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 CoverageEligibilityResponse

Official URL: https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-coverageeligibilityresponse Version: 0.1.0
Draft as of 2026-07-24 Computable Name: AtriusInCoverageEligibilityResponse
Other Identifiers: OID:1.3.6.1.4.1.66219.1.42.39

Atrius India Core profile. Parent: FHIR R4. NDHM 6.5.0 CoverageEligibilityResponse 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
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.0.1) CoverageEligibilityResponse 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
... 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(Patient) Intended recipient of products and services
... created Σ 1..1 dateTime Response creation date
... request Σ 1..1 Reference(Atrius India Core CoverageEligibilityRequest(0.1.0)) Eligibility request reference
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... disposition S 0..1 string Disposition Message
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... insurance S 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... coverage SΣ 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... inforce S 0..1 boolean Coverage inforce indicator
.... item SC 0..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... 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)
..... benefit S 0..* BackboneElement Benefit Summary
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
... error S 0..* BackboneElement Processing errors
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The error codes for adjudication processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​error.code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ces-1 error CoverageEligibilityResponse.insurance.item SHALL contain a category or a billcode but not both. category.exists() xor productOrService.exists()
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse 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 CoverageEligibilityResponse 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 CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.created, CoverageEligibilityResponse.request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, CoverageEligibilityResponse.insurance.inforce, CoverageEligibilityResponse.insurance.item, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.category, CoverageEligibilityResponse.insurance.item.productOrService, CoverageEligibilityResponse.insurance.item.benefit, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.type, CoverageEligibilityResponse.error, CoverageEligibilityResponse.error.modifierExtension, CoverageEligibilityResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse CoverageEligibilityResponse(4.0.1)
... purpose S 1..* code auth-requirements | benefits | discovery | validation
... request 1..1 Reference(Atrius India Core CoverageEligibilityRequest(0.1.0)) Eligibility request reference
... outcome S 1..1 code queued | complete | error | partial
... insurer S 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... insurance S 0..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... inforce S 0..1 boolean Coverage inforce indicator
.... item S 0..* BackboneElement Benefits and authorization details
..... 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)
..... benefit S 0..* BackboneElement Benefit Summary
... error S 0..* BackboneElement Processing errors

