{ "resourceType": "StructureDefinition", "id": "EligibilityResponse", "meta": { "lastUpdated": "2017-04-18T21:44:43.294+00:00" }, "text": { "status": "generated", "div": "
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\"EligibilityResponseDomainResourceEligibilityResponse resource\n
Elements defined in Ancestors: \n id, \n meta, \n implicitRules, \n language, \n text, \n contained, \n extension, \n modifierExtension
\".\"\".\"\".\"identifier0..*IdentifierBusiness Identifier\n
\".\"\".\"\".\"status?!Σ0..1codeactive | cancelled | draft | entered-in-error\n
Financial Resource Status Codes (\n Required)\n
\".\"\".\"\".\"created0..1dateTimeCreation date
\".\"\".\"\".\"requestProvider0..1Reference(\n Practitioner)\n Responsible practitioner
\".\"\".\"\".\"requestOrganization0..1Reference(\n Organization)\n Responsible organization
\".\"\".\"\".\"request0..1Reference(\n EligibilityRequest)\n Eligibility reference
\".\"\".\"\".\"outcome0..1CodeableConceptcomplete | error | partial\n
RemittanceOutcome (\n Required)\n
\".\"\".\"\".\"disposition0..1stringDisposition Message
\".\"\".\"\".\"insurer0..1Reference(\n Organization)\n Insurer issuing the coverage
\".\"\".\"\".\"inforce0..1booleanCoverage inforce indicator
\".\"\".\"\".\"insurance0..*BackboneElementDetails by insurance coverage\n
\".\"\".\"\".\"\".\"coverage0..1Reference(\n Coverage)\n Updated Coverage details
\".\"\".\"\".\"\".\"contract0..1Reference(\n Contract)\n Contract details
\".\"\".\"\".\"\".\"benefitBalance0..*BackboneElementBenefits by Category\n
\".\"\".\"\".\"\".\"\".\"category1..1CodeableConceptType of services covered\n
Benefit Category Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"subCategory0..1CodeableConceptDetailed services covered within the type\n
Benefit SubCategory Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"excluded0..1booleanExcluded from the plan
\".\"\".\"\".\"\".\"\".\"name0..1stringShort name for the benefit
\".\"\".\"\".\"\".\"\".\"description0..1stringDescription of the benefit or services covered
\".\"\".\"\".\"\".\"\".\"network0..1CodeableConceptIn or out of network\n
Network Type Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"unit0..1CodeableConceptIndividual or family\n
Unit Type Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"term0..1CodeableConceptAnnual or lifetime\n
Benefit Term Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"financial0..*BackboneElementBenefit Summary\n
\".\"\".\"\".\"\".\"\".\"\".\"type1..1CodeableConceptDeductable, visits, benefit amount\n
Benefit Type Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"\".\"allowed[x]0..1Benefits allowed
\".\"\".\"\".\"\".\"\".\"\".\"\".\"allowedUnsignedIntunsignedInt
\".\"\".\"\".\"\".\"\".\"\".\"\".\"allowedStringstring
\".\"\".\"\".\"\".\"\".\"\".\"\".\"allowedMoneyMoney
\".\"\".\"\".\"\".\"\".\"\".\"used[x]0..1Benefits used
\".\"\".\"\".\"\".\"\".\"\".\"\".\"usedUnsignedIntunsignedInt
\".\"\".\"\".\"\".\"\".\"\".\"\".\"usedMoneyMoney
\".\"\".\"\".\"form0..1CodeableConceptPrinted Form Identifier\n
Form Codes (\n Example)\n
\".\"\".\"\".\"error0..*BackboneElementProcessing errors\n
\".\"\".\"\".\"\".\"code1..1CodeableConceptError code detailing processing issues\n
Adjudication Error Codes (\n Example)\n

\"doco\" Documentation for this format\n
" }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 2 }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "fm" } ], "url": "http://hl7.org/fhir/StructureDefinition/EligibilityResponse", "name": "EligibilityResponse", "status": "draft", "date": "2017-04-18T21:44:43+00:00", "publisher": "Health Level Seven International (Financial Management)", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] }, { "telecom": [ { "system": "url", "value": "http://www.hl7.org/Special/committees/fm/index.cfm" } ] } ], "description": "Base StructureDefinition for EligibilityResponse Resource", "fhirVersion": "3.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/w5", "name": "W5 Mapping" }, { "identity": "cdanetv4", "uri": "http://www.cda-adc.ca/en/services/cdanet/", "name": "Canadian Dental Association eclaims standard" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "resource", "abstract": false, "type": "EligibilityResponse", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource", "derivation": "specialization", "snapshot": { "element": [ { "id": "EligibilityResponse", "path": "EligibilityResponse", "short": "EligibilityResponse resource", "definition": "This resource provides eligibility and plan details from the processing of an Eligibility resource.", "min": 0, "max": "*", "base": { "path": "Resource", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-1", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain any narrative", "expression": "contained.text.empty()", "xpath": "not(parent::f:contained and f:text)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource", "expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()", "xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.support" } ] }, { "id": "EligibilityResponse.id", "path": "EligibilityResponse.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.meta", "path": "EligibilityResponse.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.implicitRules", "path": "EligibilityResponse.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.language", "path": "EligibilityResponse.