Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build
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
| Official URL: http://example.org/StructureDefinition/MOPEDCoverageEligibilityRequest | Version: 0.1.0 | |||
| Draft as of 2024-09-12 | Responsible: Example Publisher | Computable Name: MOPEDCoverageEligibilityRequest | ||
MOPED Profil der CoverageEligibilityRequest Ressource für die Kostenübernahmeanfrage.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
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 | |
   VDASID |
0..1 | string | VDAS-ID - VersichertenDatenAbfrageService URL: http://example.org/StructureDefinition/moped-ext-vdasid | |
| ExtensionDays |
0..1 | unsignedInt | Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-extensionDays | |
 PremiumClass |
0..1 | code | "KLAS – Allgemeine Gebührenklasse/Sonderklasse" URL: http://example.org/StructureDefinition/moped-ext-PremiumClass Binding: http://tbd.at/MOPED-LKFAbrechnungsKnoten (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 | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| CoverageEligibilityRequest |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |
 implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| contained |
0..* | Resource | Contained, inline Resources | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| VDASID |
0..1 | string | VDAS-ID - VersichertenDatenAbfrageService URL: http://example.org/StructureDefinition/moped-ext-vdasid | |
| ExtensionDays |
0..1 | unsignedInt | Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-extensionDays | |
| PremiumClass |
0..1 | code | "KLAS – Allgemeine Gebührenklasse/Sonderklasse" URL: http://example.org/StructureDefinition/moped-ext-PremiumClass Binding: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required) | |
 modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| purpose |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: 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 |
| created |
Σ | 1..1 | dateTime | Creation date |
| provider |
0..1 | Reference(HL7® AT Core Organization Profile) | Party responsible for the request | |
| insurer |
Σ | 1..1 | Reference(Organization) | Coverage issuer |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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
| |||||
| 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 | |||||
| VDASID |
0..1 | string | VDAS-ID - VersichertenDatenAbfrageService URL: http://example.org/StructureDefinition/moped-ext-vdasid | |||||
| ExtensionDays |
0..1 | unsignedInt | Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-extensionDays | |||||
| PremiumClass |
0..1 | code | "KLAS – Allgemeine Gebührenklasse/Sonderklasse" URL: http://example.org/StructureDefinition/moped-ext-PremiumClass Binding: http://tbd.at/MOPED-LKFAbrechnungsKnoten (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(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 | ||||||||
| Path | Conformance | ValueSet | URI |
| CoverageEligibilityRequest.language | required | AllLanguageshttp://hl7.org/fhir/ValueSet/all-languages|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | |
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.event.type | example | DatesTypeCodeshttp://hl7.org/fhir/ValueSet/datestypefrom the FHIR Standard | |
| CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | |
| CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | |
| CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | |
| CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD10Codeshttp://hl7.org/fhir/ValueSet/icd-10from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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:
Extensions
This structure refers to these extensions:
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 | |
| VDASID |
0..1 | string | VDAS-ID - VersichertenDatenAbfrageService URL: http://example.org/StructureDefinition/moped-ext-vdasid | |
| ExtensionDays |
0..1 | unsignedInt | Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-extensionDays | |
| PremiumClass |
0..1 | code | "KLAS – Allgemeine Gebührenklasse/Sonderklasse" URL: http://example.org/StructureDefinition/moped-ext-PremiumClass Binding: http://tbd.at/MOPED-LKFAbrechnungsKnoten (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 | |
| Documentation for this format | ||||
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| CoverageEligibilityRequest |
0..* | CoverageEligibilityRequest | CoverageEligibilityRequest resource | |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| contained |
0..* | Resource | Contained, inline Resources | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| VDASID |
0..1 | string | VDAS-ID - VersichertenDatenAbfrageService URL: http://example.org/StructureDefinition/moped-ext-vdasid | |
| ExtensionDays |
0..1 | unsignedInt | Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-extensionDays | |
| PremiumClass |
0..1 | code | "KLAS – Allgemeine Gebührenklasse/Sonderklasse" URL: http://example.org/StructureDefinition/moped-ext-PremiumClass Binding: http://tbd.at/MOPED-LKFAbrechnungsKnoten (required) | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| purpose |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: 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 |
| created |
Σ | 1..1 | dateTime | Creation date |
| provider |
0..1 | Reference(HL7® AT Core Organization Profile) | Party responsible for the request | |
| insurer |
Σ | 1..1 | Reference(Organization) | Coverage issuer |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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
| |||||
| 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 | |||||
| VDASID |
0..1 | string | VDAS-ID - VersichertenDatenAbfrageService URL: http://example.org/StructureDefinition/moped-ext-vdasid | |||||
| ExtensionDays |
0..1 | unsignedInt | Verlaengerungstage URL: http://example.org/StructureDefinition/moped-ext-extensionDays | |||||
| PremiumClass |
0..1 | code | "KLAS – Allgemeine Gebührenklasse/Sonderklasse" URL: http://example.org/StructureDefinition/moped-ext-PremiumClass Binding: http://tbd.at/MOPED-LKFAbrechnungsKnoten (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(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 | ||||||||
| Path | Conformance | ValueSet | URI |
| CoverageEligibilityRequest.language | required | AllLanguageshttp://hl7.org/fhir/ValueSet/all-languages|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | |
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0from the FHIR Standard | |
| CoverageEligibilityRequest.event.type | example | DatesTypeCodeshttp://hl7.org/fhir/ValueSet/datestypefrom the FHIR Standard | |
| CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | |
| CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | |
| CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | |
| CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD10Codeshttp://hl7.org/fhir/ValueSet/icd-10from the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | CoverageEligibilityRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id 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:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron