abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisherpurposestatustitletypeurlversion- Values Differ
| Left: | CoverageEligibilityResponse (https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse) |
| Right: | CoverageEligibilityResponse (https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse) |
| Error | StructureDefinition.version | Values for version differ: '6.0.0' vs '6.5.0' |
| Information | StructureDefinition.date | Values for date differ: '2024-01-24T14:28:59+05:30' vs '2025-03-18T17:41:18+05:30' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse | ||
| copyright | |||
| date | 2024-01-24T14:28:59+05:30 | 2025-03-18T17:41:18+05:30 |
|
| description | This profile provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#IN | ||
| kind | resource | ||
| name | CoverageEligibilityResponse | ||
| publisher | National Resource Center for EHR Standards | ||
| purpose | |||
| status | draft | ||
| title | |||
| type | CoverageEligibilityResponse | ||
| url | https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse | ||
| version | 6.0.0 | 6.5.0 |
|
| 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..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| 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..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| 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 | SΣ | 1..* | code | auth-requirements | benefits | discovery | validation Binding: ?? (required): A code specifying the types of information being requested. | SΣ | 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 | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the request | |||||||||||
| request | Σ | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference | Σ | 1..1 | Reference(CoverageEligibilityRequest) | Eligibility request reference | |||||||||
| outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The outcome of the processing. | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The outcome of the processing. | |||||||||
| disposition | S | 0..1 | string | Disposition Message | S | 0..1 | string | Disposition Message | |||||||||
| insurer | SΣ | 1..1 | Reference(Organization) | Coverage issuer | SΣ | 1..1 | Reference(Organization) | Coverage issuer | |||||||||
 insurance | S | 0..* | BackboneElement | Patient insurance information | S | 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 | SΣ | 1..1 | Reference(Coverage) | Insurance information | SΣ | 1..1 | Reference(Coverage) | Insurance information | |||||||||
| inforce | S | 0..1 | boolean | Coverage inforce indicator | S | 0..1 | boolean | Coverage inforce indicator | |||||||||
| benefitPeriod | 0..1 | Period | When the benefits are applicable | 0..1 | Period | When the benefits are applicable | |||||||||||
 item | SC | 0..* | BackboneElement | Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both. | SC | 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) | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example) | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | Σ | 0..* | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system | Σ | 1..1 | uri | Identity of the terminology system | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 1..1 | string | Representation defined by the system | Σ | 1..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes . | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes . | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | Σ | 0..* | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system | Σ | 1..1 | uri | Identity of the terminology system | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 1..1 | string | Representation defined by the system | Σ | 1..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| 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 | S | 0..* | BackboneElement | Benefit Summary | S | 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 | S | 0..* | BackboneElement | Processing errors | S | 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 | |||||||||||||||||