

        ShortBilling, service, product, or drug code
        Comments

        Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI).

        Control0..1
        This element is affected by the following invariants: ces-1
        BindingFor example codes, see USCLSCodes
        (example to http://hl7.org/fhir/ValueSet/service-uscls)

        Allowable service and product codes.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the actual service or product for which eligibility is sought.

        Alternate NamesDrug Code, Bill Code, Service Code
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        86. CoverageEligibilityResponse.insurance.item.modifier
        Definition

        Item typification or modifiers codes to convey additional context for the product or service.

        ShortProduct or service billing modifiers
        Comments

        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.

        Control0..*
        BindingFor example codes, see ModifierTypeCodes
        (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

        Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        To support provision of the item or to charge an elevated fee.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. CoverageEligibilityResponse.insurance.item.provider
        Definition

        The practitioner who is eligible for the provision of the product or service.

        ShortPerforming practitioner
        Control0..1
        TypeReference(Practitioner, PractitionerRole)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the eligible provider.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        90. CoverageEligibilityResponse.insurance.item.excluded
        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.

        ShortExcluded from the plan
        Control0..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to identify items that are specifically excluded from the coverage.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        92. CoverageEligibilityResponse.insurance.item.name
        Definition

        A short name or tag for the benefit.

        ShortShort name for the benefit
        Comments

        For example: MED01, or DENT2.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Required to align with other plan names.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        94. CoverageEligibilityResponse.insurance.item.description
        Definition

        A richer description of the benefit or services covered.

        ShortDescription of the benefit or services covered
        Comments

        For example 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed for human readable reference.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        96. CoverageEligibilityResponse.insurance.item.network
        Definition

        Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.

        ShortIn or out of network
        Control0..1
        BindingFor example codes, see NetworkTypeCodes
        (example to http://hl7.org/fhir/ValueSet/benefit-network)

        Code to classify in or out of network services.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed as in or out of network providers are treated differently under the coverage.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        98. CoverageEligibilityResponse.insurance.item.unit
        Definition

        Indicates if the benefits apply to an individual or to the family.

        ShortIndividual or family
        Control0..1
        BindingFor example codes, see UnitTypeCodes
        (example to http://hl7.org/fhir/ValueSet/benefit-unit)

        Unit covered/serviced - individual or family.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed for the understanding of the benefits.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        100. CoverageEligibilityResponse.insurance.item.term
        Definition

        The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.

        ShortAnnual or lifetime
        Control0..1
        BindingFor example codes, see BenefitTermCodes
        (example to http://hl7.org/fhir/ValueSet/benefit-term)

        Coverage unit - annual, lifetime.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed for the understanding of the benefits.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        102. CoverageEligibilityResponse.insurance.item.benefit
        Definition

        Benefits used to date.

        ShortBenefit Summary
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        104. CoverageEligibilityResponse.insurance.item.benefit.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        106. CoverageEligibilityResponse.insurance.item.benefit.extension
        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 managable, 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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        108. CoverageEligibilityResponse.insurance.item.benefit.modifierExtension
        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 managable, 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        110. CoverageEligibilityResponse.insurance.item.benefit.type
        Definition

        Classification of benefit being provided.

        ShortBenefit classification
        Comments

        For example: deductible, visits, benefit amount.

        Control1..1
        BindingFor example codes, see BenefitTypeCodes
        (example to http://hl7.org/fhir/ValueSet/benefit-type)

        Deductable, visits, co-pay, etc.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the nature of the benefit.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        112. CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
        Definition

        The quantity of the benefit which is permitted under the coverage.

        ShortBenefits allowed
        Control0..1
        TypeChoice of: unsignedInt, string, Money
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the benefits offered under the coverage.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        114. CoverageEligibilityResponse.insurance.item.benefit.used[x]
        Definition

        The quantity of the benefit which have been consumed to date.

        ShortBenefits used
        Control0..1
        TypeChoice of: unsignedInt, string, Money
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey the benefits consumed to date.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        116. CoverageEligibilityResponse.insurance.item.authorizationRequired
        Definition

        A boolean flag indicating whether a preauthorization is required prior to actual service delivery.

        ShortAuthorization required flag
        Control0..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to convey that preauthorization is required.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        118. CoverageEligibilityResponse.insurance.item.authorizationSupporting
        Definition

        Codes or comments regarding information or actions associated with the preauthorization.

        ShortType of required supporting materials
        Control0..*
        BindingFor example codes, see CoverageEligibilityResponseAuthSupportCodes
        (example to http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support)

        Type of supporting information to provide with a preauthorization.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to inform the provider of collateral materials or actions needed for preauthorization.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        120. CoverageEligibilityResponse.insurance.item.authorizationUrl
        Definition

        A web location for obtaining requirements or descriptive information regarding the preauthorization.

        ShortPreauthorization requirements endpoint
        Control0..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to enable insurers to advise providers of informative information.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        122. CoverageEligibilityResponse.preAuthRef
        Definition

        A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.

        ShortPreauthorization reference
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        To provide any preauthorization reference for provider use.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        124. CoverageEligibilityResponse.form
        Definition

        A code for the form to be used for printing the content.

        ShortPrinted form identifier
        Comments

        May be needed to identify specific jurisdictional forms.

        Control0..1
        BindingFor example codes, see FormCodes
        (example to http://hl7.org/fhir/ValueSet/forms)

        The forms codes.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Needed to specify the specific form used for producing output for this response.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        126. CoverageEligibilityResponse.error
        Definition

        Errors encountered during the processing of the request.

        ShortProcessing errors
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Need to communicate processing issues to the requestor.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        128. CoverageEligibilityResponse.error.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        130. CoverageEligibilityResponse.error.extension
        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 managable, 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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        132. CoverageEligibilityResponse.error.modifierExtension
        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 managable, 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        134. CoverageEligibilityResponse.error.code
        Definition

        An error code,from a specified code system, which details why the eligibility check could not be performed.

        ShortError code detailing processing issues
        Control1..1
        BindingFor example codes, see AdjudicationErrorCodes
        (example to http://hl7.org/fhir/ValueSet/adjudication-error)

        The error codes for adjudication processing.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Required to convey processing errors.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        136. CoverageEligibilityResponse.error.expression
        Definition

        A simple subset of FHIRPath limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.

        ShortFHIRPath of element(s) related to issue
        Comments

        The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node.

        Control0..*
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))