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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: MOPED Coverage Eligibility Response

MOPED Profil der CoverageEligibilityResponse Ressource für die Versichertenanspruchserklärung-Antwort.

Usage:

• Examples for this Resource Profile: CoverageEligibilityResponse/Test1MOPEDCoverageEligibilityResponse1 and CoverageEligibilityResponse/Test2MOPEDCoverageEligibilityResponse1

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 CoverageEligibilityResponse

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

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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
fristende		0..1	boolean	"Fristende" URL: http://example.org/StructureDefinition/moped-ext-fristende ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
vaeStatus		0..1	Coding	"VAEST - Status der Versichertenanspruchserklärung" URL: http://example.org/StructureDefinition/moped-ext-vaestatus Binding: Status der Versichertenanspruchserklärung (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
verpflegskostenBeitragsbefreiung		0..1	Coding	"VKBEFR – Verpflegskosten-Beitragsbefreiung" URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung Binding: Befreiung für den Verpflegskostenbeitrag (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
vortageanzahlAufKostenbeitrag		0..1	unsignedInt	"Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage. URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag 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: EligibilityResponsePurpose (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	Response creation date ele-1: All FHIR elements must have a @value or children
request	Σ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (required): The outcome of the processing. 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
CoverageEligibilityResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.outcome	required	EligibilityOutcome http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
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
fristende		0..1	boolean	"Fristende" URL: http://example.org/StructureDefinition/moped-ext-fristende
vaeStatus		0..1	Coding	"VAEST - Status der Versichertenanspruchserklärung" URL: http://example.org/StructureDefinition/moped-ext-vaestatus Binding: Status der Versichertenanspruchserklärung (required)
verpflegskostenBeitragsbefreiung		0..1	Coding	"VKBEFR – Verpflegskosten-Beitragsbefreiung" URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung Binding: Befreiung für den Verpflegskostenbeitrag (required)
vortageanzahlAufKostenbeitrag		0..1	unsignedInt	"Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage. URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	Intended recipient of products and services
event		0..*	BackboneElement	Event information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
serviced[x]		0..1		Estimated date or dates of service
servicedDate			date
servicedPeriod			Period
created	Σ	1..1	dateTime	Response creation date
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	Σ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (required): The outcome of the processing.
disposition		0..1	string	Disposition Message
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	Σ	1..1	Reference(MOPED Coverage)	Insurance information
inforce		0..1	boolean	Coverage inforce indicator
benefitPeriod		0..1	Period	When the benefits are applicable
item	C	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	C	0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService	C	0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
benefit		0..*	BackboneElement	Benefit Summary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
authorizationRequired		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: FormCodes (example): The forms codes.
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The error codes for adjudication processing.
expression	Σ	0..*	string	FHIRPath of element(s) related to issue
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CoverageEligibilityResponse.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
CoverageEligibilityResponse.outcome	required	EligibilityOutcome http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityResponse.insurance.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityResponse.insurance.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityResponse.insurance.item.network	example	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	example	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	example	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	example	BenefitTypeCodes http://hl7.org/fhir/ValueSet/benefit-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.authorizationSupporting	example	CoverageEligibilityResponseAuthSupportCodes http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support from the FHIR Standard
CoverageEligibilityResponse.form	example	FormCodes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
CoverageEligibilityResponse.error.code	example	AdjudicationErrorCodes http://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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 CoverageEligibilityResponse

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)
• MOPED Coverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/moped-ext-fristende
• http://example.org/StructureDefinition/moped-ext-vaestatus
• http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
• http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag