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueReference": { "reference": "http://hl7.org/fhir/ValueSet/all-languages" } }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "extensible", "description": "A human language.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/languages" } }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.text", "path": "EligibilityResponse.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1", "dom-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "EligibilityResponse.contained", "path": "EligibilityResponse.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.extension", "path": "EligibilityResponse.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.modifierExtension", "path": "EligibilityResponse.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.identifier", "path": "EligibilityResponse.identifier", "short": "Business Identifier", "definition": "The Response business identifier.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "id" } ] }, { "id": "EligibilityResponse.status", "path": "EligibilityResponse.status", "short": "active | cancelled | draft | entered-in-error", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains codes that mark the response as not currently valid.", "min": 0, "max": "1", "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "EligibilityResponseStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fm-status" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "EligibilityResponse.created", "path": "EligibilityResponse.created", "short": "Creation date", "definition": "The date when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "EligibilityResponse.requestProvider", "path": "EligibilityResponse.requestProvider", "short": "Responsible practitioner", "definition": "The practitioner who is responsible for the services rendered to the patient.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "cdanetv4", "map": "B01" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "EligibilityResponse.requestOrganization", "path": "EligibilityResponse.requestOrganization", "short": "Responsible organization", "definition": "The organization which is responsible for the services rendered to the patient.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.performer.onBehalfOf" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "EligibilityResponse.request", "path": "EligibilityResponse.request", "short": "Eligibility reference", "definition": "Original request resource reference.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/EligibilityRequest" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "cdanetv4", "map": "A02|G01" }, { "identity": "w5", "map": "why" } ] }, { "id": "EligibilityResponse.outcome", "path": "EligibilityResponse.outcome", "short": "complete | error | partial", "definition": "Transaction status: error, complete.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RemittanceOutcome" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The outcome of the processing.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/remittance-outcome" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.disposition", "path": "EligibilityResponse.disposition", "short": "Disposition Message", "definition": "A description of the status of the adjudication.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.note" } ] }, { "id": "EligibilityResponse.insurer", "path": "EligibilityResponse.insurer", "short": "Insurer issuing the coverage", "definition": "The Insurer who produced this adjudicated response.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "EligibilityResponse.inforce", "path": "EligibilityResponse.inforce", "short": "Coverage inforce indicator", "definition": "Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.", "min": 0, "max": "1", "type": [ { "code": "boolean" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "EligibilityResponse.insurance", "short": "Details by insurance coverage", "definition": "The insurer may provide both the details for the requested coverage as well as details for additional coverages known to the insurer.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.id", "path": "EligibilityResponse.insurance.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.extension", "path": "EligibilityResponse.insurance.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.insurance.modifierExtension", "path": "EligibilityResponse.insurance.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.insurance.coverage", "path": "EligibilityResponse.insurance.coverage", "short": "Updated Coverage details", "definition": "A suite of updated or additional Coverages from the Insurer.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "EligibilityResponse.insurance.contract", "path": "EligibilityResponse.insurance.contract", "short": "Contract details", "definition": "The contract resource which may provide more detailed information.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Contract" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Benefits" } ], "path": "EligibilityResponse.insurance.benefitBalance", "short": "Benefits by Category", "definition": "Benefits and optionally current balances by Category.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.id", "path": "EligibilityResponse.insurance.benefitBalance.