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.0.1) CoverageEligibilityResponse 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 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.
... purpose SΣ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Patient) 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 Response creation date
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(Atrius India Core CoverageEligibilityRequest(0.1.0)) Eligibility request reference
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... disposition S 0..1 string Disposition Message
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... 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
.... coverage SΣ 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... inforce S 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item SC 0..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... 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
..... 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(Practitioner | PractitionerRole) Performing practitioner
..... excluded 0..1 boolean Excluded from the plan
..... name 0..1 string Short name for the benefit
..... description 0..1 string Description of the benefit or services covered
..... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
..... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
..... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
..... benefit S 0..* BackboneElement Benefit Summary
...... 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
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Benefits allowed
....... allowedUnsignedInt unsignedInt
....... allowedString string
....... allowedMoney Money
...... used[x] 0..1 Benefits used
....... usedUnsignedInt unsignedInt
....... usedString string
....... usedMoney Money
..... authorizationRequired 0..1 boolean Authorization required flag
..... authorizationSupporting 0..* CodeableConcept Type of required supporting materials
Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
..... authorizationUrl 0..1 uri Preauthorization requirements endpoint
... preAuthRef 0..1 string Preauthorization reference
... form 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... error S 0..* BackboneElement Processing errors
.... 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
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The error codes for adjudication processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.network Base example Network Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit Base example Unit Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.term Base example Benefit Term Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.authorizationSupporting Base example CoverageEligibilityResponse Auth Support Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​form Base example Forms 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​error.code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ces-1 error CoverageEligibilityResponse.insurance.item SHALL contain a category or a billcode but not both. category.exists() xor productOrService.exists()
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse 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 CoverageEligibilityResponse 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 CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityResponse.meta, CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.language, CoverageEligibilityResponse.text, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.serviced[x], CoverageEligibilityResponse.created, CoverageEligibilityResponse.requestor, CoverageEligibilityResponse.request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, CoverageEligibilityResponse.insurance.inforce, CoverageEligibilityResponse.insurance.benefitPeriod, CoverageEligibilityResponse.insurance.item, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.category, CoverageEligibilityResponse.insurance.item.productOrService, CoverageEligibilityResponse.insurance.item.modifier, CoverageEligibilityResponse.insurance.item.provider, CoverageEligibilityResponse.insurance.item.excluded, CoverageEligibilityResponse.insurance.item.name, CoverageEligibilityResponse.insurance.item.description, CoverageEligibilityResponse.insurance.item.network, CoverageEligibilityResponse.insurance.item.unit, CoverageEligibilityResponse.insurance.item.term, CoverageEligibilityResponse.insurance.item.benefit, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.type, CoverageEligibilityResponse.insurance.item.benefit.allowed[x], CoverageEligibilityResponse.insurance.item.benefit.used[x], CoverageEligibilityResponse.insurance.item.authorizationRequired, CoverageEligibilityResponse.insurance.item.authorizationSupporting, CoverageEligibilityResponse.insurance.item.authorizationUrl, CoverageEligibilityResponse.preAuthRef, CoverageEligibilityResponse.form, CoverageEligibilityResponse.error, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension, CoverageEligibilityResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.0.1) CoverageEligibilityResponse 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
... 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(Patient) Intended recipient of products and services
... created Σ 1..1 dateTime Response creation date
... request Σ 1..1 Reference(Atrius India Core CoverageEligibilityRequest(0.1.0)) Eligibility request reference
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... disposition S 0..1 string Disposition Message
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... insurance S 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... coverage SΣ 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... inforce S 0..1 boolean Coverage inforce indicator
.... item SC 0..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... 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)
..... benefit S 0..* BackboneElement Benefit Summary
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
... error S 0..* BackboneElement Processing errors
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The error codes for adjudication processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​error.code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ces-1 error CoverageEligibilityResponse.insurance.item SHALL contain a category or a billcode but not both. category.exists() xor productOrService.exists()
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse 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 CoverageEligibilityResponse 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 CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.created, CoverageEligibilityResponse.request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, CoverageEligibilityResponse.insurance.inforce, CoverageEligibilityResponse.insurance.item, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.category, CoverageEligibilityResponse.insurance.item.productOrService, CoverageEligibilityResponse.insurance.item.benefit, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.type, CoverageEligibilityResponse.error, CoverageEligibilityResponse.error.modifierExtension, CoverageEligibilityResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse CoverageEligibilityResponse(4.0.1)
... purpose S 1..* code auth-requirements | benefits | discovery | validation
... request 1..1 Reference(Atrius India Core CoverageEligibilityRequest(0.1.0)) Eligibility request reference
... outcome S 1..1 code queued | complete | error | partial
... insurer S 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... insurance S 0..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... inforce S 0..1 boolean Coverage inforce indicator
.... item S 0..* BackboneElement Benefits and authorization details
..... 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)
..... benefit S 0..* BackboneElement Benefit Summary
... error S 0..* BackboneElement Processing errors

