FHIR Implementation Guide for ABDM
3.0.0 - CI Build
FHIR Implementation Guide for ABDM - Local Development build (v3.0.0). See the Directory of published versions
Official URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse | Version: 3.0.0 | |||
Draft as of 2023-04-20 | Computable Name: CoverageEligibilityResponse |
This profile is set minimum expectation for CoverageEligibilityResponse resource which provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource. It combines key information from a payor as to whether a Coverage is in-force, and optionally the nature of the Policy benefit details as well as the ability for the insurer to indicate whether the insurance provides benefits for requested types of services or requires preauthorization and if so what supporting information may be required.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from CoverageEligibilityResponse
Summary
Mandatory: 1 element (1 nested mandatory element)
Must-Support: 11 elements
Structures
This structure refers to these other structures:
This structure is derived from CoverageEligibilityResponse
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
![]() ![]() ![]() | S | 1..* | code | auth-requirements | benefits | discovery | validation |
![]() ![]() ![]() | 1..1 | Reference(Patient) | Intended recipient of products and services | |
![]() ![]() ![]() | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |
![]() ![]() ![]() | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference | |
![]() ![]() ![]() | S | 1..1 | code | queued | complete | error | partial |
![]() ![]() ![]() | S | 0..1 | string | Disposition Message |
![]() ![]() ![]() | S | 1..1 | Reference(Organization) | Coverage issuer |
![]() ![]() ![]() | S | 0..* | BackboneElement | Patient insurance information |
![]() ![]() ![]() ![]() | S | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() ![]() ![]() | S | 0..1 | boolean | Coverage inforce indicator |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Benefits and authorization details |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: Benefit Category (example): Benefit categories such as: oral, medical, vision etc. | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ProductorService (example): Allowable service and product codes . |
![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |
![]() ![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Benefit Summary |
![]() ![]() ![]() | S | 0..* | BackboneElement | Processing errors |
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |||||
![]() ![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | 0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Intended recipient of products and services | ||||
![]() ![]() ![]() | 0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() | Σ | 1..1 | dateTime | Response creation date | ||||
![]() ![]() ![]() | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |||||
![]() ![]() ![]() | Σ | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference | ||||
![]() ![]() ![]() | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. | ||||
![]() ![]() ![]() | S | 0..1 | string | Disposition Message | ||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(Organization) | Coverage issuer | ||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Patient insurance information | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | SΣ | 1..1 | Reference(Coverage) | Insurance information | ||||
![]() ![]() ![]() ![]() | S | 0..1 | boolean | Coverage inforce indicator | ||||
![]() ![]() ![]() ![]() | 0..1 | Period | When the benefits are applicable | |||||
![]() ![]() ![]() ![]() | SC | 0..* | BackboneElement | Benefits and authorization details | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: Benefit Category (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ProductorService (example): Allowable service and product codes . | ||||
![]() ![]() ![]() ![]() ![]() | 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. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Excluded from the plan | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Short name for the benefit | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Description of the benefit or services covered | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
![]() ![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Benefit Summary | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Authorization required flag | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Preauthorization requirements endpoint | |||||
![]() ![]() ![]() | 0..1 | string | Preauthorization reference | |||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Processing errors | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing. | |||||
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
![]() ![]() ![]() | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. |
![]() ![]() ![]() | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. |
![]() ![]() ![]() | 0..1 | string | Disposition Message | |
![]() ![]() ![]() | Σ | 1..1 | Reference(Organization) | Coverage issuer |
![]() ![]() ![]() | 0..* | BackboneElement | Patient insurance information | |
![]() ![]() ![]() ![]() | Σ | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() ![]() ![]() | 0..1 | boolean | Coverage inforce indicator | |
![]() ![]() ![]() ![]() | C | 0..* | BackboneElement | Benefits and authorization details |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ProductorService (example): Allowable service and product codes . | |
![]() ![]() ![]() ![]() ![]() | 0..* | BackboneElement | Benefit Summary | |
![]() ![]() ![]() | 0..* | BackboneElement | Processing errors | |
![]() |
This structure is derived from CoverageEligibilityResponse
Summary
Mandatory: 1 element (1 nested mandatory element)
Must-Support: 11 elements
Structures
This structure refers to these other structures:
Differential View
This structure is derived from CoverageEligibilityResponse
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |
![]() ![]() ![]() | S | 1..* | code | auth-requirements | benefits | discovery | validation |
![]() ![]() ![]() | 1..1 | Reference(Patient) | Intended recipient of products and services | |
![]() ![]() ![]() | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |
![]() ![]() ![]() | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference | |
![]() ![]() ![]() | S | 1..1 | code | queued | complete | error | partial |
![]() ![]() ![]() | S | 0..1 | string | Disposition Message |
![]() ![]() ![]() | S | 1..1 | Reference(Organization) | Coverage issuer |
![]() ![]() ![]() | S | 0..* | BackboneElement | Patient insurance information |