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.extension", "path": "EligibilityResponse.insurance.benefitBalance.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.modifierExtension", "path": "EligibilityResponse.insurance.benefitBalance.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.category", "path": "EligibilityResponse.insurance.benefitBalance.category", "short": "Type of services covered", "definition": "Dental, Vision, Medical, Pharmacy, Rehab etc.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitCategory" } ], "strength": "example", "description": "Benefit categories such as: oral, medical, vision etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-category" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.subCategory", "path": "EligibilityResponse.insurance.benefitBalance.subCategory", "short": "Detailed services covered within the type", "definition": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.excluded", "path": "EligibilityResponse.insurance.benefitBalance.excluded", "short": "Excluded from the plan", "definition": "True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage.", "min": 0, "max": "1", "type": [ { "code": "boolean" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.name", "path": "EligibilityResponse.insurance.benefitBalance.name", "short": "Short name for the benefit", "definition": "A short name or tag for the benefit, for example MED01, or DENT2.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.description", "path": "EligibilityResponse.insurance.benefitBalance.description", "short": "Description of the benefit or services covered", "definition": "A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.network", "path": "EligibilityResponse.insurance.benefitBalance.network", "short": "In or out of network", "definition": "Network designation.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitNetwork" } ], "strength": "example", "description": "Code to classify in or out of network services", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-network" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.unit", "path": "EligibilityResponse.insurance.benefitBalance.unit", "short": "Individual or family", "definition": "Unit designation: individual or family.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitUnit" } ], "strength": "example", "description": "Unit covered/serviced - individual or family", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-unit" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.term", "path": "EligibilityResponse.insurance.benefitBalance.term", "short": "Annual or lifetime", "definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitTerm" } ], "strength": "example", "description": "Coverage unit - annual, lifetime", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-term" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Benefit" } ], "path": "EligibilityResponse.insurance.benefitBalance.financial", "short": "Benefit Summary", "definition": "Benefits Used to date.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.id", "path": "EligibilityResponse.insurance.benefitBalance.financial.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.extension", "path": "EligibilityResponse.insurance.benefitBalance.financial.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.modifierExtension", "path": "EligibilityResponse.insurance.benefitBalance.financial.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.type", "path": "EligibilityResponse.insurance.benefitBalance.financial.type", "short": "Deductable, visits, benefit amount", "definition": "Deductable, visits, benefit amount.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitType" } ], "strength": "example", "description": "Deductable, visits, co-pay, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-type" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.allowed[x]", "path": "EligibilityResponse.insurance.benefitBalance.financial.allowed[x]", "short": "Benefits allowed", "definition": "Benefits allowed.", "min": 0, "max": "1", "type": [ { "code": "unsignedInt" }, { "code": "string" }, { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.used[x]", "path": "EligibilityResponse.insurance.benefitBalance.financial.used[x]", "short": "Benefits used", "definition": "Benefits used.", "min": 0, "max": "1", "type": [ { "code": "unsignedInt" }, { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.form", "path": "EligibilityResponse.form", "short": "Printed Form Identifier", "definition": "The form to be used for printing the content.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Forms" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "The forms codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/forms" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "cdanetv4", "map": "G42" } ] }, { "id": "EligibilityResponse.error", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Errors" } ], "path": "EligibilityResponse.error", "short": "Processing errors", "definition": "Mutually exclusive with Services Provided (Item).", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.error.id", "path": "EligibilityResponse.error.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "EligibilityResponse.error.extension", "path": "EligibilityResponse.error.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.error.modifierExtension", "path": "EligibilityResponse.error.