Differential View

This structure is derived from CoverageEligibilityResponse

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

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse 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
fristende		0..1	boolean	"Fristende" URL: http://example.org/StructureDefinition/moped-ext-fristende ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
vaeStatus		0..1	Coding	"VAEST - Status der Versichertenanspruchserklärung" URL: http://example.org/StructureDefinition/moped-ext-vaestatus Binding: Status der Versichertenanspruchserklärung (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
verpflegskostenBeitragsbefreiung		0..1	Coding	"VKBEFR – Verpflegskosten-Beitragsbefreiung" URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung Binding: Befreiung für den Verpflegskostenbeitrag (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
vortageanzahlAufKostenbeitrag		0..1	unsignedInt	"Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage. URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag 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: EligibilityResponsePurpose (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	Response creation date ele-1: All FHIR elements must have a @value or children
request	Σ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (required): The outcome of the processing. 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
CoverageEligibilityResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.outcome	required	EligibilityOutcome http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
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
fristende		0..1	boolean	"Fristende" URL: http://example.org/StructureDefinition/moped-ext-fristende
vaeStatus		0..1	Coding	"VAEST - Status der Versichertenanspruchserklärung" URL: http://example.org/StructureDefinition/moped-ext-vaestatus Binding: Status der Versichertenanspruchserklärung (required)
verpflegskostenBeitragsbefreiung		0..1	Coding	"VKBEFR – Verpflegskosten-Beitragsbefreiung" URL: http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung Binding: Befreiung für den Verpflegskostenbeitrag (required)
vortageanzahlAufKostenbeitrag		0..1	unsignedInt	"Vortageanzahl auf Kostenbeitrag:" Zur Berechnung des Verpflegskostenbeitrags für Versicherte sowie des Kostenbeitrags für Angehörige ist die Angabe der zu berücksichtigenden Vortage erforderlich. Der Krankenversicherungsträger ist auf Grund der ihm zugänglichen Informationen in der Lage, Vorpflegetage zu berücksichtigen. Berücksichtigt werden alle stationären Aufenthalte eines Patienten innerhalb eines Kalenderjahres. Der höchste Wert, mit welchem das Feld VTAGE befüllt werden kann, ist jener Wert, für welchen maximal ein Verpflegskostenbeitrag pro Kalenderjahr zu entrichten ist. Der Maximale Höchstwert beträgt somit 28 Tage. URL: http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	Intended recipient of products and services
event		0..*	BackboneElement	Event information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
serviced[x]		0..1		Estimated date or dates of service
servicedDate			date
servicedPeriod			Period
created	Σ	1..1	dateTime	Response creation date
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	Σ	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: EligibilityOutcome (required): The outcome of the processing.
disposition		0..1	string	Disposition Message
insurer	Σ	1..1	Reference(Organization)	Coverage issuer
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	Σ	1..1	Reference(MOPED Coverage)	Insurance information
inforce		0..1	boolean	Coverage inforce indicator
benefitPeriod		0..1	Period	When the benefits are applicable
item	C	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	C	0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService	C	0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
benefit		0..*	BackboneElement	Benefit Summary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedString			string
usedMoney			Money
authorizationRequired		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: FormCodes (example): The forms codes.
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The error codes for adjudication processing.
expression	Σ	0..*	string	FHIRPath of element(s) related to issue
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CoverageEligibilityResponse.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.purpose	required	EligibilityResponsePurpose http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
CoverageEligibilityResponse.outcome	required	EligibilityOutcome http://hl7.org/fhir/ValueSet/eligibility-outcome|5.0.0 from the FHIR Standard
CoverageEligibilityResponse.insurance.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityResponse.insurance.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityResponse.insurance.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityResponse.insurance.item.network	example	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
CoverageEligibilityResponse.insurance.item.unit	example	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
CoverageEligibilityResponse.insurance.item.term	example	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
CoverageEligibilityResponse.insurance.item.benefit.type	example	BenefitTypeCodes http://hl7.org/fhir/ValueSet/benefit-type from the FHIR Standard
CoverageEligibilityResponse.insurance.item.authorizationSupporting	example	CoverageEligibilityResponseAuthSupportCodes http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support from the FHIR Standard
CoverageEligibilityResponse.form	example	FormCodes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
CoverageEligibilityResponse.error.code	example	AdjudicationErrorCodes http://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ces-1	error	CoverageEligibilityResponse.insurance.item	SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists()
dom-2	error	CoverageEligibilityResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityResponse	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	CoverageEligibilityResponse	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	CoverageEligibilityResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityResponse	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 CoverageEligibilityResponse

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)
• MOPED Coverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/moped-ext-fristende
• http://example.org/StructureDefinition/moped-ext-vaestatus
• http://example.org/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
• http://example.org/StructureDefinition/moped-ext-vortageanzahlAufKostenbeitrag

Other representations of profile: CSV, Excel, Schematron