IL Core Implementation Guide
0.18.0 - draft
Publication Build: This will be filled in by the publication tooling
| 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![]() |
|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. |
![]() ![]() |
Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services |
![]() ![]() |
Σ | 1..1 | dateTime | Creation date |
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |
![]() ![]() |
Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer |
![]() ![]() |
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|4.0.1from the FHIR Standard | |
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1from the FHIR Standard |
| Name | Flags | Card. | Type | Description & Constraints![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() |
0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. | ||||
![]() ![]() |
Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services | ||||
![]() ![]() |
0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() |
Period | |||||||
![]() ![]() |
Σ | 1..1 | dateTime | Creation date | ||||
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |||||
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |||||
![]() ![]() |
Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer | ||||
![]() ![]() |
0..1 | Reference(ILCore Location Profile) | Servicing facility | |||||
![]() ![]() |
0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() |
1..1 | Reference(Resource) | Data to be provided | |||||
![]() ![]() ![]() |
0..1 | boolean | Applies to all items | |||||
![]() ![]() |
0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..1 | boolean | Applicable coverage | |||||
![]() ![]() ![]() |
1..1 | Reference(Coverage) | Insurance information | |||||
![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..* | positiveInt | Applicable exception or supporting information | |||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() |
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. | |||||
![]() ![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Perfoming practitioner | |||||
![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() |
0..1 | Reference(Location | Organization) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Applicable diagnosis | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Reference(ILCore Condition Profile) | Nature of illness or problem | |||||
![]() ![]() ![]() |
0..* | Reference(Resource) | Product or service details | |||||
Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| CoverageEligibilityRequest.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1from the FHIR Standard | ||||
| CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10from 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![]() |
|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. |
![]() ![]() |
Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services |
![]() ![]() |
Σ | 1..1 | dateTime | Creation date |
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |
![]() ![]() |
Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer |
![]() ![]() |
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|4.0.1from the FHIR Standard | |
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1from the FHIR Standard |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | CoverageEligibilityRequest | ILCore CoverageEligibilityRequest Profile | |||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
0..* | Identifier | Business Identifier for coverage eligiblity request | |||||
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() |
0..1 | CodeableConcept | Desired processing priority Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. | |||||
![]() ![]() |
Σ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested. | ||||
![]() ![]() |
Σ | 1..1 | Reference(ILCore Patient Profile) | Intended recipient of products and services | ||||
![]() ![]() |
0..1 | Estimated date or dates of service | ||||||
![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() |
Period | |||||||
![]() ![]() |
Σ | 1..1 | dateTime | Creation date | ||||
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Author | |||||
![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile | ILCore Organization Profile) | Party responsible for the request | |||||
![]() ![]() |
Σ | 1..1 | Reference(ILCore Organization Profile) | Coverage issuer | ||||
![]() ![]() |
0..1 | Reference(ILCore Location Profile) | Servicing facility | |||||
![]() ![]() |
0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() |
1..1 | Reference(Resource) | Data to be provided | |||||
![]() ![]() ![]() |
0..1 | boolean | Applies to all items | |||||
![]() ![]() |
0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..1 | boolean | Applicable coverage | |||||
![]() ![]() ![]() |
1..1 | Reference(Coverage) | Insurance information | |||||
![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() |
0..* | BackboneElement | Item to be evaluated for eligibiity | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
0..* | positiveInt | Applicable exception or supporting information | |||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc. | |||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() |
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. | |||||
![]() ![]() ![]() |
0..1 | Reference(ILCore Practitioner Profile | ILCore PractitionerRole Profile) | Perfoming practitioner | |||||
![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() |
0..1 | Reference(Location | Organization) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Applicable diagnosis | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Reference(ILCore Condition Profile) | Nature of illness or problem | |||||
![]() ![]() ![]() |
0..* | Reference(Resource) | Product or service details | |||||
Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| CoverageEligibilityRequest.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1from the FHIR Standard | ||||
| CoverageEligibilityRequest.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.purpose | required | EligibilityRequestPurposehttp://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1from the FHIR Standard | ||||
| CoverageEligibilityRequest.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersfrom the FHIR Standard | ||||
| CoverageEligibilityRequest.item.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10from 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