Left: | FAIS CoverageEligibilityResponse Profile (https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse) |
Right: | FAIS CoverageEligibilityResponse Profile (https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse) |
Error | StructureDefinition.version | Values for version differ: '1.0.0-comment' vs '1.0.0' |
Information | StructureDefinition.date | Values for date differ: '2024-08-07T10:05:52-05:00' vs '2024-11-13T10:59:36-06:00' |
Name | Value | Comments | |
---|---|---|---|
abstract | false | ||
baseDefinition | http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse | ||
copyright | |||
date | 2024-08-07T10:05:52-05:00 | 2024-11-13T10:59:36-06:00 |
|
description | The FAIS CoverageEligibilityResponse profile to be used as the response to the [FAIS CoverageEligibilityRequest $submit](OperationDefinition-IHE.FAIS.CoverageEligibilityRequest.Submit.html) | ||
experimental | |||
fhirVersion | 4.0.1 | ||
jurisdiction | |||
jurisdiction[0] | http://unstats.un.org/unsd/methods/m49/m49.htm#001 | ||
kind | resource | ||
name | FAISCoverageEligibilityResponse | ||
publisher | IHE IT Infrastructure Technical Committee | ||
purpose | |||
status | active | ||
title | FAIS CoverageEligibilityResponse Profile | ||
type | CoverageEligibilityResponse | ||
url | https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse | ||
version | 1.0.0-comment | 1.0.0 |
|
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CoverageEligibilityResponse | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | 0..* | CoverageEligibilityResponse | CoverageEligibilityResponse resource | |||||||||||
id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
implicitRules | ?!Σ | 0..0 | ?!Σ | 0..0 | |||||||||||||
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?! | 0..0 | ?! | 0..0 | |||||||||||||
identifier | 0..* | Identifier | Business Identifier for coverage eligiblity request | 0..* | Identifier | Business Identifier for coverage eligiblity request | |||||||||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
purpose | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: ?? (required): A code specifying the types of information being requested. | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: ?? (required): A code specifying the types of information being requested. | |||||||||
patient | Σ | 1..1 | Reference(Patient) | Intended recipient of products and services | Σ | 1..1 | Reference(Patient) | Intended recipient of products and services | |||||||||
serviced[x] | 0..1 | date, Period | Estimated date or dates of service | 0..1 | date, Period | Estimated date or dates of service | |||||||||||
created | Σ | 1..1 | dateTime | Response creation date | Σ | 1..1 | dateTime | Response creation date | |||||||||
requestor | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |||||||||||
request | Σ | 1..1 | Reference(FAIS CoverageEligibilityRequest Profile) | Eligibility request reference | Σ | 1..1 | Reference(FAIS CoverageEligibilityRequest Profile) | Eligibility request reference | |||||||||
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The outcome of the processing. | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The outcome of the processing. | |||||||||
disposition | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
insurer | Σ | 1..1 | Reference(Organization) | Coverage issuer | Σ | 1..1 | Reference(Organization) | Coverage issuer | |||||||||
insurance | 0..* | BackboneElement | Patient insurance information | 0..* | BackboneElement | Patient insurance information | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information | Σ | 1..1 | Reference(Coverage) | Insurance information | |||||||||
inforce | 0..1 | boolean | Coverage inforce indicator | 0..1 | boolean | Coverage inforce indicator | |||||||||||
benefitPeriod | 0..1 | Period | When the benefits are applicable | 0..1 | Period | When the benefits are applicable | |||||||||||
item | C | 0..* | BackboneElement | Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both. | C | 0..* | BackboneElement | Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both. | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision etc. | |||||||||||
productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
provider | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | 0..1 | Reference(Practitioner | PractitionerRole) | Performing practitioner | |||||||||||
excluded | 0..1 | boolean | Excluded from the plan | 0..1 | boolean | Excluded from the plan | |||||||||||
name | 0..1 | string | Short name for the benefit | 0..1 | string | Short name for the benefit | |||||||||||
description | 0..1 | string | Description of the benefit or services covered | 0..1 | string | Description of the benefit or services covered | |||||||||||
network | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | |||||||||||
unit | 0..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. | 0..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. | |||||||||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. | |||||||||||
benefit | 0..* | BackboneElement | Benefit Summary | 0..* | BackboneElement | Benefit Summary | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
type | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. | |||||||||||
allowed[x] | 0..1 | unsignedInt, string, Money | Benefits allowed | 0..1 | unsignedInt, string, Money | Benefits allowed | |||||||||||
used[x] | 0..1 | unsignedInt, string, Money | Benefits used | 0..1 | unsignedInt, string, Money | Benefits used | |||||||||||
authorizationRequired | 0..1 | boolean | Authorization required flag | 0..1 | boolean | Authorization required flag | |||||||||||
authorizationSupporting | 0..* | CodeableConcept | Type of required supporting materials Binding: ?? (example): Type of supporting information to provide with a preauthorization. | 0..* | CodeableConcept | Type of required supporting materials Binding: ?? (example): Type of supporting information to provide with a preauthorization. | |||||||||||
authorizationUrl | 0..1 | uri | Preauthorization requirements endpoint | 0..1 | uri | Preauthorization requirements endpoint | |||||||||||
preAuthRef | 0..1 | string | Preauthorization reference | 0..1 | string | Preauthorization reference | |||||||||||
form | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
error | 0..* | BackboneElement | Processing errors | 0..* | BackboneElement | Processing errors | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
code | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The error codes for adjudication processing. | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The error codes for adjudication processing. | |||||||||||
Documentation for this format |