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse(4.0.1) CoverageEligibilityResponse 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 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.
... purpose SΣ 1..* code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.
... patient Σ 1..1 Reference(Patient) 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 Response creation date
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(Atrius India Core CoverageEligibilityRequest(0.1.0)) Eligibility request reference
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... disposition S 0..1 string Disposition Message
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Coverage issuer
... 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
.... coverage SΣ 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... inforce S 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item SC 0..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... 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
..... 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(Practitioner | PractitionerRole) Performing practitioner
..... excluded 0..1 boolean Excluded from the plan
..... name 0..1 string Short name for the benefit
..... description 0..1 string Description of the benefit or services covered
..... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
..... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
..... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
..... benefit S 0..* BackboneElement Benefit Summary
...... 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
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Benefits allowed
....... allowedUnsignedInt unsignedInt
....... allowedString string
....... allowedMoney Money
...... used[x] 0..1 Benefits used
....... usedUnsignedInt unsignedInt
....... usedString string
....... usedMoney Money
..... authorizationRequired 0..1 boolean Authorization required flag
..... authorizationSupporting 0..* CodeableConcept Type of required supporting materials
Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
..... authorizationUrl 0..1 uri Preauthorization requirements endpoint
... preAuthRef 0..1 string Preauthorization reference
... form 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... error S 0..* BackboneElement Processing errors
.... 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
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The error codes for adjudication processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CoverageEligibilityResponse.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​purpose Base required EligibilityResponsePurpose 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
CoverageEligibilityResponse.​insurance.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.network Base example Network Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.unit Base example Unit Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.term Base example Benefit Term Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.authorizationSupporting Base example CoverageEligibilityResponse Auth Support Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​form Base example Forms 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​error.code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
ces-1 error CoverageEligibilityResponse.insurance.item SHALL contain a category or a billcode but not both. category.exists() xor productOrService.exists()
dom-2 error CoverageEligibilityResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CoverageEligibilityResponse 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 CoverageEligibilityResponse 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 CoverageEligibilityResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CoverageEligibilityResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error CoverageEligibilityResponse.meta, CoverageEligibilityResponse.implicitRules, CoverageEligibilityResponse.language, CoverageEligibilityResponse.text, CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.identifier, CoverageEligibilityResponse.status, CoverageEligibilityResponse.purpose, CoverageEligibilityResponse.patient, CoverageEligibilityResponse.serviced[x], CoverageEligibilityResponse.created, CoverageEligibilityResponse.requestor, CoverageEligibilityResponse.request, CoverageEligibilityResponse.outcome, CoverageEligibilityResponse.disposition, CoverageEligibilityResponse.insurer, CoverageEligibilityResponse.insurance, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.coverage, CoverageEligibilityResponse.insurance.inforce, CoverageEligibilityResponse.insurance.benefitPeriod, CoverageEligibilityResponse.insurance.item, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.category, CoverageEligibilityResponse.insurance.item.productOrService, CoverageEligibilityResponse.insurance.item.modifier, CoverageEligibilityResponse.insurance.item.provider, CoverageEligibilityResponse.insurance.item.excluded, CoverageEligibilityResponse.insurance.item.name, CoverageEligibilityResponse.insurance.item.description, CoverageEligibilityResponse.insurance.item.network, CoverageEligibilityResponse.insurance.item.unit, CoverageEligibilityResponse.insurance.item.term, CoverageEligibilityResponse.insurance.item.benefit, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.type, CoverageEligibilityResponse.insurance.item.benefit.allowed[x], CoverageEligibilityResponse.insurance.item.benefit.used[x], CoverageEligibilityResponse.insurance.item.authorizationRequired, CoverageEligibilityResponse.insurance.item.authorizationSupporting, CoverageEligibilityResponse.insurance.item.authorizationUrl, CoverageEligibilityResponse.preAuthRef, CoverageEligibilityResponse.form, CoverageEligibilityResponse.error, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension, CoverageEligibilityResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error CoverageEligibilityResponse.extension, CoverageEligibilityResponse.modifierExtension, CoverageEligibilityResponse.insurance.extension, CoverageEligibilityResponse.insurance.modifierExtension, CoverageEligibilityResponse.insurance.item.extension, CoverageEligibilityResponse.insurance.item.modifierExtension, CoverageEligibilityResponse.insurance.item.benefit.extension, CoverageEligibilityResponse.insurance.item.benefit.modifierExtension, CoverageEligibilityResponse.error.extension, CoverageEligibilityResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

 

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