CoverageEligibilityRequest.xml
1 <?xml version="1.0" encoding="utf-8"?>
2 <StructureDefinition xmlns="http://hl7.org/fhir">
3 <id value="CoverageEligibilityRequest" />
4 <meta>
5 <lastUpdated value="2023-03-26T06:21:02.749+02:00" />
6 </meta>
7 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-category">
8 <valueString value="Financial.Support" />
9 </extension>
10 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
11 <valueCode value="trial-use" />
12 </extension>
13 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
14 <valueInteger value="4" />
15 </extension>
16 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category">
17 <valueCode value="patient" />
18 </extension>
19 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
20 <valueCode value="fm" />
21 </extension>
22 <url value="http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest" />
23 <version value="5.0.0" />
24 <name value="CoverageEligibilityRequest" />
25 <status value="draft" />
26 <experimental value="false" />
27 <date value="2023-03-26T06:21:02.0000000+02:00" />
28 <publisher value="Health Level Seven International (Financial Management)" />
29 <contact>
30 <telecom>
31 <system value="url" />
32 <value value="http://hl7.org/fhir" />
33 </telecom>
34 </contact>
35 <contact>
36 <telecom>
37 <system value="url" />
38 <value value="http://www.hl7.org/Special/committees/fm/index.cfm" />
39 </telecom>
40 </contact>
41 <description value="The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy." />
42 <jurisdiction>
43 <coding>
44 <system value="http://unstats.un.org/unsd/methods/m49/m49.htm" />
45 <code value="001" />
46 <display value="World" />
47 </coding>
48 </jurisdiction>
49 <fhirVersion value="5.0.0" />
50 <mapping>
51 <identity value="workflow" />
52 <uri value="http://hl7.org/fhir/workflow" />
53 <name value="Workflow Pattern" />
54 </mapping>
55 <mapping>
56 <identity value="w5" />
57 <uri value="http://hl7.org/fhir/fivews" />
58 <name value="FiveWs Pattern Mapping" />
59 </mapping>
60 <mapping>
61 <identity value="v2" />
62 <uri value="http://hl7.org/v2" />
63 <name value="HL7 V2 Mapping" />
64 </mapping>
65 <mapping>
66 <identity value="rim" />
67 <uri value="http://hl7.org/v3" />
68 <name value="RIM Mapping" />
69 </mapping>
70 <kind value="resource" />
71 <abstract value="false" />
72 <type value="CoverageEligibilityRequest" />
73 <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
74 <derivation value="specialization" />
75 <snapshot>
76 <element id="CoverageEligibilityRequest">
77 <path value="CoverageEligibilityRequest" />
78 <short value="CoverageEligibilityRequest resource" />
79 <definition value="The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy." />
80 <min value="0" />
81 <max value="*" />
82 <base>
83 <path value="CoverageEligibilityRequest" />
84 <min value="0" />
85 <max value="*" />
86 </base>
87 <constraint>
88 <key value="dom-2" />
89 <severity value="error" />
90 <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
91 <expression value="contained.contained.empty()" />
92 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
93 </constraint>
94 <constraint>
95 <key value="dom-3" />
96 <severity value="error" />
97 <human value="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" />
98 <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" />
99 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
100 </constraint>
101 <constraint>
102 <key value="dom-4" />
103 <severity value="error" />
104 <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
105 <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
106 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
107 </constraint>
108 <constraint>
109 <key value="dom-5" />
110 <severity value="error" />
111 <human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
112 <expression value="contained.meta.security.empty()" />
113 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
114 </constraint>
115 <constraint>
116 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
117 <valueBoolean value="true" />
118 </extension>
119 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
120 <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
121 </extension>
122 <key value="dom-6" />
123 <severity value="warning" />
124 <human value="A resource should have narrative for robust management" />
125 <expression value="text.`div`.exists()" />
126 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
127 </constraint>
128 <mustSupport value="false" />
129 <isModifier value="false" />
130 <isSummary value="false" />
131 <mapping>
132 <identity value="rim" />
133 <map value="Entity, Role, or Act" />
134 </mapping>
135 <mapping>
136 <identity value="workflow" />
137 <map value="Request" />
138 </mapping>
139 <mapping>
140 <identity value="w5" />
141 <map value="financial.support" />
142 </mapping>
143 </element>
144 <element id="CoverageEligibilityRequest.id">
145 <path value="CoverageEligibilityRequest.id" />
146 <short value="Logical id of this artifact" />
147 <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
148 <comment value="Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case." />
149 <min value="0" />
150 <max value="1" />
151 <base>
152 <path value="Resource.id" />
153 <min value="0" />
154 <max value="1" />
155 </base>
156 <type>
157 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
158 <valueUrl value="id" />
159 </extension>
160 <code value="http://hl7.org/fhirpath/System.String" />
161 </type>
162 <mustSupport value="false" />
163 <isModifier value="false" />
164 <isSummary value="true" />
165 </element>
166 <element id="CoverageEligibilityRequest.meta">
167 <path value="CoverageEligibilityRequest.meta" />
168 <short value="Metadata about the resource" />
169 <definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource." />
170 <min value="0" />
171 <max value="1" />
172 <base>
173 <path value="Resource.meta" />
174 <min value="0" />
175 <max value="1" />
176 </base>
177 <type>
178 <code value="Meta" />
179 </type>
180 <constraint>
181 <key value="ele-1" />
182 <severity value="error" />
183 <human value="All FHIR elements must have a @value or children" />
184 <expression value="hasValue() or (children().count() > id.count())" />
185 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
186 </constraint>
187 <mustSupport value="false" />
188 <isModifier value="false" />
189 <isSummary value="true" />
190 </element>
191 <element id="CoverageEligibilityRequest.implicitRules">
192 <path value="CoverageEligibilityRequest.implicitRules" />
193 <short value="A set of rules under which this content was created" />
194 <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc." />
195 <comment value="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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc." />
196 <min value="0" />
197 <max value="1" />
198 <base>
199 <path value="Resource.implicitRules" />
200 <min value="0" />
201 <max value="1" />
202 </base>
203 <type>
204 <code value="uri" />
205 </type>
206 <constraint>
207 <key value="ele-1" />
208 <severity value="error" />
209 <human value="All FHIR elements must have a @value or children" />
210 <expression value="hasValue() or (children().count() > id.count())" />
211 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
212 </constraint>
213 <mustSupport value="false" />
214 <isModifier value="true" />
215 <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation" />
216 <isSummary value="true" />
217 </element>
218 <element id="CoverageEligibilityRequest.language">
219 <path value="CoverageEligibilityRequest.language" />
220 <short value="Language of the resource content" />
221 <definition value="The base language in which the resource is written." />
222 <comment value="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)." />
223 <min value="0" />
224 <max value="1" />
225 <base>
226 <path value="Resource.language" />
227 <min value="0" />
228 <max value="1" />
229 </base>
230 <type>
231 <code value="code" />
232 </type>
233 <constraint>
234 <key value="ele-1" />
235 <severity value="error" />
236 <human value="All FHIR elements must have a @value or children" />
237 <expression value="hasValue() or (children().count() > id.count())" />
238 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
239 </constraint>
240 <mustSupport value="false" />
241 <isModifier value="false" />
242 <isSummary value="false" />
243 <binding>
244 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
245 <valueString value="Language" />
246 </extension>
247 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
248 <valueBoolean value="true" />
249 </extension>
250 <strength value="required" />
251 <description value="IETF language tag for a human language" />
252 <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0" />
253 </binding>
254 </element>
255 <element id="CoverageEligibilityRequest.text">
256 <path value="CoverageEligibilityRequest.text" />
257 <short value="Text summary of the resource, for human interpretation" />
258 <definition value="A human-readable narrative that contains a summary of the resource and can 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." />
259 <comment value="Contained resources do not have a 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 information is added later." />
260 <alias value="narrative" />
261 <alias value="html" />
262 <alias value="xhtml" />
263 <alias value="display" />
264 <min value="0" />
265 <max value="1" />
266 <base>
267 <path value="DomainResource.text" />
268 <min value="0" />
269 <max value="1" />
270 </base>
271 <type>
272 <code value="Narrative" />
273 </type>
274 <condition value="dom-6" />
275 <constraint>
276 <key value="ele-1" />
277 <severity value="error" />
278 <human value="All FHIR elements must have a @value or children" />
279 <expression value="hasValue() or (children().count() > id.count())" />
280 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
281 </constraint>
282 <mustSupport value="false" />
283 <isModifier value="false" />
284 <isSummary value="false" />
285 <mapping>
286 <identity value="rim" />
287 <map value="Act.text?" />
288 </mapping>
289 </element>
290 <element id="CoverageEligibilityRequest.contained">
291 <path value="CoverageEligibilityRequest.contained" />
292 <short value="Contained, inline Resources" />
293 <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning." />
294 <comment value="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. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels." />
295 <alias value="inline resources" />
296 <alias value="anonymous resources" />
297 <alias value="contained resources" />
298 <min value="0" />
299 <max value="*" />
300 <base>
301 <path value="DomainResource.contained" />
302 <min value="0" />
303 <max value="*" />
304 </base>
305 <type>
306 <code value="Resource" />
307 </type>
308 <condition value="dom-2" />
309 <condition value="dom-4" />
310 <condition value="dom-3" />
311 <condition value="dom-5" />
312 <mustSupport value="false" />
313 <isModifier value="false" />
314 <isSummary value="false" />
315 <mapping>
316 <identity value="rim" />
317 <map value="N/A" />
318 </mapping>
319 </element>
320 <element id="CoverageEligibilityRequest.extension">
321 <path value="CoverageEligibilityRequest.extension" />
322 <short value="Additional content defined by implementations" />
323 <definition value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
324 <comment value="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." />
325 <alias value="extensions" />
326 <alias value="user content" />
327 <min value="0" />
328 <max value="*" />
329 <base>
330 <path value="DomainResource.extension" />
331 <min value="0" />
332 <max value="*" />
333 </base>
334 <type>
335 <code value="Extension" />
336 </type>
337 <constraint>
338 <key value="ele-1" />
339 <severity value="error" />
340 <human value="All FHIR elements must have a @value or children" />
341 <expression value="hasValue() or (children().count() > id.count())" />
342 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
343 </constraint>
344 <constraint>
345 <key value="ext-1" />
346 <severity value="error" />
347 <human value="Must have either extensions or value[x], not both" />
348 <expression value="extension.exists() != value.exists()" />
349 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
350 </constraint>
351 <mustSupport value="false" />
352 <isModifier value="false" />
353 <isSummary value="false" />
354 <mapping>
355 <identity value="rim" />
356 <map value="N/A" />
357 </mapping>
358 </element>
359 <element id="CoverageEligibilityRequest.modifierExtension">
360 <path value="CoverageEligibilityRequest.modifierExtension" />
361 <short value="Extensions that cannot be ignored" />
362 <definition value="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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
363 <comment value="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." />
364 <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
365 <alias value="extensions" />
366 <alias value="user content" />
367 <min value="0" />
368 <max value="*" />
369 <base>
370 <path value="DomainResource.modifierExtension" />
371 <min value="0" />
372 <max value="*" />
373 </base>
374 <type>
375 <code value="Extension" />
376 </type>
377 <constraint>
378 <key value="ele-1" />
379 <severity value="error" />
380 <human value="All FHIR elements must have a @value or children" />
381 <expression value="hasValue() or (children().count() > id.count())" />
382 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
383 </constraint>
384 <constraint>
385 <key value="ext-1" />
386 <severity value="error" />
387 <human value="Must have either extensions or value[x], not both" />
388 <expression value="extension.exists() != value.exists()" />
389 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
390 </constraint>
391 <mustSupport value="false" />
392 <isModifier value="true" />
393 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
394 <isSummary value="true" />
395 <mapping>
396 <identity value="rim" />
397 <map value="N/A" />
398 </mapping>
399 </element>
400 <element id="CoverageEligibilityRequest.identifier">
401 <path value="CoverageEligibilityRequest.identifier" />
402 <short value="Business Identifier for coverage eligiblity request" />
403 <definition value="A unique identifier assigned to this coverage eligiblity request." />
404 <requirements value="Allows coverage eligibility requests to be distinguished and referenced." />
405 <min value="0" />
406 <max value="*" />
407 <base>
408 <path value="CoverageEligibilityRequest.identifier" />
409 <min value="0" />
410 <max value="*" />
411 </base>
412 <type>
413 <code value="Identifier" />
414 </type>
415 <constraint>
416 <key value="ele-1" />
417 <severity value="error" />
418 <human value="All FHIR elements must have a @value or children" />
419 <expression value="hasValue() or (children().count() > id.count())" />
420 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
421 </constraint>
422 <mustSupport value="false" />
423 <isModifier value="false" />
424 <isSummary value="false" />
425 <mapping>
426 <identity value="workflow" />
427 <map value="Request.identifier" />
428 </mapping>
429 <mapping>
430 <identity value="w5" />
431 <map value="FiveWs.identifier" />
432 </mapping>
433 </element>
434 <element id="CoverageEligibilityRequest.status">
435 <path value="CoverageEligibilityRequest.status" />
436 <short value="active | cancelled | draft | entered-in-error" />
437 <definition value="The status of the resource instance." />
438 <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." />
439 <requirements value="Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'." />
440 <min value="1" />
441 <max value="1" />
442 <base>
443 <path value="CoverageEligibilityRequest.status" />
444 <min value="1" />
445 <max value="1" />
446 </base>
447 <type>
448 <code value="code" />
449 </type>
450 <constraint>
451 <key value="ele-1" />
452 <severity value="error" />
453 <human value="All FHIR elements must have a @value or children" />
454 <expression value="hasValue() or (children().count() > id.count())" />
455 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
456 </constraint>
457 <mustSupport value="false" />
458 <isModifier value="true" />
459 <isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
460 <isSummary value="true" />
461 <binding>
462 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
463 <valueString value="EligibilityRequestStatus" />
464 </extension>
465 <strength value="required" />
466 <description value="A code specifying the state of the resource instance." />
467 <valueSet value="http://hl7.org/fhir/ValueSet/fm-status|5.0.0" />
468 </binding>
469 <mapping>
470 <identity value="workflow" />
471 <map value="Request.status" />
472 </mapping>
473 <mapping>
474 <identity value="w5" />
475 <map value="FiveWs.status" />
476 </mapping>
477 </element>
478 <element id="CoverageEligibilityRequest.priority">
479 <path value="CoverageEligibilityRequest.priority" />
480 <short value="Desired processing priority" />
481 <definition value="When the requestor expects the processor to complete processing." />
482 <requirements value="Needed to advise the prossesor on the urgency of the request." />
483 <min value="0" />
484 <max value="1" />
485 <base>
486 <path value="CoverageEligibilityRequest.priority" />
487 <min value="0" />
488 <max value="1" />
489 </base>
490 <type>
491 <code value="CodeableConcept" />
492 </type>
493 <constraint>
494 <key value="ele-1" />
495 <severity value="error" />
496 <human value="All FHIR elements must have a @value or children" />
497 <expression value="hasValue() or (children().count() > id.count())" />
498 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
499 </constraint>
500 <mustSupport value="false" />
501 <isModifier value="false" />
502 <isSummary value="false" />
503 <binding>
504 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
505 <valueString value="ProcessPriority" />
506 </extension>
507 <strength value="example" />
508 <description value="The timeliness with which processing is required: STAT, normal, Deferred." />
509 <valueSet value="http://hl7.org/fhir/ValueSet/process-priority" />
510 </binding>
511 <mapping>
512 <identity value="workflow" />
513 <map value="Request.priority" />
514 </mapping>
515 <mapping>
516 <identity value="w5" />
517 <map value="FiveWs.class" />
518 </mapping>
519 </element>
520 <element id="CoverageEligibilityRequest.purpose">
521 <path value="CoverageEligibilityRequest.purpose" />
522 <short value="auth-requirements | benefits | discovery | validation" />
523 <definition value="Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified." />
524 <requirements value="To indicate the processing actions requested." />
525 <min value="1" />
526 <max value="*" />
527 <base>
528 <path value="CoverageEligibilityRequest.purpose" />
529 <min value="1" />
530 <max value="*" />
531 </base>
532 <type>
533 <code value="code" />
534 </type>
535 <constraint>
536 <key value="ele-1" />
537 <severity value="error" />
538 <human value="All FHIR elements must have a @value or children" />
539 <expression value="hasValue() or (children().count() > id.count())" />
540 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
541 </constraint>
542 <mustSupport value="false" />
543 <isModifier value="false" />
544 <isSummary value="true" />
545 <binding>
546 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
547 <valueString value="EligibilityRequestPurpose" />
548 </extension>
549 <strength value="required" />
550 <description value="A code specifying the types of information being requested." />
551 <valueSet value="http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0" />
552 </binding>
553 <mapping>
554 <identity value="w5" />
555 <map value="FiveWs.class" />
556 </mapping>
557 </element>
558 <element id="CoverageEligibilityRequest.patient">
559 <path value="CoverageEligibilityRequest.patient" />
560 <short value="Intended recipient of products and services" />
561 <definition value="The party who is the beneficiary of the supplied coverage and for whom eligibility is sought." />
562 <comment value="1..1." />
563 <requirements value="Required to provide context and coverage validation." />
564 <min value="1" />
565 <max value="1" />
566 <base>
567 <path value="CoverageEligibilityRequest.patient" />
568 <min value="1" />
569 <max value="1" />
570 </base>
571 <type>
572 <code value="Reference" />
573 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
574 </type>
575 <constraint>
576 <key value="ele-1" />
577 <severity value="error" />
578 <human value="All FHIR elements must have a @value or children" />
579 <expression value="hasValue() or (children().count() > id.count())" />
580 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
581 </constraint>
582 <mustSupport value="false" />
583 <isModifier value="false" />
584 <isSummary value="true" />
585 <mapping>
586 <identity value="workflow" />
587 <map value="Request.subject" />
588 </mapping>
589 <mapping>
590 <identity value="w5" />
591 <map value="FiveWs.subject[x]" />
592 </mapping>
593 </element>
594 <element id="CoverageEligibilityRequest.event">
595 <path value="CoverageEligibilityRequest.event" />
596 <short value="Event information" />
597 <definition value="Information code for an event with a corresponding date or period." />
598 <min value="0" />
599 <max value="*" />
600 <base>
601 <path value="CoverageEligibilityRequest.event" />
602 <min value="0" />
603 <max value="*" />
604 </base>
605 <type>
606 <code value="BackboneElement" />
607 </type>
608 <constraint>
609 <key value="ele-1" />
610 <severity value="error" />
611 <human value="All FHIR elements must have a @value or children" />
612 <expression value="hasValue() or (children().count() > id.count())" />
613 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
614 </constraint>
615 <mustSupport value="false" />
616 <isModifier value="false" />
617 <isSummary value="false" />
618 </element>
619 <element id="CoverageEligibilityRequest.event.id">
620 <path value="CoverageEligibilityRequest.event.id" />
621 <representation value="xmlAttr" />
622 <short value="Unique id for inter-element referencing" />
623 <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
624 <min value="0" />
625 <max value="1" />
626 <base>
627 <path value="Element.id" />
628 <min value="0" />
629 <max value="1" />
630 </base>
631 <type>
632 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
633 <valueUrl value="string" />
634 </extension>
635 <code value="http://hl7.org/fhirpath/System.String" />
636 </type>
637 <condition value="ele-1" />
638 <isModifier value="false" />
639 <isSummary value="false" />
640 <mapping>
641 <identity value="rim" />
642 <map value="n/a" />
643 </mapping>
644 </element>
645 <element id="CoverageEligibilityRequest.event.extension">
646 <path value="CoverageEligibilityRequest.event.extension" />
647 <short value="Additional content defined by implementations" />
648 <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
649 <comment value="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." />
650 <alias value="extensions" />
651 <alias value="user content" />
652 <min value="0" />
653 <max value="*" />
654 <base>
655 <path value="Element.extension" />
656 <min value="0" />
657 <max value="*" />
658 </base>
659 <type>
660 <code value="Extension" />
661 </type>
662 <constraint>
663 <key value="ele-1" />
664 <severity value="error" />
665 <human value="All FHIR elements must have a @value or children" />
666 <expression value="hasValue() or (children().count() > id.count())" />
667 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
668 </constraint>
669 <constraint>
670 <key value="ext-1" />
671 <severity value="error" />
672 <human value="Must have either extensions or value[x], not both" />
673 <expression value="extension.exists() != value.exists()" />
674 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
675 </constraint>
676 <isModifier value="false" />
677 <isSummary value="false" />
678 <mapping>
679 <identity value="rim" />
680 <map value="n/a" />
681 </mapping>
682 </element>
683 <element id="CoverageEligibilityRequest.event.modifierExtension">
684 <path value="CoverageEligibilityRequest.event.modifierExtension" />
685 <short value="Extensions that cannot be ignored even if unrecognized" />
686 <definition value="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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
687 <comment value="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." />
688 <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
689 <alias value="extensions" />
690 <alias value="user content" />
691 <alias value="modifiers" />
692 <min value="0" />
693 <max value="*" />
694 <base>
695 <path value="BackboneElement.modifierExtension" />
696 <min value="0" />
697 <max value="*" />
698 </base>
699 <type>
700 <code value="Extension" />
701 </type>
702 <constraint>
703 <key value="ele-1" />
704 <severity value="error" />
705 <human value="All FHIR elements must have a @value or children" />
706 <expression value="hasValue() or (children().count() > id.count())" />
707 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
708 </constraint>
709 <constraint>
710 <key value="ext-1" />
711 <severity value="error" />
712 <human value="Must have either extensions or value[x], not both" />
713 <expression value="extension.exists() != value.exists()" />
714 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
715 </constraint>
716 <isModifier value="true" />
717 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
718 <isSummary value="true" />
719 <mapping>
720 <identity value="rim" />
721 <map value="N/A" />
722 </mapping>
723 </element>
724 <element id="CoverageEligibilityRequest.event.type">
725 <path value="CoverageEligibilityRequest.event.type" />
726 <short value="Specific event" />
727 <definition value="A coded event such as when a service is expected or a card printed." />
728 <min value="1" />
729 <max value="1" />
730 <base>
731 <path value="CoverageEligibilityRequest.event.type" />
732 <min value="1" />
733 <max value="1" />
734 </base>
735 <type>
736 <code value="CodeableConcept" />
737 </type>
738 <constraint>
739 <key value="ele-1" />
740 <severity value="error" />
741 <human value="All FHIR elements must have a @value or children" />
742 <expression value="hasValue() or (children().count() > id.count())" />
743 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
744 </constraint>
745 <mustSupport value="false" />
746 <isModifier value="false" />
747 <isSummary value="false" />
748 <binding>
749 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
750 <valueString value="DatesType" />
751 </extension>
752 <strength value="example" />
753 <valueSet value="http://hl7.org/fhir/ValueSet/datestype" />
754 </binding>
755 </element>
756 <element id="CoverageEligibilityRequest.event.when[x]">
757 <path value="CoverageEligibilityRequest.event.when[x]" />
758 <short value="Occurance date or period" />
759 <definition value="A date or period in the past or future indicating when the event occurred or is expectd to occur." />
760 <min value="1" />
761 <max value="1" />
762 <base>
763 <path value="CoverageEligibilityRequest.event.when[x]" />
764 <min value="1" />
765 <max value="1" />
766 </base>
767 <type>
768 <code value="dateTime" />
769 </type>
770 <type>
771 <code value="Period" />
772 </type>
773 <constraint>
774 <key value="ele-1" />
775 <severity value="error" />
776 <human value="All FHIR elements must have a @value or children" />
777 <expression value="hasValue() or (children().count() > id.count())" />
778 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
779 </constraint>
780 <mustSupport value="false" />
781 <isModifier value="false" />
782 <isSummary value="false" />
783 </element>
784 <element id="CoverageEligibilityRequest.serviced[x]">
785 <path value="CoverageEligibilityRequest.serviced[x]" />
786 <short value="Estimated date or dates of service" />
787 <definition value="The date or dates when the enclosed suite of services were performed or completed." />
788 <requirements value="Required to provide time context for the request." />
789 <min value="0" />
790 <max value="1" />
791 <base>
792 <path value="CoverageEligibilityRequest.serviced[x]" />
793 <min value="0" />
794 <max value="1" />
795 </base>
796 <type>
797 <code value="date" />
798 </type>
799 <type>
800 <code value="Period" />
801 </type>
802 <constraint>
803 <key value="ele-1" />
804 <severity value="error" />
805 <human value="All FHIR elements must have a @value or children" />
806 <expression value="hasValue() or (children().count() > id.count())" />
807 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
808 </constraint>
809 <mustSupport value="false" />
810 <isModifier value="false" />
811 <isSummary value="false" />
812 <mapping>
813 <identity value="w5" />
814 <map value="FiveWs.done[x]" />
815 </mapping>
816 </element>
817 <element id="CoverageEligibilityRequest.created">
818 <path value="CoverageEligibilityRequest.created" />
819 <short value="Creation date" />
820 <definition value="The date when this resource was created." />
821 <requirements value="Need to record a timestamp for use by both the recipient and the issuer." />
822 <min value="1" />
823 <max value="1" />
824 <base>
825 <path value="CoverageEligibilityRequest.created" />
826 <min value="1" />
827 <max value="1" />
828 </base>
829 <type>
830 <code value="dateTime" />
831 </type>
832 <constraint>
833 <key value="ele-1" />
834 <severity value="error" />
835 <human value="All FHIR elements must have a @value or children" />
836 <expression value="hasValue() or (children().count() > id.count())" />
837 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
838 </constraint>
839 <mustSupport value="false" />
840 <isModifier value="false" />
841 <isSummary value="true" />
842 <mapping>
843 <identity value="workflow" />
844 <map value="Request.authoredOn" />
845 </mapping>
846 <mapping>
847 <identity value="w5" />
848 <map value="FiveWs.recorded" />
849 </mapping>
850 </element>
851 <element id="CoverageEligibilityRequest.enterer">
852 <path value="CoverageEligibilityRequest.enterer" />
853 <short value="Author" />
854 <definition value="Person who created the request." />
855 <requirements value="Some jurisdictions require the contact information for personnel completing eligibility requests." />
856 <min value="0" />
857 <max value="1" />
858 <base>
859 <path value="CoverageEligibilityRequest.enterer" />
860 <min value="0" />
861 <max value="1" />
862 </base>
863 <type>
864 <code value="Reference" />
865 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
866 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
867 </type>
868 <constraint>
869 <key value="ele-1" />
870 <severity value="error" />
871 <human value="All FHIR elements must have a @value or children" />
872 <expression value="hasValue() or (children().count() > id.count())" />
873 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
874 </constraint>
875 <mustSupport value="false" />
876 <isModifier value="false" />
877 <isSummary value="false" />
878 <mapping>
879 <identity value="w5" />
880 <map value="FiveWs.author" />
881 </mapping>
882 </element>
883 <element id="CoverageEligibilityRequest.provider">
884 <path value="CoverageEligibilityRequest.provider" />
885 <short value="Party responsible for the request" />
886 <definition value="The provider which is responsible for the request." />
887 <comment value="Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner." />
888 <requirements value="Needed to identify the requestor." />
889 <min value="0" />
890 <max value="1" />
891 <base>
892 <path value="CoverageEligibilityRequest.provider" />
893 <min value="0" />
894 <max value="1" />
895 </base>
896 <type>
897 <code value="Reference" />
898 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
899 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
900 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
901 </type>
902 <constraint>
903 <key value="ele-1" />
904 <severity value="error" />
905 <human value="All FHIR elements must have a @value or children" />
906 <expression value="hasValue() or (children().count() > id.count())" />
907 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
908 </constraint>
909 <mustSupport value="false" />
910 <isModifier value="false" />
911 <isSummary value="false" />
912 <mapping>
913 <identity value="workflow" />
914 <map value="Request.requester" />
915 </mapping>
916 <mapping>
917 <identity value="w5" />
918 <map value="FiveWs.source" />
919 </mapping>
920 </element>
921 <element id="CoverageEligibilityRequest.insurer">
922 <path value="CoverageEligibilityRequest.insurer" />
923 <short value="Coverage issuer" />
924 <definition value="The Insurer who issued the coverage in question and is the recipient of the request." />
925 <requirements value="Need to identify the recipient." />
926 <min value="1" />
927 <max value="1" />
928 <base>
929 <path value="CoverageEligibilityRequest.insurer" />
930 <min value="1" />
931 <max value="1" />
932 </base>
933 <type>
934 <code value="Reference" />
935 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
936 </type>
937 <constraint>
938 <key value="ele-1" />
939 <severity value="error" />
940 <human value="All FHIR elements must have a @value or children" />
941 <expression value="hasValue() or (children().count() > id.count())" />
942 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
943 </constraint>
944 <mustSupport value="false" />
945 <isModifier value="false" />
946 <isSummary value="true" />
947 <mapping>
948 <identity value="workflow" />
949 <map value="Request.performer" />
950 </mapping>
951 <mapping>
952 <identity value="w5" />
953 <map value="FiveWs.who" />
954 </mapping>
955 </element>
956 <element id="CoverageEligibilityRequest.facility">
957 <path value="CoverageEligibilityRequest.facility" />
958 <short value="Servicing facility" />
959 <definition value="Facility where the services are intended to be provided." />
960 <requirements value="Insurance adjudication can be dependant on where services were delivered." />
961 <min value="0" />
962 <max value="1" />
963 <base>
964 <path value="CoverageEligibilityRequest.facility" />
965 <min value="0" />
966 <max value="1" />
967 </base>
968 <type>
969 <code value="Reference" />
970 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
971 </type>
972 <constraint>
973 <key value="ele-1" />
974 <severity value="error" />
975 <human value="All FHIR elements must have a @value or children" />
976 <expression value="hasValue() or (children().count() > id.count())" />
977 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
978 </constraint>
979 <mustSupport value="false" />
980 <isModifier value="false" />
981 <isSummary value="false" />
982 <mapping>
983 <identity value="w5" />
984 <map value="FiveWs.where[x]" />
985 </mapping>
986 </element>
987 <element id="CoverageEligibilityRequest.supportingInfo">
988 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
989 <valueString value="SupportingInformation" />
990 </extension>
991 <path value="CoverageEligibilityRequest.supportingInfo" />
992 <short value="Supporting information" />
993 <definition value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues." />
994 <comment value="Often there are multiple jurisdiction specific valuesets which are required." />
995 <requirements value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered." />
996 <min value="0" />
997 <max value="*" />
998 <base>
999 <path value="CoverageEligibilityRequest.supportingInfo" />
1000 <min value="0" />
1001 <max value="*" />
1002 </base>
1003 <type>
1004 <code value="BackboneElement" />
1005 </type>
1006 <constraint>
1007 <key value="ele-1" />
1008 <severity value="error" />
1009 <human value="All FHIR elements must have a @value or children" />
1010 <expression value="hasValue() or (children().count() > id.count())" />
1011 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1012 </constraint>
1013 <mustSupport value="false" />
1014 <isModifier value="false" />
1015 <isSummary value="false" />
1016 </element>
1017 <element id="CoverageEligibilityRequest.supportingInfo.id">
1018 <path value="CoverageEligibilityRequest.supportingInfo.id" />
1019 <representation value="xmlAttr" />
1020 <short value="Unique id for inter-element referencing" />
1021 <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
1022 <min value="0" />
1023 <max value="1" />
1024 <base>
1025 <path value="Element.id" />
1026 <min value="0" />
1027 <max value="1" />
1028 </base>
1029 <type>
1030 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
1031 <valueUrl value="string" />
1032 </extension>
1033 <code value="http://hl7.org/fhirpath/System.String" />
1034 </type>
1035 <condition value="ele-1" />
1036 <isModifier value="false" />
1037 <isSummary value="false" />
1038 <mapping>
1039 <identity value="rim" />
1040 <map value="n/a" />
1041 </mapping>
1042 </element>
1043 <element id="CoverageEligibilityRequest.supportingInfo.extension">
1044 <path value="CoverageEligibilityRequest.supportingInfo.extension" />
1045 <short value="Additional content defined by implementations" />
1046 <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
1047 <comment value="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." />
1048 <alias value="extensions" />
1049 <alias value="user content" />
1050 <min value="0" />
1051 <max value="*" />
1052 <base>
1053 <path value="Element.extension" />
1054 <min value="0" />
1055 <max value="*" />
1056 </base>
1057 <type>
1058 <code value="Extension" />
1059 </type>
1060 <constraint>
1061 <key value="ele-1" />
1062 <severity value="error" />
1063 <human value="All FHIR elements must have a @value or children" />
1064 <expression value="hasValue() or (children().count() > id.count())" />
1065 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1066 </constraint>
1067 <constraint>
1068 <key value="ext-1" />
1069 <severity value="error" />
1070 <human value="Must have either extensions or value[x], not both" />
1071 <expression value="extension.exists() != value.exists()" />
1072 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1073 </constraint>
1074 <isModifier value="false" />
1075 <isSummary value="false" />
1076 <mapping>
1077 <identity value="rim" />
1078 <map value="n/a" />
1079 </mapping>
1080 </element>
1081 <element id="CoverageEligibilityRequest.supportingInfo.modifierExtension">
1082 <path value="CoverageEligibilityRequest.supportingInfo.modifierExtension" />
1083 <short value="Extensions that cannot be ignored even if unrecognized" />
1084 <definition value="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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
1085 <comment value="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." />
1086 <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
1087 <alias value="extensions" />
1088 <alias value="user content" />
1089 <alias value="modifiers" />
1090 <min value="0" />
1091 <max value="*" />
1092 <base>
1093 <path value="BackboneElement.modifierExtension" />
1094 <min value="0" />
1095 <max value="*" />
1096 </base>
1097 <type>
1098 <code value="Extension" />
1099 </type>
1100 <constraint>
1101 <key value="ele-1" />
1102 <severity value="error" />
1103 <human value="All FHIR elements must have a @value or children" />
1104 <expression value="hasValue() or (children().count() > id.count())" />
1105 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1106 </constraint>
1107 <constraint>
1108 <key value="ext-1" />
1109 <severity value="error" />
1110 <human value="Must have either extensions or value[x], not both" />
1111 <expression value="extension.exists() != value.exists()" />
1112 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1113 </constraint>
1114 <isModifier value="true" />
1115 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
1116 <isSummary value="true" />
1117 <mapping>
1118 <identity value="rim" />
1119 <map value="N/A" />
1120 </mapping>
1121 </element>
1122 <element id="CoverageEligibilityRequest.supportingInfo.sequence">
1123 <path value="CoverageEligibilityRequest.supportingInfo.sequence" />
1124 <short value="Information instance identifier" />
1125 <definition value="A number to uniquely identify supporting information entries." />
1126 <requirements value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details." />
1127 <min value="1" />
1128 <max value="1" />
1129 <base>
1130 <path value="CoverageEligibilityRequest.supportingInfo.sequence" />
1131 <min value="1" />
1132 <max value="1" />
1133 </base>
1134 <type>
1135 <code value="positiveInt" />
1136 </type>
1137 <constraint>
1138 <key value="ele-1" />
1139 <severity value="error" />
1140 <human value="All FHIR elements must have a @value or children" />
1141 <expression value="hasValue() or (children().count() > id.count())" />
1142 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1143 </constraint>
1144 <mustSupport value="false" />
1145 <isModifier value="false" />
1146 <isSummary value="false" />
1147 </element>
1148 <element id="CoverageEligibilityRequest.supportingInfo.information">
1149 <path value="CoverageEligibilityRequest.supportingInfo.information" />
1150 <short value="Data to be provided" />
1151 <definition value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data." />
1152 <comment value="Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident." />
1153 <requirements value="To convey the data content to be provided when the information is more than a simple code or period." />
1154 <min value="1" />
1155 <max value="1" />
1156 <base>
1157 <path value="CoverageEligibilityRequest.supportingInfo.information" />
1158 <min value="1" />
1159 <max value="1" />
1160 </base>
1161 <type>
1162 <code value="Reference" />
1163 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
1164 </type>
1165 <constraint>
1166 <key value="ele-1" />
1167 <severity value="error" />
1168 <human value="All FHIR elements must have a @value or children" />
1169 <expression value="hasValue() or (children().count() > id.count())" />
1170 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1171 </constraint>
1172 <mustSupport value="false" />
1173 <isModifier value="false" />
1174 <isSummary value="false" />
1175 </element>
1176 <element id="CoverageEligibilityRequest.supportingInfo.appliesToAll">
1177 <path value="CoverageEligibilityRequest.supportingInfo.appliesToAll" />
1178 <short value="Applies to all items" />
1179 <definition value="The supporting materials are applicable for all detail items, product/servce categories and specific billing codes." />
1180 <requirements value="Needed to convey that the information is universal to the request." />
1181 <min value="0" />
1182 <max value="1" />
1183 <base>
1184 <path value="CoverageEligibilityRequest.supportingInfo.appliesToAll" />
1185 <min value="0" />
1186 <max value="1" />
1187 </base>
1188 <type>
1189 <code value="boolean" />
1190 </type>
1191 <constraint>
1192 <key value="ele-1" />
1193 <severity value="error" />
1194 <human value="All FHIR elements must have a @value or children" />
1195 <expression value="hasValue() or (children().count() > id.count())" />
1196 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1197 </constraint>
1198 <mustSupport value="false" />
1199 <isModifier value="false" />
1200 <isSummary value="false" />
1201 </element>
1202 <element id="CoverageEligibilityRequest.insurance">
1203 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
1204 <valueString value="Insurance" />
1205 </extension>
1206 <path value="CoverageEligibilityRequest.insurance" />
1207 <short value="Patient insurance information" />
1208 <definition value="Financial instruments for reimbursement for the health care products and services." />
1209 <comment value="All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim." />
1210 <requirements value="There must be at least one coverage for which eligibility is requested." />
1211 <min value="0" />
1212 <max value="*" />
1213 <base>
1214 <path value="CoverageEligibilityRequest.insurance" />
1215 <min value="0" />
1216 <max value="*" />
1217 </base>
1218 <type>
1219 <code value="BackboneElement" />
1220 </type>
1221 <constraint>
1222 <key value="ele-1" />
1223 <severity value="error" />
1224 <human value="All FHIR elements must have a @value or children" />
1225 <expression value="hasValue() or (children().count() > id.count())" />
1226 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1227 </constraint>
1228 <mustSupport value="false" />
1229 <isModifier value="false" />
1230 <isSummary value="false" />
1231 </element>
1232 <element id="CoverageEligibilityRequest.insurance.id">
1233 <path value="CoverageEligibilityRequest.insurance.id" />
1234 <representation value="xmlAttr" />
1235 <short value="Unique id for inter-element referencing" />
1236 <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
1237 <min value="0" />
1238 <max value="1" />
1239 <base>
1240 <path value="Element.id" />
1241 <min value="0" />
1242 <max value="1" />
1243 </base>
1244 <type>
1245 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
1246 <valueUrl value="string" />
1247 </extension>
1248 <code value="http://hl7.org/fhirpath/System.String" />
1249 </type>
1250 <condition value="ele-1" />
1251 <isModifier value="false" />
1252 <isSummary value="false" />
1253 <mapping>
1254 <identity value="rim" />
1255 <map value="n/a" />
1256 </mapping>
1257 </element>
1258 <element id="CoverageEligibilityRequest.insurance.extension">
1259 <path value="CoverageEligibilityRequest.insurance.extension" />
1260 <short value="Additional content defined by implementations" />
1261 <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
1262 <comment value="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." />
1263 <alias value="extensions" />
1264 <alias value="user content" />
1265 <min value="0" />
1266 <max value="*" />
1267 <base>
1268 <path value="Element.extension" />
1269 <min value="0" />
1270 <max value="*" />
1271 </base>
1272 <type>
1273 <code value="Extension" />
1274 </type>
1275 <constraint>
1276 <key value="ele-1" />
1277 <severity value="error" />
1278 <human value="All FHIR elements must have a @value or children" />
1279 <expression value="hasValue() or (children().count() > id.count())" />
1280 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1281 </constraint>
1282 <constraint>
1283 <key value="ext-1" />
1284 <severity value="error" />
1285 <human value="Must have either extensions or value[x], not both" />
1286 <expression value="extension.exists() != value.exists()" />
1287 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1288 </constraint>
1289 <isModifier value="false" />
1290 <isSummary value="false" />
1291 <mapping>
1292 <identity value="rim" />
1293 <map value="n/a" />
1294 </mapping>
1295 </element>
1296 <element id="CoverageEligibilityRequest.insurance.modifierExtension">
1297 <path value="CoverageEligibilityRequest.insurance.modifierExtension" />
1298 <short value="Extensions that cannot be ignored even if unrecognized" />
1299 <definition value="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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
1300 <comment value="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." />
1301 <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
1302 <alias value="extensions" />
1303 <alias value="user content" />
1304 <alias value="modifiers" />
1305 <min value="0" />
1306 <max value="*" />
1307 <base>
1308 <path value="BackboneElement.modifierExtension" />
1309 <min value="0" />
1310 <max value="*" />
1311 </base>
1312 <type>
1313 <code value="Extension" />
1314 </type>
1315 <constraint>
1316 <key value="ele-1" />
1317 <severity value="error" />
1318 <human value="All FHIR elements must have a @value or children" />
1319 <expression value="hasValue() or (children().count() > id.count())" />
1320 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1321 </constraint>
1322 <constraint>
1323 <key value="ext-1" />
1324 <severity value="error" />
1325 <human value="Must have either extensions or value[x], not both" />
1326 <expression value="extension.exists() != value.exists()" />
1327 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1328 </constraint>
1329 <isModifier value="true" />
1330 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
1331 <isSummary value="true" />
1332 <mapping>
1333 <identity value="rim" />
1334 <map value="N/A" />
1335 </mapping>
1336 </element>
1337 <element id="CoverageEligibilityRequest.insurance.focal">
1338 <path value="CoverageEligibilityRequest.insurance.focal" />
1339 <short value="Applicable coverage" />
1340 <definition value="A flag to indicate that this Coverage is to be used for evaluation of this request when set to true." />
1341 <comment value="A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies." />
1342 <requirements value="To identify which coverage in the list is being used to evaluate this request." />
1343 <min value="0" />
1344 <max value="1" />
1345 <base>
1346 <path value="CoverageEligibilityRequest.insurance.focal" />
1347 <min value="0" />
1348 <max value="1" />
1349 </base>
1350 <type>
1351 <code value="boolean" />
1352 </type>
1353 <constraint>
1354 <key value="ele-1" />
1355 <severity value="error" />
1356 <human value="All FHIR elements must have a @value or children" />
1357 <expression value="hasValue() or (children().count() > id.count())" />
1358 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1359 </constraint>
1360 <mustSupport value="false" />
1361 <isModifier value="false" />
1362 <isSummary value="false" />
1363 </element>
1364 <element id="CoverageEligibilityRequest.insurance.coverage">
1365 <path value="CoverageEligibilityRequest.insurance.coverage" />
1366 <short value="Insurance information" />
1367 <definition value="Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system." />
1368 <requirements value="Required to allow the adjudicator to locate the correct policy and history within their information system." />
1369 <min value="1" />
1370 <max value="1" />
1371 <base>
1372 <path value="CoverageEligibilityRequest.insurance.coverage" />
1373 <min value="1" />
1374 <max value="1" />
1375 </base>
1376 <type>
1377 <code value="Reference" />
1378 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage" />
1379 </type>
1380 <constraint>
1381 <key value="ele-1" />
1382 <severity value="error" />
1383 <human value="All FHIR elements must have a @value or children" />
1384 <expression value="hasValue() or (children().count() > id.count())" />
1385 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1386 </constraint>
1387 <mustSupport value="false" />
1388 <isModifier value="false" />
1389 <isSummary value="false" />
1390 </element>
1391 <element id="CoverageEligibilityRequest.insurance.businessArrangement">
1392 <path value="CoverageEligibilityRequest.insurance.businessArrangement" />
1393 <short value="Additional provider contract number" />
1394 <definition value="A business agreement number established between the provider and the insurer for special business processing purposes." />
1395 <requirements value="Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication." />
1396 <min value="0" />
1397 <max value="1" />
1398 <base>
1399 <path value="CoverageEligibilityRequest.insurance.businessArrangement" />
1400 <min value="0" />
1401 <max value="1" />
1402 </base>
1403 <type>
1404 <code value="string" />
1405 </type>
1406 <constraint>
1407 <key value="ele-1" />
1408 <severity value="error" />
1409 <human value="All FHIR elements must have a @value or children" />
1410 <expression value="hasValue() or (children().count() > id.count())" />
1411 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1412 </constraint>
1413 <mustSupport value="false" />
1414 <isModifier value="false" />
1415 <isSummary value="false" />
1416 </element>
1417 <element id="CoverageEligibilityRequest.item">
1418 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
1419 <valueString value="Details" />
1420 </extension>
1421 <path value="CoverageEligibilityRequest.item" />
1422 <short value="Item to be evaluated for eligibiity" />
1423 <definition value="Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor." />
1424 <requirements value="The items to be processed for the request." />
1425 <min value="0" />
1426 <max value="*" />
1427 <base>
1428 <path value="CoverageEligibilityRequest.item" />
1429 <min value="0" />
1430 <max value="*" />
1431 </base>
1432 <type>
1433 <code value="BackboneElement" />
1434 </type>
1435 <constraint>
1436 <key value="ele-1" />
1437 <severity value="error" />
1438 <human value="All FHIR elements must have a @value or children" />
1439 <expression value="hasValue() or (children().count() > id.count())" />
1440 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1441 </constraint>
1442 <mustSupport value="false" />
1443 <isModifier value="false" />
1444 <isSummary value="false" />
1445 </element>
1446 <element id="CoverageEligibilityRequest.item.id">
1447 <path value="CoverageEligibilityRequest.item.id" />
1448 <representation value="xmlAttr" />
1449 <short value="Unique id for inter-element referencing" />
1450 <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
1451 <min value="0" />
1452 <max value="1" />
1453 <base>
1454 <path value="Element.id" />
1455 <min value="0" />
1456 <max value="1" />
1457 </base>
1458 <type>
1459 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
1460 <valueUrl value="string" />
1461 </extension>
1462 <code value="http://hl7.org/fhirpath/System.String" />
1463 </type>
1464 <condition value="ele-1" />
1465 <isModifier value="false" />
1466 <isSummary value="false" />
1467 <mapping>
1468 <identity value="rim" />
1469 <map value="n/a" />
1470 </mapping>
1471 </element>
1472 <element id="CoverageEligibilityRequest.item.extension">
1473 <path value="CoverageEligibilityRequest.item.extension" />
1474 <short value="Additional content defined by implementations" />
1475 <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
1476 <comment value="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." />
1477 <alias value="extensions" />
1478 <alias value="user content" />
1479 <min value="0" />
1480 <max value="*" />
1481 <base>
1482 <path value="Element.extension" />
1483 <min value="0" />
1484 <max value="*" />
1485 </base>
1486 <type>
1487 <code value="Extension" />
1488 </type>
1489 <constraint>
1490 <key value="ele-1" />
1491 <severity value="error" />
1492 <human value="All FHIR elements must have a @value or children" />
1493 <expression value="hasValue() or (children().count() > id.count())" />
1494 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1495 </constraint>
1496 <constraint>
1497 <key value="ext-1" />
1498 <severity value="error" />
1499 <human value="Must have either extensions or value[x], not both" />
1500 <expression value="extension.exists() != value.exists()" />
1501 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1502 </constraint>
1503 <isModifier value="false" />
1504 <isSummary value="false" />
1505 <mapping>
1506 <identity value="rim" />
1507 <map value="n/a" />
1508 </mapping>
1509 </element>
1510 <element id="CoverageEligibilityRequest.item.modifierExtension">
1511 <path value="CoverageEligibilityRequest.item.modifierExtension" />
1512 <short value="Extensions that cannot be ignored even if unrecognized" />
1513 <definition value="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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
1514 <comment value="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." />
1515 <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
1516 <alias value="extensions" />
1517 <alias value="user content" />
1518 <alias value="modifiers" />
1519 <min value="0" />
1520 <max value="*" />
1521 <base>
1522 <path value="BackboneElement.modifierExtension" />
1523 <min value="0" />
1524 <max value="*" />
1525 </base>
1526 <type>
1527 <code value="Extension" />
1528 </type>
1529 <constraint>
1530 <key value="ele-1" />
1531 <severity value="error" />
1532 <human value="All FHIR elements must have a @value or children" />
1533 <expression value="hasValue() or (children().count() > id.count())" />
1534 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1535 </constraint>
1536 <constraint>
1537 <key value="ext-1" />
1538 <severity value="error" />
1539 <human value="Must have either extensions or value[x], not both" />
1540 <expression value="extension.exists() != value.exists()" />
1541 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1542 </constraint>
1543 <isModifier value="true" />
1544 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
1545 <isSummary value="true" />
1546 <mapping>
1547 <identity value="rim" />
1548 <map value="N/A" />
1549 </mapping>
1550 </element>
1551 <element id="CoverageEligibilityRequest.item.supportingInfoSequence">
1552 <path value="CoverageEligibilityRequest.item.supportingInfoSequence" />
1553 <short value="Applicable exception or supporting information" />
1554 <definition value="Exceptions, special conditions and supporting information applicable for this service or product line." />
1555 <requirements value="Needed to support or inform the consideration for eligibility." />
1556 <min value="0" />
1557 <max value="*" />
1558 <base>
1559 <path value="CoverageEligibilityRequest.item.supportingInfoSequence" />
1560 <min value="0" />
1561 <max value="*" />
1562 </base>
1563 <type>
1564 <code value="positiveInt" />
1565 </type>
1566 <constraint>
1567 <key value="ele-1" />
1568 <severity value="error" />
1569 <human value="All FHIR elements must have a @value or children" />
1570 <expression value="hasValue() or (children().count() > id.count())" />
1571 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1572 </constraint>
1573 <mustSupport value="false" />
1574 <isModifier value="false" />
1575 <isSummary value="false" />
1576 </element>
1577 <element id="CoverageEligibilityRequest.item.category">
1578 <path value="CoverageEligibilityRequest.item.category" />
1579 <short value="Benefit classification" />
1580 <definition value="Code to identify the general type of benefits under which products and services are provided." />
1581 <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage." />
1582 <requirements value="Needed to convey the category of service or product for which eligibility is sought." />
1583 <min value="0" />
1584 <max value="1" />
1585 <base>
1586 <path value="CoverageEligibilityRequest.item.category" />
1587 <min value="0" />
1588 <max value="1" />
1589 </base>
1590 <type>
1591 <code value="CodeableConcept" />
1592 </type>
1593 <constraint>
1594 <key value="ele-1" />
1595 <severity value="error" />
1596 <human value="All FHIR elements must have a @value or children" />
1597 <expression value="hasValue() or (children().count() > id.count())" />
1598 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1599 </constraint>
1600 <mustSupport value="false" />
1601 <isModifier value="false" />
1602 <isSummary value="false" />
1603 <binding>
1604 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1605 <valueString value="BenefitCategory" />
1606 </extension>
1607 <strength value="example" />
1608 <description value="Benefit categories such as: oral, medical, vision etc." />
1609 <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory" />
1610 </binding>
1611 </element>
1612 <element id="CoverageEligibilityRequest.item.productOrService">
1613 <path value="CoverageEligibilityRequest.item.productOrService" />
1614 <short value="Billing, service, product, or drug code" />
1615 <definition value="This contains the product, service, drug or other billing code for the item." />
1616 <comment value="Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI)." />
1617 <requirements value="Needed to convey the actual service or product for which eligibility is sought." />
1618 <min value="0" />
1619 <max value="1" />
1620 <base>
1621 <path value="CoverageEligibilityRequest.item.productOrService" />
1622 <min value="0" />
1623 <max value="1" />
1624 </base>
1625 <type>
1626 <code value="CodeableConcept" />
1627 </type>
1628 <constraint>
1629 <key value="ele-1" />
1630 <severity value="error" />
1631 <human value="All FHIR elements must have a @value or children" />
1632 <expression value="hasValue() or (children().count() > id.count())" />
1633 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1634 </constraint>
1635 <mustSupport value="false" />
1636 <isModifier value="false" />
1637 <isSummary value="false" />
1638 <binding>
1639 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1640 <valueString value="ServiceProduct" />
1641 </extension>
1642 <strength value="example" />
1643 <description value="Allowable service and product codes." />
1644 <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" />
1645 </binding>
1646 </element>
1647 <element id="CoverageEligibilityRequest.item.modifier">
1648 <path value="CoverageEligibilityRequest.item.modifier" />
1649 <short value="Product or service billing modifiers" />
1650 <definition value="Item typification or modifiers codes to convey additional context for the product or service." />
1651 <comment value="For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours." />
1652 <requirements value="To support provision of the item or to charge an elevated fee." />
1653 <min value="0" />
1654 <max value="*" />
1655 <base>
1656 <path value="CoverageEligibilityRequest.item.modifier" />
1657 <min value="0" />
1658 <max value="*" />
1659 </base>
1660 <type>
1661 <code value="CodeableConcept" />
1662 </type>
1663 <constraint>
1664 <key value="ele-1" />
1665 <severity value="error" />
1666 <human value="All FHIR elements must have a @value or children" />
1667 <expression value="hasValue() or (children().count() > id.count())" />
1668 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1669 </constraint>
1670 <mustSupport value="false" />
1671 <isModifier value="false" />
1672 <isSummary value="false" />
1673 <binding>
1674 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1675 <valueString value="Modifiers" />
1676 </extension>
1677 <strength value="example" />
1678 <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." />
1679 <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers" />
1680 </binding>
1681 </element>
1682 <element id="CoverageEligibilityRequest.item.provider">
1683 <path value="CoverageEligibilityRequest.item.provider" />
1684 <short value="Perfoming practitioner" />
1685 <definition value="The practitioner who is responsible for the product or service to be rendered to the patient." />
1686 <requirements value="Needed to support the evaluation of the eligibility." />
1687 <min value="0" />
1688 <max value="1" />
1689 <base>
1690 <path value="CoverageEligibilityRequest.item.provider" />
1691 <min value="0" />
1692 <max value="1" />
1693 </base>
1694 <type>
1695 <code value="Reference" />
1696 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
1697 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
1698 </type>
1699 <constraint>
1700 <key value="ele-1" />
1701 <severity value="error" />
1702 <human value="All FHIR elements must have a @value or children" />
1703 <expression value="hasValue() or (children().count() > id.count())" />
1704 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1705 </constraint>
1706 <mustSupport value="false" />
1707 <isModifier value="false" />
1708 <isSummary value="false" />
1709 <mapping>
1710 <identity value="workflow" />
1711 <map value="Request.requester" />
1712 </mapping>
1713 <mapping>
1714 <identity value="w5" />
1715 <map value="FiveWs.source" />
1716 </mapping>
1717 </element>
1718 <element id="CoverageEligibilityRequest.item.quantity">
1719 <path value="CoverageEligibilityRequest.item.quantity" />
1720 <short value="Count of products or services" />
1721 <definition value="The number of repetitions of a service or product." />
1722 <requirements value="Required when the product or service code does not convey the quantity provided." />
1723 <min value="0" />
1724 <max value="1" />
1725 <base>
1726 <path value="CoverageEligibilityRequest.item.quantity" />
1727 <min value="0" />
1728 <max value="1" />
1729 </base>
1730 <type>
1731 <code value="Quantity" />
1732 <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
1733 </type>
1734 <constraint>
1735 <key value="ele-1" />
1736 <severity value="error" />
1737 <human value="All FHIR elements must have a @value or children" />
1738 <expression value="hasValue() or (children().count() > id.count())" />
1739 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1740 </constraint>
1741 <mustSupport value="false" />
1742 <isModifier value="false" />
1743 <isSummary value="false" />
1744 </element>
1745 <element id="CoverageEligibilityRequest.item.unitPrice">
1746 <path value="CoverageEligibilityRequest.item.unitPrice" />
1747 <short value="Fee, charge or cost per item" />
1748 <definition value="The amount charged to the patient by the provider for a single unit." />
1749 <requirements value="Needed to support the evaluation of the eligibility." />
1750 <min value="0" />
1751 <max value="1" />
1752 <base>
1753 <path value="CoverageEligibilityRequest.item.unitPrice" />
1754 <min value="0" />
1755 <max value="1" />
1756 </base>
1757 <type>
1758 <code value="Money" />
1759 </type>
1760 <constraint>
1761 <key value="ele-1" />
1762 <severity value="error" />
1763 <human value="All FHIR elements must have a @value or children" />
1764 <expression value="hasValue() or (children().count() > id.count())" />
1765 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1766 </constraint>
1767 <mustSupport value="false" />
1768 <isModifier value="false" />
1769 <isSummary value="false" />
1770 </element>
1771 <element id="CoverageEligibilityRequest.item.facility">
1772 <path value="CoverageEligibilityRequest.item.facility" />
1773 <short value="Servicing facility" />
1774 <definition value="Facility where the services will be provided." />
1775 <requirements value="Needed to support the evaluation of the eligibility." />
1776 <min value="0" />
1777 <max value="1" />
1778 <base>
1779 <path value="CoverageEligibilityRequest.item.facility" />
1780 <min value="0" />
1781 <max value="1" />
1782 </base>
1783 <type>
1784 <code value="Reference" />
1785 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
1786 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
1787 </type>
1788 <constraint>
1789 <key value="ele-1" />
1790 <severity value="error" />
1791 <human value="All FHIR elements must have a @value or children" />
1792 <expression value="hasValue() or (children().count() > id.count())" />
1793 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1794 </constraint>
1795 <mustSupport value="false" />
1796 <isModifier value="false" />
1797 <isSummary value="false" />
1798 </element>
1799 <element id="CoverageEligibilityRequest.item.diagnosis">
1800 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
1801 <valueString value="Diagnosis" />
1802 </extension>
1803 <path value="CoverageEligibilityRequest.item.diagnosis" />
1804 <short value="Applicable diagnosis" />
1805 <definition value="Patient diagnosis for which care is sought." />
1806 <requirements value="Needed to support the evaluation of the eligibility." />
1807 <min value="0" />
1808 <max value="*" />
1809 <base>
1810 <path value="CoverageEligibilityRequest.item.diagnosis" />
1811 <min value="0" />
1812 <max value="*" />
1813 </base>
1814 <type>
1815 <code value="BackboneElement" />
1816 </type>
1817 <constraint>
1818 <key value="ele-1" />
1819 <severity value="error" />
1820 <human value="All FHIR elements must have a @value or children" />
1821 <expression value="hasValue() or (children().count() > id.count())" />
1822 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1823 </constraint>
1824 <mustSupport value="false" />
1825 <isModifier value="false" />
1826 <isSummary value="false" />
1827 <mapping>
1828 <identity value="v2" />
1829 <map value="Request.reasonReference" />
1830 </mapping>
1831 </element>
1832 <element id="CoverageEligibilityRequest.item.diagnosis.id">
1833 <path value="CoverageEligibilityRequest.item.diagnosis.id" />
1834 <representation value="xmlAttr" />
1835 <short value="Unique id for inter-element referencing" />
1836 <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
1837 <min value="0" />
1838 <max value="1" />
1839 <base>
1840 <path value="Element.id" />
1841 <min value="0" />
1842 <max value="1" />
1843 </base>
1844 <type>
1845 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
1846 <valueUrl value="string" />
1847 </extension>
1848 <code value="http://hl7.org/fhirpath/System.String" />
1849 </type>
1850 <condition value="ele-1" />
1851 <isModifier value="false" />
1852 <isSummary value="false" />
1853 <mapping>
1854 <identity value="rim" />
1855 <map value="n/a" />
1856 </mapping>
1857 </element>
1858 <element id="CoverageEligibilityRequest.item.diagnosis.extension">
1859 <path value="CoverageEligibilityRequest.item.diagnosis.extension" />
1860 <short value="Additional content defined by implementations" />
1861 <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
1862 <comment value="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." />
1863 <alias value="extensions" />
1864 <alias value="user content" />
1865 <min value="0" />
1866 <max value="*" />
1867 <base>
1868 <path value="Element.extension" />
1869 <min value="0" />
1870 <max value="*" />
1871 </base>
1872 <type>
1873 <code value="Extension" />
1874 </type>
1875 <constraint>
1876 <key value="ele-1" />
1877 <severity value="error" />
1878 <human value="All FHIR elements must have a @value or children" />
1879 <expression value="hasValue() or (children().count() > id.count())" />
1880 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1881 </constraint>
1882 <constraint>
1883 <key value="ext-1" />
1884 <severity value="error" />
1885 <human value="Must have either extensions or value[x], not both" />
1886 <expression value="extension.exists() != value.exists()" />
1887 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1888 </constraint>
1889 <isModifier value="false" />
1890 <isSummary value="false" />
1891 <mapping>
1892 <identity value="rim" />
1893 <map value="n/a" />
1894 </mapping>
1895 </element>
1896 <element id="CoverageEligibilityRequest.item.diagnosis.modifierExtension">
1897 <path value="CoverageEligibilityRequest.item.diagnosis.modifierExtension" />
1898 <short value="Extensions that cannot be ignored even if unrecognized" />
1899 <definition value="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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
1900 <comment value="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." />
1901 <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
1902 <alias value="extensions" />
1903 <alias value="user content" />
1904 <alias value="modifiers" />
1905 <min value="0" />
1906 <max value="*" />
1907 <base>
1908 <path value="BackboneElement.modifierExtension" />
1909 <min value="0" />
1910 <max value="*" />
1911 </base>
1912 <type>
1913 <code value="Extension" />
1914 </type>
1915 <constraint>
1916 <key value="ele-1" />
1917 <severity value="error" />
1918 <human value="All FHIR elements must have a @value or children" />
1919 <expression value="hasValue() or (children().count() > id.count())" />
1920 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1921 </constraint>
1922 <constraint>
1923 <key value="ext-1" />
1924 <severity value="error" />
1925 <human value="Must have either extensions or value[x], not both" />
1926 <expression value="extension.exists() != value.exists()" />
1927 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1928 </constraint>
1929 <isModifier value="true" />
1930 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
1931 <isSummary value="true" />
1932 <mapping>
1933 <identity value="rim" />
1934 <map value="N/A" />
1935 </mapping>
1936 </element>
1937 <element id="CoverageEligibilityRequest.item.diagnosis.diagnosis[x]">
1938 <path value="CoverageEligibilityRequest.item.diagnosis.diagnosis[x]" />
1939 <short value="Nature of illness or problem" />
1940 <definition value="The nature of illness or problem in a coded form or as a reference to an external defined Condition." />
1941 <requirements value="Provides health context for the evaluation of the products and/or services." />
1942 <min value="0" />
1943 <max value="1" />
1944 <base>
1945 <path value="CoverageEligibilityRequest.item.diagnosis.diagnosis[x]" />
1946 <min value="0" />
1947 <max value="1" />
1948 </base>
1949 <type>
1950 <code value="CodeableConcept" />
1951 </type>
1952 <type>
1953 <code value="Reference" />
1954 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
1955 </type>
1956 <constraint>
1957 <key value="ele-1" />
1958 <severity value="error" />
1959 <human value="All FHIR elements must have a @value or children" />
1960 <expression value="hasValue() or (children().count() > id.count())" />
1961 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1962 </constraint>
1963 <mustSupport value="false" />
1964 <isModifier value="false" />
1965 <isSummary value="false" />
1966 <binding>
1967 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1968 <valueString value="ICD10" />
1969 </extension>
1970 <strength value="example" />
1971 <description value="ICD10 Diagnostic codes." />
1972 <valueSet value="http://hl7.org/fhir/ValueSet/icd-10" />
1973 </binding>
1974 </element>
1975 <element id="CoverageEligibilityRequest.item.detail">
1976 <path value="CoverageEligibilityRequest.item.detail" />
1977 <short value="Product or service details" />
1978 <definition value="The plan/proposal/order describing the proposed service in detail." />
1979 <requirements value="Needed to provide complex service proposal such as a Device or a plan." />
1980 <min value="0" />
1981 <max value="*" />
1982 <base>
1983 <path value="CoverageEligibilityRequest.item.detail" />
1984 <min value="0" />
1985 <max value="*" />
1986 </base>
1987 <type>
1988 <code value="Reference" />
1989 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
1990 </type>
1991 <constraint>
1992 <key value="ele-1" />
1993 <severity value="error" />
1994 <human value="All FHIR elements must have a @value or children" />
1995 <expression value="hasValue() or (children().count() > id.count())" />
1996 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1997 </constraint>
1998 <mustSupport value="false" />
1999 <isModifier value="false" />
2000 <isSummary value="false" />
2001 </element>
2002 </snapshot>
2003 <differential>
2004 <element id="CoverageEligibilityRequest">
2005 <path value="CoverageEligibilityRequest" />
2006 <short value="CoverageEligibilityRequest resource" />
2007 <definition value="The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy." />
2008 <min value="0" />
2009 <max value="*" />
2010 <mustSupport value="false" />
2011 <isModifier value="false" />
2012 <mapping>
2013 <identity value="workflow" />
2014 <map value="Request" />
2015 </mapping>
2016 <mapping>
2017 <identity value="w5" />
2018 <map value="financial.support" />
2019 </mapping>
2020 </element>
2021 <element id="CoverageEligibilityRequest.identifier">
2022 <path value="CoverageEligibilityRequest.identifier" />
2023 <short value="Business Identifier for coverage eligiblity request" />
2024 <definition value="A unique identifier assigned to this coverage eligiblity request." />
2025 <requirements value="Allows coverage eligibility requests to be distinguished and referenced." />
2026 <min value="0" />
2027 <max value="*" />
2028 <type>
2029 <code value="Identifier" />
2030 </type>
2031 <mustSupport value="false" />
2032 <isModifier value="false" />
2033 <isSummary value="false" />
2034 <mapping>
2035 <identity value="workflow" />
2036 <map value="Request.identifier" />
2037 </mapping>
2038 <mapping>
2039 <identity value="w5" />
2040 <map value="FiveWs.identifier" />
2041 </mapping>
2042 </element>
2043 <element id="CoverageEligibilityRequest.status">
2044 <path value="CoverageEligibilityRequest.status" />
2045 <short value="active | cancelled | draft | entered-in-error" />
2046 <definition value="The status of the resource instance." />
2047 <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." />
2048 <requirements value="Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'." />
2049 <min value="1" />
2050 <max value="1" />
2051 <type>
2052 <code value="code" />
2053 </type>
2054 <mustSupport value="false" />
2055 <isModifier value="true" />
2056 <isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
2057 <isSummary value="true" />
2058 <binding>
2059 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2060 <valueString value="EligibilityRequestStatus" />
2061 </extension>
2062 <strength value="required" />
2063 <description value="A code specifying the state of the resource instance." />
2064 <valueSet value="http://hl7.org/fhir/ValueSet/fm-status|5.0.0" />
2065 </binding>
2066 <mapping>
2067 <identity value="workflow" />
2068 <map value="Request.status" />
2069 </mapping>
2070 <mapping>
2071 <identity value="w5" />
2072 <map value="FiveWs.status" />
2073 </mapping>
2074 </element>
2075 <element id="CoverageEligibilityRequest.priority">
2076 <path value="CoverageEligibilityRequest.priority" />
2077 <short value="Desired processing priority" />
2078 <definition value="When the requestor expects the processor to complete processing." />
2079 <requirements value="Needed to advise the prossesor on the urgency of the request." />
2080 <min value="0" />
2081 <max value="1" />
2082 <type>
2083 <code value="CodeableConcept" />
2084 </type>
2085 <mustSupport value="false" />
2086 <isModifier value="false" />
2087 <isSummary value="false" />
2088 <binding>
2089 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2090 <valueString value="ProcessPriority" />
2091 </extension>
2092 <strength value="example" />
2093 <description value="The timeliness with which processing is required: STAT, normal, Deferred." />
2094 <valueSet value="http://hl7.org/fhir/ValueSet/process-priority" />
2095 </binding>
2096 <mapping>
2097 <identity value="workflow" />
2098 <map value="Request.priority" />
2099 </mapping>
2100 <mapping>
2101 <identity value="w5" />
2102 <map value="FiveWs.class" />
2103 </mapping>
2104 </element>
2105 <element id="CoverageEligibilityRequest.purpose">
2106 <path value="CoverageEligibilityRequest.purpose" />
2107 <short value="auth-requirements | benefits | discovery | validation" />
2108 <definition value="Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified." />
2109 <requirements value="To indicate the processing actions requested." />
2110 <min value="1" />
2111 <max value="*" />
2112 <type>
2113 <code value="code" />
2114 </type>
2115 <mustSupport value="false" />
2116 <isModifier value="false" />
2117 <isSummary value="true" />
2118 <binding>
2119 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2120 <valueString value="EligibilityRequestPurpose" />
2121 </extension>
2122 <strength value="required" />
2123 <description value="A code specifying the types of information being requested." />
2124 <valueSet value="http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|5.0.0" />
2125 </binding>
2126 <mapping>
2127 <identity value="w5" />
2128 <map value="FiveWs.class" />
2129 </mapping>
2130 </element>
2131 <element id="CoverageEligibilityRequest.patient">
2132 <path value="CoverageEligibilityRequest.patient" />
2133 <short value="Intended recipient of products and services" />
2134 <definition value="The party who is the beneficiary of the supplied coverage and for whom eligibility is sought." />
2135 <comment value="1..1." />
2136 <requirements value="Required to provide context and coverage validation." />
2137 <min value="1" />
2138 <max value="1" />
2139 <type>
2140 <code value="Reference" />
2141 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
2142 </type>
2143 <mustSupport value="false" />
2144 <isModifier value="false" />
2145 <isSummary value="true" />
2146 <mapping>
2147 <identity value="workflow" />
2148 <map value="Request.subject" />
2149 </mapping>
2150 <mapping>
2151 <identity value="w5" />
2152 <map value="FiveWs.subject[x]" />
2153 </mapping>
2154 </element>
2155 <element id="CoverageEligibilityRequest.event">
2156 <path value="CoverageEligibilityRequest.event" />
2157 <short value="Event information" />
2158 <definition value="Information code for an event with a corresponding date or period." />
2159 <min value="0" />
2160 <max value="*" />
2161 <type>
2162 <code value="BackboneElement" />
2163 </type>
2164 <mustSupport value="false" />
2165 <isModifier value="false" />
2166 <isSummary value="false" />
2167 </element>
2168 <element id="CoverageEligibilityRequest.event.type">
2169 <path value="CoverageEligibilityRequest.event.type" />
2170 <short value="Specific event" />
2171 <definition value="A coded event such as when a service is expected or a card printed." />
2172 <min value="1" />
2173 <max value="1" />
2174 <type>
2175 <code value="CodeableConcept" />
2176 </type>
2177 <mustSupport value="false" />
2178 <isModifier value="false" />
2179 <isSummary value="false" />
2180 <binding>
2181 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2182 <valueString value="DatesType" />
2183 </extension>
2184 <strength value="example" />
2185 <valueSet value="http://hl7.org/fhir/ValueSet/datestype" />
2186 </binding>
2187 </element>
2188 <element id="CoverageEligibilityRequest.event.when[x]">
2189 <path value="CoverageEligibilityRequest.event.when[x]" />
2190 <short value="Occurance date or period" />
2191 <definition value="A date or period in the past or future indicating when the event occurred or is expectd to occur." />
2192 <min value="1" />
2193 <max value="1" />
2194 <type>
2195 <code value="dateTime" />
2196 </type>
2197 <type>
2198 <code value="Period" />
2199 </type>
2200 <mustSupport value="false" />
2201 <isModifier value="false" />
2202 <isSummary value="false" />
2203 </element>
2204 <element id="CoverageEligibilityRequest.serviced[x]">
2205 <path value="CoverageEligibilityRequest.serviced[x]" />
2206 <short value="Estimated date or dates of service" />
2207 <definition value="The date or dates when the enclosed suite of services were performed or completed." />
2208 <requirements value="Required to provide time context for the request." />
2209 <min value="0" />
2210 <max value="1" />
2211 <type>
2212 <code value="date" />
2213 </type>
2214 <type>
2215 <code value="Period" />
2216 </type>
2217 <mustSupport value="false" />
2218 <isModifier value="false" />
2219 <isSummary value="false" />
2220 <mapping>
2221 <identity value="w5" />
2222 <map value="FiveWs.done[x]" />
2223 </mapping>
2224 </element>
2225 <element id="CoverageEligibilityRequest.created">
2226 <path value="CoverageEligibilityRequest.created" />
2227 <short value="Creation date" />
2228 <definition value="The date when this resource was created." />
2229 <requirements value="Need to record a timestamp for use by both the recipient and the issuer." />
2230 <min value="1" />
2231 <max value="1" />
2232 <type>
2233 <code value="dateTime" />
2234 </type>
2235 <mustSupport value="false" />
2236 <isModifier value="false" />
2237 <isSummary value="true" />
2238 <mapping>
2239 <identity value="workflow" />
2240 <map value="Request.authoredOn" />
2241 </mapping>
2242 <mapping>
2243 <identity value="w5" />
2244 <map value="FiveWs.recorded" />
2245 </mapping>
2246 </element>
2247 <element id="CoverageEligibilityRequest.enterer">
2248 <path value="CoverageEligibilityRequest.enterer" />
2249 <short value="Author" />
2250 <definition value="Person who created the request." />
2251 <requirements value="Some jurisdictions require the contact information for personnel completing eligibility requests." />
2252 <min value="0" />
2253 <max value="1" />
2254 <type>
2255 <code value="Reference" />
2256 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
2257 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
2258 </type>
2259 <mustSupport value="false" />
2260 <isModifier value="false" />
2261 <isSummary value="false" />
2262 <mapping>
2263 <identity value="w5" />
2264 <map value="FiveWs.author" />
2265 </mapping>
2266 </element>
2267 <element id="CoverageEligibilityRequest.provider">
2268 <path value="CoverageEligibilityRequest.provider" />
2269 <short value="Party responsible for the request" />
2270 <definition value="The provider which is responsible for the request." />
2271 <comment value="Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner." />
2272 <requirements value="Needed to identify the requestor." />
2273 <min value="0" />
2274 <max value="1" />
2275 <type>
2276 <code value="Reference" />
2277 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
2278 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
2279 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
2280 </type>
2281 <mustSupport value="false" />
2282 <isModifier value="false" />
2283 <isSummary value="false" />
2284 <mapping>
2285 <identity value="workflow" />
2286 <map value="Request.requester" />
2287 </mapping>
2288 <mapping>
2289 <identity value="w5" />
2290 <map value="FiveWs.source" />
2291 </mapping>
2292 </element>
2293 <element id="CoverageEligibilityRequest.insurer">
2294 <path value="CoverageEligibilityRequest.insurer" />
2295 <short value="Coverage issuer" />
2296 <definition value="The Insurer who issued the coverage in question and is the recipient of the request." />
2297 <requirements value="Need to identify the recipient." />
2298 <min value="1" />
2299 <max value="1" />
2300 <type>
2301 <code value="Reference" />
2302 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
2303 </type>
2304 <mustSupport value="false" />
2305 <isModifier value="false" />
2306 <isSummary value="true" />
2307 <mapping>
2308 <identity value="workflow" />
2309 <map value="Request.performer" />
2310 </mapping>
2311 <mapping>
2312 <identity value="w5" />
2313 <map value="FiveWs.who" />
2314 </mapping>
2315 </element>
2316 <element id="CoverageEligibilityRequest.facility">
2317 <path value="CoverageEligibilityRequest.facility" />
2318 <short value="Servicing facility" />
2319 <definition value="Facility where the services are intended to be provided." />
2320 <requirements value="Insurance adjudication can be dependant on where services were delivered." />
2321 <min value="0" />
2322 <max value="1" />
2323 <type>
2324 <code value="Reference" />
2325 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
2326 </type>
2327 <mustSupport value="false" />
2328 <isModifier value="false" />
2329 <isSummary value="false" />
2330 <mapping>
2331 <identity value="w5" />
2332 <map value="FiveWs.where[x]" />
2333 </mapping>
2334 </element>
2335 <element id="CoverageEligibilityRequest.supportingInfo">
2336 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
2337 <valueString value="SupportingInformation" />
2338 </extension>
2339 <path value="CoverageEligibilityRequest.supportingInfo" />
2340 <short value="Supporting information" />
2341 <definition value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues." />
2342 <comment value="Often there are multiple jurisdiction specific valuesets which are required." />
2343 <requirements value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered." />
2344 <min value="0" />
2345 <max value="*" />
2346 <type>
2347 <code value="BackboneElement" />
2348 </type>
2349 <mustSupport value="false" />
2350 <isModifier value="false" />
2351 <isSummary value="false" />
2352 </element>
2353 <element id="CoverageEligibilityRequest.supportingInfo.sequence">
2354 <path value="CoverageEligibilityRequest.supportingInfo.sequence" />
2355 <short value="Information instance identifier" />
2356 <definition value="A number to uniquely identify supporting information entries." />
2357 <requirements value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details." />
2358 <min value="1" />
2359 <max value="1" />
2360 <type>
2361 <code value="positiveInt" />
2362 </type>
2363 <mustSupport value="false" />
2364 <isModifier value="false" />
2365 <isSummary value="false" />
2366 </element>
2367 <element id="CoverageEligibilityRequest.supportingInfo.information">
2368 <path value="CoverageEligibilityRequest.supportingInfo.information" />
2369 <short value="Data to be provided" />
2370 <definition value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data." />
2371 <comment value="Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident." />
2372 <requirements value="To convey the data content to be provided when the information is more than a simple code or period." />
2373 <min value="1" />
2374 <max value="1" />
2375 <type>
2376 <code value="Reference" />
2377 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
2378 </type>
2379 <mustSupport value="false" />
2380 <isModifier value="false" />
2381 <isSummary value="false" />
2382 </element>
2383 <element id="CoverageEligibilityRequest.supportingInfo.appliesToAll">
2384 <path value="CoverageEligibilityRequest.supportingInfo.appliesToAll" />
2385 <short value="Applies to all items" />
2386 <definition value="The supporting materials are applicable for all detail items, product/servce categories and specific billing codes." />
2387 <requirements value="Needed to convey that the information is universal to the request." />
2388 <min value="0" />
2389 <max value="1" />
2390 <type>
2391 <code value="boolean" />
2392 </type>
2393 <mustSupport value="false" />
2394 <isModifier value="false" />
2395 <isSummary value="false" />
2396 </element>
2397 <element id="CoverageEligibilityRequest.insurance">
2398 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
2399 <valueString value="Insurance" />
2400 </extension>
2401 <path value="CoverageEligibilityRequest.insurance" />
2402 <short value="Patient insurance information" />
2403 <definition value="Financial instruments for reimbursement for the health care products and services." />
2404 <comment value="All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim." />
2405 <requirements value="There must be at least one coverage for which eligibility is requested." />
2406 <min value="0" />
2407 <max value="*" />
2408 <type>
2409 <code value="BackboneElement" />
2410 </type>
2411 <mustSupport value="false" />
2412 <isModifier value="false" />
2413 <isSummary value="false" />
2414 </element>
2415 <element id="CoverageEligibilityRequest.insurance.focal">
2416 <path value="CoverageEligibilityRequest.insurance.focal" />
2417 <short value="Applicable coverage" />
2418 <definition value="A flag to indicate that this Coverage is to be used for evaluation of this request when set to true." />
2419 <comment value="A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies." />
2420 <requirements value="To identify which coverage in the list is being used to evaluate this request." />
2421 <min value="0" />
2422 <max value="1" />
2423 <type>
2424 <code value="boolean" />
2425 </type>
2426 <mustSupport value="false" />
2427 <isModifier value="false" />
2428 <isSummary value="false" />
2429 </element>
2430 <element id="CoverageEligibilityRequest.insurance.coverage">
2431 <path value="CoverageEligibilityRequest.insurance.coverage" />
2432 <short value="Insurance information" />
2433 <definition value="Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system." />
2434 <requirements value="Required to allow the adjudicator to locate the correct policy and history within their information system." />
2435 <min value="1" />
2436 <max value="1" />
2437 <type>
2438 <code value="Reference" />
2439 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage" />
2440 </type>
2441 <mustSupport value="false" />
2442 <isModifier value="false" />
2443 <isSummary value="false" />
2444 </element>
2445 <element id="CoverageEligibilityRequest.insurance.businessArrangement">
2446 <path value="CoverageEligibilityRequest.insurance.businessArrangement" />
2447 <short value="Additional provider contract number" />
2448 <definition value="A business agreement number established between the provider and the insurer for special business processing purposes." />
2449 <requirements value="Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication." />
2450 <min value="0" />
2451 <max value="1" />
2452 <type>
2453 <code value="string" />
2454 </type>
2455 <mustSupport value="false" />
2456 <isModifier value="false" />
2457 <isSummary value="false" />
2458 </element>
2459 <element id="CoverageEligibilityRequest.item">
2460 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
2461 <valueString value="Details" />
2462 </extension>
2463 <path value="CoverageEligibilityRequest.item" />
2464 <short value="Item to be evaluated for eligibiity" />
2465 <definition value="Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor." />
2466 <requirements value="The items to be processed for the request." />
2467 <min value="0" />
2468 <max value="*" />
2469 <type>
2470 <code value="BackboneElement" />
2471 </type>
2472 <mustSupport value="false" />
2473 <isModifier value="false" />
2474 <isSummary value="false" />
2475 </element>
2476 <element id="CoverageEligibilityRequest.item.supportingInfoSequence">
2477 <path value="CoverageEligibilityRequest.item.supportingInfoSequence" />
2478 <short value="Applicable exception or supporting information" />
2479 <definition value="Exceptions, special conditions and supporting information applicable for this service or product line." />
2480 <requirements value="Needed to support or inform the consideration for eligibility." />
2481 <min value="0" />
2482 <max value="*" />
2483 <type>
2484 <code value="positiveInt" />
2485 </type>
2486 <mustSupport value="false" />
2487 <isModifier value="false" />
2488 <isSummary value="false" />
2489 </element>
2490 <element id="CoverageEligibilityRequest.item.category">
2491 <path value="CoverageEligibilityRequest.item.category" />
2492 <short value="Benefit classification" />
2493 <definition value="Code to identify the general type of benefits under which products and services are provided." />
2494 <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage." />
2495 <requirements value="Needed to convey the category of service or product for which eligibility is sought." />
2496 <min value="0" />
2497 <max value="1" />
2498 <type>
2499 <code value="CodeableConcept" />
2500 </type>
2501 <mustSupport value="false" />
2502 <isModifier value="false" />
2503 <isSummary value="false" />
2504 <binding>
2505 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2506 <valueString value="BenefitCategory" />
2507 </extension>
2508 <strength value="example" />
2509 <description value="Benefit categories such as: oral, medical, vision etc." />
2510 <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory" />
2511 </binding>
2512 </element>
2513 <element id="CoverageEligibilityRequest.item.productOrService">
2514 <path value="CoverageEligibilityRequest.item.productOrService" />
2515 <short value="Billing, service, product, or drug code" />
2516 <definition value="This contains the product, service, drug or other billing code for the item." />
2517 <comment value="Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI)." />
2518 <requirements value="Needed to convey the actual service or product for which eligibility is sought." />
2519 <min value="0" />
2520 <max value="1" />
2521 <type>
2522 <code value="CodeableConcept" />
2523 </type>
2524 <mustSupport value="false" />
2525 <isModifier value="false" />
2526 <isSummary value="false" />
2527 <binding>
2528 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2529 <valueString value="ServiceProduct" />
2530 </extension>
2531 <strength value="example" />
2532 <description value="Allowable service and product codes." />
2533 <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" />
2534 </binding>
2535 </element>
2536 <element id="CoverageEligibilityRequest.item.modifier">
2537 <path value="CoverageEligibilityRequest.item.modifier" />
2538 <short value="Product or service billing modifiers" />
2539 <definition value="Item typification or modifiers codes to convey additional context for the product or service." />
2540 <comment value="For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours." />
2541 <requirements value="To support provision of the item or to charge an elevated fee." />
2542 <min value="0" />
2543 <max value="*" />
2544 <type>
2545 <code value="CodeableConcept" />
2546 </type>
2547 <mustSupport value="false" />
2548 <isModifier value="false" />
2549 <isSummary value="false" />
2550 <binding>
2551 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2552 <valueString value="Modifiers" />
2553 </extension>
2554 <strength value="example" />
2555 <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." />
2556 <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers" />
2557 </binding>
2558 </element>
2559 <element id="CoverageEligibilityRequest.item.provider">
2560 <path value="CoverageEligibilityRequest.item.provider" />
2561 <short value="Perfoming practitioner" />
2562 <definition value="The practitioner who is responsible for the product or service to be rendered to the patient." />
2563 <requirements value="Needed to support the evaluation of the eligibility." />
2564 <min value="0" />
2565 <max value="1" />
2566 <type>
2567 <code value="Reference" />
2568 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
2569 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
2570 </type>
2571 <mustSupport value="false" />
2572 <isModifier value="false" />
2573 <isSummary value="false" />
2574 <mapping>
2575 <identity value="workflow" />
2576 <map value="Request.requester" />
2577 </mapping>
2578 <mapping>
2579 <identity value="w5" />
2580 <map value="FiveWs.source" />
2581 </mapping>
2582 </element>
2583 <element id="CoverageEligibilityRequest.item.quantity">
2584 <path value="CoverageEligibilityRequest.item.quantity" />
2585 <short value="Count of products or services" />
2586 <definition value="The number of repetitions of a service or product." />
2587 <requirements value="Required when the product or service code does not convey the quantity provided." />
2588 <min value="0" />
2589 <max value="1" />
2590 <type>
2591 <code value="Quantity" />
2592 <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
2593 </type>
2594 <mustSupport value="false" />
2595 <isModifier value="false" />
2596 <isSummary value="false" />
2597 </element>
2598 <element id="CoverageEligibilityRequest.item.unitPrice">
2599 <path value="CoverageEligibilityRequest.item.unitPrice" />
2600 <short value="Fee, charge or cost per item" />
2601 <definition value="The amount charged to the patient by the provider for a single unit." />
2602 <requirements value="Needed to support the evaluation of the eligibility." />
2603 <min value="0" />
2604 <max value="1" />
2605 <type>
2606 <code value="Money" />
2607 </type>
2608 <mustSupport value="false" />
2609 <isModifier value="false" />
2610 <isSummary value="false" />
2611 </element>
2612 <element id="CoverageEligibilityRequest.item.facility">
2613 <path value="CoverageEligibilityRequest.item.facility" />
2614 <short value="Servicing facility" />
2615 <definition value="Facility where the services will be provided." />
2616 <requirements value="Needed to support the evaluation of the eligibility." />
2617 <min value="0" />
2618 <max value="1" />
2619 <type>
2620 <code value="Reference" />
2621 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
2622 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
2623 </type>
2624 <mustSupport value="false" />
2625 <isModifier value="false" />
2626 <isSummary value="false" />
2627 </element>
2628 <element id="CoverageEligibilityRequest.item.diagnosis">
2629 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
2630 <valueString value="Diagnosis" />
2631 </extension>
2632 <path value="CoverageEligibilityRequest.item.diagnosis" />
2633 <short value="Applicable diagnosis" />
2634 <definition value="Patient diagnosis for which care is sought." />
2635 <requirements value="Needed to support the evaluation of the eligibility." />
2636 <min value="0" />
2637 <max value="*" />
2638 <type>
2639 <code value="BackboneElement" />
2640 </type>
2641 <mustSupport value="false" />
2642 <isModifier value="false" />
2643 <isSummary value="false" />
2644 <mapping>
2645 <identity value="v2" />
2646 <map value="Request.reasonReference" />
2647 </mapping>
2648 </element>
2649 <element id="CoverageEligibilityRequest.item.diagnosis.diagnosis[x]">
2650 <path value="CoverageEligibilityRequest.item.diagnosis.diagnosis[x]" />
2651 <short value="Nature of illness or problem" />
2652 <definition value="The nature of illness or problem in a coded form or as a reference to an external defined Condition." />
2653 <requirements value="Provides health context for the evaluation of the products and/or services." />
2654 <min value="0" />
2655 <max value="1" />
2656 <type>
2657 <code value="CodeableConcept" />
2658 </type>
2659 <type>
2660 <code value="Reference" />
2661 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
2662 </type>
2663 <mustSupport value="false" />
2664 <isModifier value="false" />
2665 <isSummary value="false" />
2666 <binding>
2667 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
2668 <valueString value="ICD10" />
2669 </extension>
2670 <strength value="example" />
2671 <description value="ICD10 Diagnostic codes." />
2672 <valueSet value="http://hl7.org/fhir/ValueSet/icd-10" />
2673 </binding>
2674 </element>
2675 <element id="CoverageEligibilityRequest.item.detail">
2676 <path value="CoverageEligibilityRequest.item.detail" />
2677 <short value="Product or service details" />
2678 <definition value="The plan/proposal/order describing the proposed service in detail." />
2679 <requirements value="Needed to provide complex service proposal such as a Device or a plan." />
2680 <min value="0" />
2681 <max value="*" />
2682 <type>
2683 <code value="Reference" />
2684 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
2685 </type>
2686 <mustSupport value="false" />
2687 <isModifier value="false" />
2688 <isSummary value="false" />
2689 </element>
2690 </differential>
2691 </StructureDefinition>