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "EligibilityResponse.error.code", "path": "EligibilityResponse.error.code", "short": "Error code detailing processing issues", "definition": "An error code,from a specified code system, which details why the eligibility check could not be performed.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationError" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "The error codes for adjudication processing.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication-error" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] } ] }, "differential": { "element": [ { "id": "EligibilityResponse", "path": "EligibilityResponse", "short": "EligibilityResponse resource", "definition": "This resource provides eligibility and plan details from the processing of an Eligibility resource.", "min": 0, "max": "*", "mapping": [ { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.support" } ] }, { "id": "EligibilityResponse.identifier", "path": "EligibilityResponse.identifier", "short": "Business Identifier", "definition": "The Response business identifier.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "id" } ] }, { "id": "EligibilityResponse.status", "path": "EligibilityResponse.status", "short": "active | cancelled | draft | entered-in-error", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains codes that mark the response as not currently valid.", "min": 0, "max": "1", "type": [ { "code": "code" } ], "isModifier": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "EligibilityResponseStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fm-status" } }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "EligibilityResponse.created", "path": "EligibilityResponse.created", "short": "Creation date", "definition": "The date when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "w5", "map": "when.recorded" } ] }, { "id": "EligibilityResponse.requestProvider", "path": "EligibilityResponse.requestProvider", "short": "Responsible practitioner", "definition": "The practitioner who is responsible for the services rendered to the patient.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "mapping": [ { "identity": "cdanetv4", "map": "B01" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "EligibilityResponse.requestOrganization", "path": "EligibilityResponse.requestOrganization", "short": "Responsible organization", "definition": "The organization which is responsible for the services rendered to the patient.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "mapping": [ { "identity": "workflow", "map": "Event.performer.onBehalfOf" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "EligibilityResponse.request", "path": "EligibilityResponse.request", "short": "Eligibility reference", "definition": "Original request resource reference.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/EligibilityRequest" } ], "mapping": [ { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "cdanetv4", "map": "A02|G01" }, { "identity": "w5", "map": "why" } ] }, { "id": "EligibilityResponse.outcome", "path": "EligibilityResponse.outcome", "short": "complete | error | partial", "definition": "Transaction status: error, complete.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RemittanceOutcome" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The outcome of the processing.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/remittance-outcome" } } }, { "id": "EligibilityResponse.disposition", "path": "EligibilityResponse.disposition", "short": "Disposition Message", "definition": "A description of the status of the adjudication.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mapping": [ { "identity": "workflow", "map": "Event.note" } ] }, { "id": "EligibilityResponse.insurer", "path": "EligibilityResponse.insurer", "short": "Insurer issuing the coverage", "definition": "The Insurer who produced this adjudicated response.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ] }, { "id": "EligibilityResponse.inforce", "path": "EligibilityResponse.inforce", "short": "Coverage inforce indicator", "definition": "Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.", "min": 0, "max": "1", "type": [ { "code": "boolean" } ] }, { "id": "EligibilityResponse.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "EligibilityResponse.insurance", "short": "Details by insurance coverage", "definition": "The insurer may provide both the details for the requested coverage as well as details for additional coverages known to the insurer.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "EligibilityResponse.insurance.coverage", "path": "EligibilityResponse.insurance.coverage", "short": "Updated Coverage details", "definition": "A suite of updated or additional Coverages from the Insurer.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage" } ] }, { "id": "EligibilityResponse.insurance.contract", "path": "EligibilityResponse.insurance.contract", "short": "Contract details", "definition": "The contract resource which may provide more detailed information.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Contract" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Benefits" } ], "path": "EligibilityResponse.insurance.benefitBalance", "short": "Benefits by Category", "definition": "Benefits and optionally current balances by Category.