Universal API Implementation Guide
1.1.19 - ci-build

Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions

Resource Profile: UAPI CoverageEligibilityRequest

Official URL: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-request Version: 1.1.19
Active as of 2020-12-11 Responsible: Genentech USIX PE Realm: United States of America flag Computable Name: UapiCoverageEligibilityRequest

This profile constrains the CoverageEligibilityRequest resource to be used in sharing service request results in UAPI

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... serviceRequestType 0..1CodeableConceptUAPI CoverageEligibilityRequest ServiceRequestType
URL: https://fhir.developer.gene.com/StructureDefinition/SRType
Binding: UAPI Value Set - Service Request Type (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.


... patient Σ1..1Reference(Patient)Intended recipient of products and services
... created Σ1..1dateTimeCreation date
... insurer Σ1..1Reference(Organization)Coverage issuer

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... serviceRequestType 0..1CodeableConceptUAPI CoverageEligibilityRequest ServiceRequestType
URL: https://fhir.developer.gene.com/StructureDefinition/SRType
Binding: UAPI Value Set - Service Request Type (required)
... medication 0..1CodeableConceptUAPI CoverageEligibilityRequest Product
URL: https://fhir.developer.gene.com/StructureDefinition/Product
Binding: UAPI Value Set - Product Name (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for coverage eligiblity request
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... priority 0..1CodeableConceptDesired processing priority
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred.

... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.


... patient Σ1..1Reference(Patient)Intended recipient of products and services
... serviced[x] 0..1Estimated date or dates of service
.... servicedDatedate
.... servicedPeriodPeriod
... created Σ1..1dateTimeCreation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author
... provider 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the request
... insurer Σ1..1Reference(Organization)Coverage issuer
... facility 0..1Reference(Location)Servicing facility
... supportingInfo 0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... information 1..1Reference(Resource)Data to be provided
.... appliesToAll 0..1booleanApplies to all items
... insurance 0..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... focal 0..1booleanApplicable coverage
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
... item 0..*BackboneElementItem to be evaluated for eligibiity
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... supportingInfoSequence 0..*positiveIntApplicable exception or supporting information
.... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.

.... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptProduct 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..1Reference(Practitioner | PractitionerRole)Perfoming practitioner
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... facility 0..1Reference(Location | Organization)Servicing facility
.... diagnosis 0..*BackboneElementApplicable diagnosis
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... diagnosis[x] 0..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

...... diagnosisCodeableConceptCodeableConcept
...... diagnosisReferenceReference(Condition)
.... detail 0..*Reference(Resource)Product or service details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
CoverageEligibilityRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
CoverageEligibilityRequest.priorityexampleProcessPriorityCodes
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
CoverageEligibilityRequest.item.categoryexampleBenefitCategoryCodes
CoverageEligibilityRequest.item.productOrServiceexampleUSCLSCodes
CoverageEligibilityRequest.item.modifierexampleModifierTypeCodes
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]exampleICD-10Codes

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... serviceRequestType 0..1CodeableConceptUAPI CoverageEligibilityRequest ServiceRequestType
URL: https://fhir.developer.gene.com/StructureDefinition/SRType
Binding: UAPI Value Set - Service Request Type (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.


... patient Σ1..1Reference(Patient)Intended recipient of products and services
... created Σ1..1dateTimeCreation date
... insurer Σ1..1Reference(Organization)Coverage issuer

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CoverageEligibilityRequest 0..*CoverageEligibilityRequestCoverageEligibilityRequest resource
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... serviceRequestType 0..1CodeableConceptUAPI CoverageEligibilityRequest ServiceRequestType
URL: https://fhir.developer.gene.com/StructureDefinition/SRType
Binding: UAPI Value Set - Service Request Type (required)
... medication 0..1CodeableConceptUAPI CoverageEligibilityRequest Product
URL: https://fhir.developer.gene.com/StructureDefinition/Product
Binding: UAPI Value Set - Product Name (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for coverage eligiblity request
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... priority 0..1CodeableConceptDesired processing priority
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred.

... purpose Σ1..*codeauth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.


... patient Σ1..1Reference(Patient)Intended recipient of products and services
... serviced[x] 0..1Estimated date or dates of service
.... servicedDatedate
.... servicedPeriodPeriod
... created Σ1..1dateTimeCreation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author
... provider 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the request
... insurer Σ1..1Reference(Organization)Coverage issuer
... facility 0..1Reference(Location)Servicing facility
... supportingInfo 0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... information 1..1Reference(Resource)Data to be provided
.... appliesToAll 0..1booleanApplies to all items
... insurance 0..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... focal 0..1booleanApplicable coverage
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
... item 0..*BackboneElementItem to be evaluated for eligibiity
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... supportingInfoSequence 0..*positiveIntApplicable exception or supporting information
.... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.

.... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptProduct 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..1Reference(Practitioner | PractitionerRole)Perfoming practitioner
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... facility 0..1Reference(Location | Organization)Servicing facility
.... diagnosis 0..*BackboneElementApplicable diagnosis
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... diagnosis[x] 0..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

...... diagnosisCodeableConceptCodeableConcept
...... diagnosisReferenceReference(Condition)
.... detail 0..*Reference(Resource)Product or service details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
CoverageEligibilityRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
CoverageEligibilityRequest.statusrequiredFinancialResourceStatusCodes
CoverageEligibilityRequest.priorityexampleProcessPriorityCodes
CoverageEligibilityRequest.purposerequiredEligibilityRequestPurpose
CoverageEligibilityRequest.item.categoryexampleBenefitCategoryCodes
CoverageEligibilityRequest.item.productOrServiceexampleUSCLSCodes
CoverageEligibilityRequest.item.modifierexampleModifierTypeCodes
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]exampleICD-10Codes

This structure is derived from CoverageEligibilityRequest

 

Other representations of profile: CSV, Excel, Schematron