Atrius India Core FHIR Implementation Guide
0.1.0 - ci-build

Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Atrius India Core CoverageEligibilityRequest

Official URL: https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-coverageeligibilityrequest Version: 0.1.0
Draft as of 2026-07-24 Computable Name: AtriusInCoverageEligibilityRequest
Other Identifiers: OID:1.3.6.1.4.1.66219.1.42.37

Atrius India Core profile. Parent: FHIR R4. NDHM 6.5.0 CoverageEligibilityRequest parity.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest(4.0.1) CoverageEligibilityRequest resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 0..* Identifier Business Identifier for coverage eligiblity request
... purpose SΣ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) Intended recipient of products and services
... created Σ 1..1 dateTime Creation date
... insurer Σ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... supportingInfo S 0..* BackboneElement Supporting information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Information instance identifier
.... information 1..1 Reference(Resource) Data to be provided
... insurance S 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
... item S 0..* BackboneElement Item to be evaluated for eligibiity
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategory (6.5.0) (example)
.... productOrService S 0..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... provider 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0)) Perfoming practitioner
.... diagnosis S 0..* BackboneElement Applicable diagnosis
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... diagnosis[x] 0..1 Nature of illness or problem
Binding: ICD10Diagnosticcodes (6.5.0) (example)
...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD10 Diagnostic codes 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityRequest.implicitRules, CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.identifier, CoverageEligibilityRequest.status, CoverageEligibilityRequest.purpose, CoverageEligibilityRequest.patient, CoverageEligibilityRequest.created, CoverageEligibilityRequest.insurer, CoverageEligibilityRequest.supportingInfo, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.supportingInfo.sequence, CoverageEligibilityRequest.supportingInfo.information, CoverageEligibilityRequest.insurance, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.insurance.coverage, CoverageEligibilityRequest.item, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.category, CoverageEligibilityRequest.item.productOrService, CoverageEligibilityRequest.item.provider, CoverageEligibilityRequest.item.diagnosis, CoverageEligibilityRequest.item.diagnosis.modifierExtension, CoverageEligibilityRequest.item.diagnosis.diagnosis[x] All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.diagnosis.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest CoverageEligibilityRequest(4.0.1)
... identifier S 0..* Identifier Business Identifier for coverage eligiblity request
... purpose S 1..* code auth-requirements | benefits | discovery | validation
... patient 1..1 Reference(Atrius India Core Patient(0.1.0)) Intended recipient of products and services
... supportingInfo S 0..* BackboneElement Supporting information
... insurance S 0..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
... item S 0..* BackboneElement Item to be evaluated for eligibiity
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategory (6.5.0) (example)
.... productOrService S 0..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... provider 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0)) Perfoming practitioner
.... diagnosis S 0..* BackboneElement Applicable diagnosis
..... diagnosis[x] 0..1 CodeableConcept, Reference(Condition) Nature of illness or problem
Binding: ICD10Diagnosticcodes (6.5.0) (example)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD10 Diagnostic codes 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest(4.0.1) CoverageEligibilityRequest resource
... 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
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 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 SΣ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) 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(Practitioner | PractitionerRole) Author
... provider 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... insurer Σ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... facility 0..1 Reference(Location) Servicing facility
... supportingInfo S 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... 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 S 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... focal 0..1 boolean Applicable coverage
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
... item S 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
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... supportingInfoSequence 0..* positiveInt Applicable exception or supporting information
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategory (6.5.0) (example)
.... productOrService S 0..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... 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(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0)) Perfoming practitioner
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... facility 0..1 Reference(Location | Organization) Servicing facility
.... diagnosis S 0..* BackboneElement Applicable diagnosis