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.category", "path": "EligibilityResponse.insurance.benefitBalance.category", "short": "Type of services covered", "definition": "Dental, Vision, Medical, Pharmacy, Rehab etc.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitCategory" } ], "strength": "example", "description": "Benefit categories such as: oral, medical, vision etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-category" } } }, { "id": "EligibilityResponse.insurance.benefitBalance.subCategory", "path": "EligibilityResponse.insurance.benefitBalance.subCategory", "short": "Detailed services covered within the type", "definition": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } } }, { "id": "EligibilityResponse.insurance.benefitBalance.excluded", "path": "EligibilityResponse.insurance.benefitBalance.excluded", "short": "Excluded from the plan", "definition": "True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage.", "min": 0, "max": "1", "type": [ { "code": "boolean" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.name", "path": "EligibilityResponse.insurance.benefitBalance.name", "short": "Short name for the benefit", "definition": "A short name or tag for the benefit, for example MED01, or DENT2.", "min": 0, "max": "1", "type": [ { "code": "string" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.description", "path": "EligibilityResponse.insurance.benefitBalance.description", "short": "Description of the benefit or services covered", "definition": "A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'.", "min": 0, "max": "1", "type": [ { "code": "string" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.network", "path": "EligibilityResponse.insurance.benefitBalance.network", "short": "In or out of network", "definition": "Network designation.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitNetwork" } ], "strength": "example", "description": "Code to classify in or out of network services", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-network" } } }, { "id": "EligibilityResponse.insurance.benefitBalance.unit", "path": "EligibilityResponse.insurance.benefitBalance.unit", "short": "Individual or family", "definition": "Unit designation: individual or family.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitUnit" } ], "strength": "example", "description": "Unit covered/serviced - individual or family", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-unit" } } }, { "id": "EligibilityResponse.insurance.benefitBalance.term", "path": "EligibilityResponse.insurance.benefitBalance.term", "short": "Annual or lifetime", "definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitTerm" } ], "strength": "example", "description": "Coverage unit - annual, lifetime", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-term" } } }, { "id": "EligibilityResponse.insurance.benefitBalance.financial", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Benefit" } ], "path": "EligibilityResponse.insurance.benefitBalance.financial", "short": "Benefit Summary", "definition": "Benefits Used to date.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.type", "path": "EligibilityResponse.insurance.benefitBalance.financial.type", "short": "Deductable, visits, benefit amount", "definition": "Deductable, visits, benefit amount.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitType" } ], "strength": "example", "description": "Deductable, visits, co-pay, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-type" } } }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.allowed[x]", "path": "EligibilityResponse.insurance.benefitBalance.financial.allowed[x]", "short": "Benefits allowed", "definition": "Benefits allowed.", "min": 0, "max": "1", "type": [ { "code": "unsignedInt" }, { "code": "string" }, { "code": "Money" } ] }, { "id": "EligibilityResponse.insurance.benefitBalance.financial.used[x]", "path": "EligibilityResponse.insurance.benefitBalance.financial.used[x]", "short": "Benefits used", "definition": "Benefits used.", "min": 0, "max": "1", "type": [ { "code": "unsignedInt" }, { "code": "Money" } ] }, { "id": "EligibilityResponse.form", "path": "EligibilityResponse.form", "short": "Printed Form Identifier", "definition": "The form to be used for printing the content.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Forms" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "The forms codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/forms" } }, "mapping": [ { "identity": "cdanetv4", "map": "G42" } ] }, { "id": "EligibilityResponse.error", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Errors" } ], "path": "EligibilityResponse.error", "short": "Processing errors", "definition": "Mutually exclusive with Services Provided (Item).", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "EligibilityResponse.error.code", "path": "EligibilityResponse.error.code", "short": "Error code detailing processing issues", "definition": "An error code,from a specified code system, which details why the eligibility check could not be performed.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationError" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "The error codes for adjudication processing.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication-error" } } } ] } }