IL Core Implementation Guide
0.18.0 - draft Israel flag

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

Resource Profile: ILCore CoverageEligibilityRequest Profile

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:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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.

... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
CoverageEligibilityRequest.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1
from the FHIR Standard
CoverageEligibilityRequest.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
CoverageEligibilityRequest.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
CoverageEligibilityRequest.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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.

... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
CoverageEligibilityRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
CoverageEligibilityRequest.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1
from the FHIR Standard
CoverageEligibilityRequest.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
CoverageEligibilityRequest.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
CoverageEligibilityRequest.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard

 

Other representations of profile: CSV, Excel, Schematron