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... diagnosis[x] 0..1 Nature of illness or problem
Binding: ICD10Diagnosticcodes (6.5.0) (example)
...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
.... detail 0..* Reference(Resource) Product or service details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD10 Diagnostic codes 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityRequest.meta, CoverageEligibilityRequest.implicitRules, CoverageEligibilityRequest.language, CoverageEligibilityRequest.text, CoverageEligibilityRequest.extension, CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.identifier, CoverageEligibilityRequest.status, CoverageEligibilityRequest.priority, CoverageEligibilityRequest.purpose, CoverageEligibilityRequest.patient, CoverageEligibilityRequest.serviced[x], CoverageEligibilityRequest.created, CoverageEligibilityRequest.enterer, CoverageEligibilityRequest.provider, CoverageEligibilityRequest.insurer, CoverageEligibilityRequest.facility, CoverageEligibilityRequest.supportingInfo, CoverageEligibilityRequest.supportingInfo.extension, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.supportingInfo.sequence, CoverageEligibilityRequest.supportingInfo.information, CoverageEligibilityRequest.supportingInfo.appliesToAll, CoverageEligibilityRequest.insurance, CoverageEligibilityRequest.insurance.extension, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.insurance.focal, CoverageEligibilityRequest.insurance.coverage, CoverageEligibilityRequest.insurance.businessArrangement, CoverageEligibilityRequest.item, CoverageEligibilityRequest.item.extension, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.supportingInfoSequence, CoverageEligibilityRequest.item.category, CoverageEligibilityRequest.item.productOrService, CoverageEligibilityRequest.item.modifier, CoverageEligibilityRequest.item.provider, CoverageEligibilityRequest.item.quantity, CoverageEligibilityRequest.item.unitPrice, CoverageEligibilityRequest.item.facility, CoverageEligibilityRequest.item.diagnosis, CoverageEligibilityRequest.item.diagnosis.extension, CoverageEligibilityRequest.item.diagnosis.modifierExtension, CoverageEligibilityRequest.item.diagnosis.diagnosis[x], CoverageEligibilityRequest.item.detail All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityRequest.extension, CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.supportingInfo.extension, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.insurance.extension, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.item.extension, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.diagnosis.extension, CoverageEligibilityRequest.item.diagnosis.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest(4.0.1) CoverageEligibilityRequest resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 0..* Identifier Business Identifier for coverage eligiblity request
... purpose SΣ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) Intended recipient of products and services
... created Σ 1..1 dateTime Creation date
... insurer Σ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... supportingInfo S 0..* BackboneElement Supporting information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Information instance identifier
.... information 1..1 Reference(Resource) Data to be provided
... insurance S 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
... item S 0..* BackboneElement Item to be evaluated for eligibiity
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategory (6.5.0) (example)
.... productOrService S 0..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... provider 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0)) Perfoming practitioner
.... diagnosis S 0..* BackboneElement Applicable diagnosis
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... diagnosis[x] 0..1 Nature of illness or problem
Binding: ICD10Diagnosticcodes (6.5.0) (example)
...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD10 Diagnostic codes 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityRequest.implicitRules, CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.identifier, CoverageEligibilityRequest.status, CoverageEligibilityRequest.purpose, CoverageEligibilityRequest.patient, CoverageEligibilityRequest.created, CoverageEligibilityRequest.insurer, CoverageEligibilityRequest.supportingInfo, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.supportingInfo.sequence, CoverageEligibilityRequest.supportingInfo.information, CoverageEligibilityRequest.insurance, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.insurance.coverage, CoverageEligibilityRequest.item, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.category, CoverageEligibilityRequest.item.productOrService, CoverageEligibilityRequest.item.provider, CoverageEligibilityRequest.item.diagnosis, CoverageEligibilityRequest.item.diagnosis.modifierExtension, CoverageEligibilityRequest.item.diagnosis.diagnosis[x] All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.diagnosis.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest CoverageEligibilityRequest(4.0.1)
... identifier S 0..* Identifier Business Identifier for coverage eligiblity request
... purpose S 1..* code auth-requirements | benefits | discovery | validation
... patient 1..1 Reference(Atrius India Core Patient(0.1.0)) Intended recipient of products and services
... supportingInfo S 0..* BackboneElement Supporting information
... insurance S 0..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