![]() ![]() ![]() ![]() | S | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() ![]() ![]() | S | 0..1 | boolean | Coverage inforce indicator |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Benefits and authorization details |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: Benefit Category (example): Benefit categories such as: oral, medical, vision etc. | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ProductorService (example): Allowable service and product codes . |
![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |
![]() ![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Benefit Summary |
![]() ![]() ![]() | S | 0..* | BackboneElement | Processing errors |
![]() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |||||
![]() ![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | 0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. | ||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | Intended recipient of products and services | ||||
![]() ![]() ![]() | 0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() | Σ | 1..1 | dateTime | Response creation date | ||||
![]() ![]() ![]() | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |||||
![]() ![]() ![]() | Σ | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference | ||||
![]() ![]() ![]() | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing. | ||||
![]() ![]() ![]() | S | 0..1 | string | Disposition Message | ||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(Organization) | Coverage issuer | ||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Patient insurance information | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | SΣ | 1..1 | Reference(Coverage) | Insurance information | ||||
![]() ![]() ![]() ![]() | S | 0..1 | boolean | Coverage inforce indicator | ||||
![]() ![]() ![]() ![]() | 0..1 | Period | When the benefits are applicable | |||||
![]() ![]() ![]() ![]() | SC | 0..* | BackboneElement | Benefits and authorization details | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: Benefit Category (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ProductorService (example): Allowable service and product codes . | ||||
![]() ![]() ![]() ![]() ![]() | 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. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Excluded from the plan | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Short name for the benefit | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Description of the benefit or services covered | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime. | |||||
![]() ![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Benefit Summary | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc. | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | unsignedInt | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Money | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | Authorization required flag | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | uri | Preauthorization requirements endpoint | |||||
![]() ![]() ![]() | 0..1 | string | Preauthorization reference | |||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Processing errors | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing. | |||||
![]() |
Other representations of profile: CSV, Excel, Schematron
Path | Conformance | ValueSet |
CoverageEligibilityResponse.language | preferred | CommonLanguages Max Binding: AllLanguages |
CoverageEligibilityResponse.status | required | FinancialResourceStatusCodes |
CoverageEligibilityResponse.purpose | required | EligibilityResponsePurpose |
CoverageEligibilityResponse.outcome | required | ClaimProcessingCodes |
CoverageEligibilityResponse.insurance.item.category | example | BenefitCategory |
CoverageEligibilityResponse.insurance.item.productOrService | example | ProductorService |
CoverageEligibilityResponse.insurance.item.modifier | example | ModifierTypeCodes |
CoverageEligibilityResponse.insurance.item.network | example | NetworkTypeCodes |
CoverageEligibilityResponse.insurance.item.unit | example | UnitTypeCodes |
CoverageEligibilityResponse.insurance.item.term | example | BenefitTermCodes |
CoverageEligibilityResponse.insurance.item.benefit.type | example | BenefitTypeCodes |
CoverageEligibilityResponse.insurance.item.authorizationSupporting | example | CoverageEligibilityResponseAuthSupportCodes |
CoverageEligibilityResponse.form | example | Form Codes |
CoverageEligibilityResponse.error.code | example | Adjudication Error Codes |
Id | Grade | Path | 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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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 | CoverageEligibilityResponse.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.purpose | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.patient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.serviced[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.created | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.requestor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.request | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.outcome | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.disposition | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.coverage | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.inforce | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.benefitPeriod | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ces-1 | error | CoverageEligibilityResponse.insurance.item | SHALL contain a category or a billcode but not both. : category.exists() xor productOrService.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.excluded | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.name | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.network | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.unit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.term | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.benefit.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.insurance.item.benefit.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.allowed[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.benefit.used[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.authorizationRequired | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.authorizationSupporting | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.insurance.item.authorizationUrl | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.preAuthRef | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.form | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.error | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ele-1 | error | CoverageEligibilityResponse.error.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.error.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.error.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | CoverageEligibilityResponse.error.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
ele-1 | error | CoverageEligibilityResponse.error.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |