IL Core Implementation Guide
0.18.0 - draft
This page is part of the IL-Core IG (v0.18.0: draft-1 Draft) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
Official URL: http://fhir.health.gov.il/StructureDefinition/il-core-coverage-eligibility-request | Version: 0.18.0 | |||
Standards status: Draft | Maturity Level: 0 | Computable Name: ILCoreCoverageEligibilityRequest |
Israel Core proposed constraints and extensions on the CoverageEligibilityRequest Resource
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from CoverageEligibilityRequest
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
CoverageEligibilityRequest | 0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
purpose | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. |
patient | Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services |
created | Σ | 1..1 | dateTime | Creation date |
enterer | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |
provider | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |
insurer | Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer |
facility | 0..1 | Reference(ILCore Location Profile) | Servicing facility | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
CoverageEligibilityRequest | 0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | 0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
priority | 0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
purpose | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. | ||||
patient | Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services | ||||
serviced[x] | 0..1 | Estimated date or dates of service | ||||||
servicedDate | date | |||||||
servicedPeriod | Period | |||||||
created | Σ | 1..1 | dateTime | Creation date | ||||
enterer | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |||||
provider | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |||||
insurer | Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer | ||||
facility | 0..1 | Reference(ILCore Location Profile) | Servicing facility | |||||
supportingInfo | 0..* | BackboneElement | Supporting information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
information | 1..1 | Reference(Resource) | Data to be provided | |||||
appliesToAll | 0..1 | boolean | Applies to all items | |||||
insurance | 0..* | BackboneElement | Patient insurance information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
focal | 0..1 | boolean | Applicable coverage | |||||
coverage | 1..1 | Reference(Coverage) | Insurance information | |||||
businessArrangement | 0..1 | string | Additional provider contract number | |||||
item | 0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
supportingInfoSequence | 0..* | positiveInt | Applicable exception or supporting information | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
provider | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Perfoming practitioner | |||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
facility | 0..1 | Reference(Location | Organization) | Servicing facility | |||||
diagnosis | 0..* | BackboneElement | Applicable diagnosis | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
Slices for diagnosis[x] | 0..1 | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
diagnosisCodeableConcept | CodeableConcept | |||||||
diagnosisReference | Reference(Condition) | |||||||
diagnosis[x]:diagnosisReference | 0..1 | Reference(ILCore Condition Profile) | Nature of illness or problem | |||||
detail | 0..* | Reference(Resource) | Product or service details | |||||
Documentation for this format |
Path | Conformance | ValueSet | URI | |||
CoverageEligibilityRequest.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | ||||
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard | ||||
CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard |
This structure is derived from CoverageEligibilityRequest
Summary
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Maturity: 0
Differential View
This structure is derived from CoverageEligibilityRequest
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
CoverageEligibilityRequest | 0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
purpose | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. |
patient | Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services |
created | Σ | 1..1 | dateTime | Creation date |
enterer | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |
provider | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |
insurer | Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer |
facility | 0..1 | Reference(ILCore Location Profile) | Servicing facility | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
CoverageEligibilityRequest | 0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | 0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
priority | 0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
purpose | Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. | ||||
patient | Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services | ||||
serviced[x] | 0..1 | Estimated date or dates of service | ||||||
servicedDate | date | |||||||
servicedPeriod | Period | |||||||
created | Σ | 1..1 | dateTime | Creation date | ||||
enterer | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |||||
provider | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |||||
insurer | Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer | ||||
facility | 0..1 | Reference(ILCore Location Profile) | Servicing facility | |||||
supportingInfo | 0..* | BackboneElement | Supporting information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
information | 1..1 | Reference(Resource) | Data to be provided | |||||
appliesToAll | 0..1 | boolean | Applies to all items | |||||
insurance | 0..* | BackboneElement | Patient insurance information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
focal | 0..1 | boolean | Applicable coverage | |||||
coverage | 1..1 | Reference(Coverage) | Insurance information | |||||
businessArrangement | 0..1 | string | Additional provider contract number | |||||
item | 0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
supportingInfoSequence | 0..* | positiveInt | Applicable exception or supporting information | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
productOrService | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
provider | 0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Perfoming practitioner | |||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
facility | 0..1 | Reference(Location | Organization) | Servicing facility | |||||
diagnosis | 0..* | BackboneElement | Applicable diagnosis | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
Slices for diagnosis[x] | 0..1 | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
diagnosisCodeableConcept | CodeableConcept | |||||||
diagnosisReference | Reference(Condition) | |||||||
diagnosis[x]:diagnosisReference | 0..1 | Reference(ILCore Condition Profile) | Nature of illness or problem | |||||
detail | 0..* | Reference(Resource) | Product or service details | |||||
Documentation for this format |
Path | Conformance | ValueSet | URI | |||
CoverageEligibilityRequest.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | ||||
CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard | ||||
CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard |
This structure is derived from CoverageEligibilityRequest
Summary
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Maturity: 0
Other representations of profile: CSV, Excel, Schematron