... item S 0..* BackboneElement Item to be evaluated for eligibiity
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategory (6.5.0) (example)
.... productOrService S 0..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... provider 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0)) Perfoming practitioner
.... diagnosis S 0..* BackboneElement Applicable diagnosis
..... diagnosis[x] 0..1 CodeableConcept, Reference(Condition) Nature of illness or problem
Binding: ICD10Diagnosticcodes (6.5.0) (example)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD10 Diagnostic codes 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityRequest 0..* CoverageEligibilityRequest(4.0.1) CoverageEligibilityRequest resource
... 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
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 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 SΣ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) 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(Practitioner | PractitionerRole) Author
... provider 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... insurer Σ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... facility 0..1 Reference(Location) Servicing facility
... supportingInfo S 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... 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 S 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... focal 0..1 boolean Applicable coverage
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
... item S 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
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... supportingInfoSequence 0..* positiveInt Applicable exception or supporting information
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategory (6.5.0) (example)
.... productOrService S 0..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... 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(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0)) Perfoming practitioner
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... facility 0..1 Reference(Location | Organization) Servicing facility
.... diagnosis S 0..* BackboneElement Applicable diagnosis
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... diagnosis[x] 0..1 Nature of illness or problem
Binding: ICD10Diagnosticcodes (6.5.0) (example)
...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
.... detail 0..* Reference(Resource) Product or service details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityRequest.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​purpose Base required EligibilityRequestPurpose 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityRequest.​item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityRequest.​item.diagnosis.diagnosis[x] Base example ICD10 Diagnostic codes 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityRequest If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error CoverageEligibilityRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityRequest.meta, CoverageEligibilityRequest.implicitRules, CoverageEligibilityRequest.language, CoverageEligibilityRequest.text, CoverageEligibilityRequest.extension, CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.identifier, CoverageEligibilityRequest.status, CoverageEligibilityRequest.priority, CoverageEligibilityRequest.purpose, CoverageEligibilityRequest.patient, CoverageEligibilityRequest.serviced[x], CoverageEligibilityRequest.created, CoverageEligibilityRequest.enterer, CoverageEligibilityRequest.provider, CoverageEligibilityRequest.insurer, CoverageEligibilityRequest.facility, CoverageEligibilityRequest.supportingInfo, CoverageEligibilityRequest.supportingInfo.extension, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.supportingInfo.sequence, CoverageEligibilityRequest.supportingInfo.information, CoverageEligibilityRequest.supportingInfo.appliesToAll, CoverageEligibilityRequest.insurance, CoverageEligibilityRequest.insurance.extension, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.insurance.focal, CoverageEligibilityRequest.insurance.coverage, CoverageEligibilityRequest.insurance.businessArrangement, CoverageEligibilityRequest.item, CoverageEligibilityRequest.item.extension, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.supportingInfoSequence, CoverageEligibilityRequest.item.category, CoverageEligibilityRequest.item.productOrService, CoverageEligibilityRequest.item.modifier, CoverageEligibilityRequest.item.provider, CoverageEligibilityRequest.item.quantity, CoverageEligibilityRequest.item.unitPrice, CoverageEligibilityRequest.item.facility, CoverageEligibilityRequest.item.diagnosis, CoverageEligibilityRequest.item.diagnosis.extension, CoverageEligibilityRequest.item.diagnosis.modifierExtension, CoverageEligibilityRequest.item.diagnosis.diagnosis[x], CoverageEligibilityRequest.item.detail All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityRequest.extension, CoverageEligibilityRequest.modifierExtension, CoverageEligibilityRequest.supportingInfo.extension, CoverageEligibilityRequest.supportingInfo.modifierExtension, CoverageEligibilityRequest.insurance.extension, CoverageEligibilityRequest.insurance.modifierExtension, CoverageEligibilityRequest.item.extension, CoverageEligibilityRequest.item.modifierExtension, CoverageEligibilityRequest.item.diagnosis.extension, CoverageEligibilityRequest.item.diagnosis.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

 

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