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

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Resource Profile: MOPED Coverage Eligibility Request

MOPED Profil der CoverageEligibilityRequest Ressource für die Versichertenanspruchserklärung-Anfrage.

Usage:

• Refer to this Resource Profile: CoverageEligibilityRequest Referenz
• Examples for this Resource Profile: CoverageEligibilityRequest/Test1MOPEDCoverageEligibilityRequest1 and CoverageEligibilityRequest/Test2MOPEDCoverageEligibilityRequest1

Formal Views of Profile Content

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

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from CoverageEligibilityRequest

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
verlaengerungstage		0..1	unsignedInt	Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-verlaengerungstage
sonderklasse		0..1	Coding	KLAS: Allgemeine Gebuehrenklasse bzw. Sonderklasse URL: http://example.org/StructureDefinition/moped-ext-sonderklasse Binding: Sonderklasse ValueSet (required)
patient		1..1	Reference(HL7® AT Core Patient Profile)	Intended recipient of products and services
provider		0..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the request
insurance
coverage		1..1	Reference(MOPED Coverage)	Insurance information
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
verlaengerungstage		0..1	unsignedInt	Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-verlaengerungstage ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sonderklasse		0..1	Coding	KLAS: Allgemeine Gebuehrenklasse bzw. Sonderklasse URL: http://example.org/StructureDefinition/moped-ext-sonderklasse Binding: Sonderklasse ValueSet (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	Intended recipient of products and services ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	dateTime	Creation date ele-1: All FHIR elements must have a @value or children
provider		0..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the request ele-1: All FHIR elements must have a @value or children
insurer	Σ	1..1	Reference(Organization)	Coverage issuer ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest 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
language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
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
verlaengerungstage		0..1	unsignedInt	Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-verlaengerungstage
sonderklasse		0..1	Coding	KLAS: Allgemeine Gebuehrenklasse bzw. Sonderklasse URL: http://example.org/StructureDefinition/moped-ext-sonderklasse Binding: Sonderklasse ValueSet (required)
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.
priority		0..1	CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred.
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (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	Creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		0..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the request
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
facility		0..1	Reference(Location)	Servicing facility
supportingInfo		0..*	BackboneElement	Supporting 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
sequence		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items
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
focal		0..1	boolean	Applicable coverage
coverage		1..1	Reference(MOPED Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity
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
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService		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)	Perfoming practitioner
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis
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
diagnosis[x]		0..1		Nature of illness or problem Binding: ICD10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
detail		0..*	Reference(Resource)	Product or service details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from CoverageEligibilityRequest

Summary

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)
• HL7® AT Core Organization Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-organization)
• MOPED Coverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/moped-ext-verlaengerungstage
• http://example.org/StructureDefinition/moped-ext-sonderklasse

Differential View

This structure is derived from CoverageEligibilityRequest

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
verlaengerungstage		0..1	unsignedInt	Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-verlaengerungstage
sonderklasse		0..1	Coding	KLAS: Allgemeine Gebuehrenklasse bzw. Sonderklasse URL: http://example.org/StructureDefinition/moped-ext-sonderklasse Binding: Sonderklasse ValueSet (required)
patient		1..1	Reference(HL7® AT Core Patient Profile)	Intended recipient of products and services
provider		0..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the request
insurance
coverage		1..1	Reference(MOPED Coverage)	Insurance information
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
verlaengerungstage		0..1	unsignedInt	Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-verlaengerungstage ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sonderklasse		0..1	Coding	KLAS: Allgemeine Gebuehrenklasse bzw. Sonderklasse URL: http://example.org/StructureDefinition/moped-ext-sonderklasse Binding: Sonderklasse ValueSet (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	Intended recipient of products and services ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	dateTime	Creation date ele-1: All FHIR elements must have a @value or children
provider		0..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the request ele-1: All FHIR elements must have a @value or children
insurer	Σ	1..1	Reference(Organization)	Coverage issuer ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest 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
language		0..1	code	Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
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
verlaengerungstage		0..1	unsignedInt	Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-verlaengerungstage
sonderklasse		0..1	Coding	KLAS: Allgemeine Gebuehrenklasse bzw. Sonderklasse URL: http://example.org/StructureDefinition/moped-ext-sonderklasse Binding: Sonderklasse ValueSet (required)
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.
priority		0..1	CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred.
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (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	Creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		0..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the request
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
facility		0..1	Reference(Location)	Servicing facility
supportingInfo		0..*	BackboneElement	Supporting 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
sequence		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items
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
focal		0..1	boolean	Applicable coverage
coverage		1..1	Reference(MOPED Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity
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
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService		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)	Perfoming practitioner
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis
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
diagnosis[x]		0..1		Nature of illness or problem Binding: ICD10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
detail		0..*	Reference(Resource)	Product or service details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0 from the FHIR Standard
CoverageEligibilityRequest.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from CoverageEligibilityRequest

Summary

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)
• HL7® AT Core Organization Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-organization)
• MOPED Coverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/moped-ext-verlaengerungstage
• http://example.org/StructureDefinition/moped-ext-sonderklasse

Other representations of profile: CSV, Excel, Schematron