FHIR Release 3 (STU) R5 Final QA

This page is part of the FHIR Specification (v3.0.2: STU (v5.0.0-draft-final: Final QA Preview for R5 - see ballot notes 3). ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R3 R2 Content Examples Detailed Descriptions Mappings Profiles & Extensions 13.3.5 R5 Resource EligibilityResponse - Detailed Descriptions R4B

Example ValueSet/disease-symptom-procedure (XML)

EligibilityResponse.requestOrganization Definition The organization which is responsible for the services rendered to the patient.
Financial Management Terminology Infrastructure Work Group Maturity Level : 2   Trial Use Compartments : Practitioner Detailed Descriptions for the elements in the EligibilityResponse resource. EligibilityResponse Definition This resource provides eligibility and plan details from the processing of an Eligibility resource. Control 1..1 EligibilityResponse.identifier Definition The Response business identifier. Note This is a business identifer, not a resource identifier (see discussion ) Control 0..* Type Identifier EligibilityResponse.status Definition The status of the resource instance. Control 0..1 Terminology Binding N/A Financial Resource Standards Status Codes ( Required ) Type code Is Modifier true Summary true Comments This element is labeled as a modifier because the status contains codes that mark the response as not currently valid. EligibilityResponse.created Definition The date when the enclosed suite of services were performed or completed. Control 0..1 Type dateTime EligibilityResponse.requestProvider Definition The practitioner who is responsible for the services rendered to the patient. Control 0..1 Type : Informative Reference ( Practitioner )

Original request resource reference. Control 0..1 Type Reference Raw XML ( EligibilityRequest ) EligibilityResponse.outcome Definition Transaction status: error, complete. Control 0..1 Terminology Binding RemittanceOutcome canonical form ( Required + also see XML Format Specification ) Type CodeableConcept EligibilityResponse.disposition Definition A description of the status of the adjudication.

Control 0..1 Type string EligibilityResponse.insurer Definition

The Insurer who produced this adjudicated response. Control 0..1 Type Reference ( Organization ) EligibilityResponse.inforce Definition Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates. Value SetDisease Symptom Procedure

Control 0..1 Type boolean EligibilityResponse.insurance 
<?xml version="1.0" encoding="UTF-8"?>

<ValueSet xmlns="http://hl7.org/fhir">
  <id value="disease-symptom-procedure"/> 
  <meta> 
    <lastUpdated value="2023-03-01T23:03:57.298+11:00"/> 
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablevalueset"/> 
  </meta> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">

      
      
      <ul> 

        
        
        <li> Include all codes defined in 

          
          
          <a href="codesystem-disease-symptom-procedurem.html">

            
            
            <code> http://hl7.org/fhir/disease-symptom-procedure</code> 

          
          
          </a> 

        
        
        </li> 

      
      
      </ul> disease-symptom-procedurem

    
    
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="brr"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1"/> 
  </extension> 
  <url value="http://hl7.org/fhir/ValueSet/disease-symptom-procedure"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.3.3114"/> 
  </identifier> 
  <version value="5.0.0-draft-final"/> 
  <name value="DiseaseSymptomProcedure"/> 
  <title value="Disease Symptom Procedure"/> 
  <status value="draft"/> 
  <experimental value="true"/> 
  <date value="2020-12-28T16:55:11+11:00"/> 
  <publisher value="HL7 (FHIR Project)"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
    <telecom> 
      <system value="email"/> 
      <value value="fhir@lists.hl7.org"/> 
    </telecom> 
  </contact> 
  <description value="A symptom, disease or procedure."/> 
  <jurisdiction> 
    <coding> 
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/> 
      <code value="001"/> 
      <display value="World"/> 
    </coding> 
  </jurisdiction> 
  <immutable value="true"/> 
  <copyright value="This resource includes content from SNOMED Clinical Terms® (SNOMED CT®) which is

   copyright of the International Health Terminology Standards Development Organisation
   (IHTSDO). Implementers of these specifications must have the appropriate SNOMED
   CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snome
  d-ct or info@snomed.org"/> 
  <compose> 
    <include> 
      <system value="http://snomed.info/sct"/> 
      <filter> 
        <property value="concept"/> 
        <op value="is-a"/> 
        <value value="363788007"/> 
      </filter> 
    </include> 
    <include> 
      <system value="http://snomed.info/sct"/> 
      <filter> 
        <property value="concept"/> 
        <op value="is-a"/> 
        <value value="64572001"/> 
      </filter> 
    </include> 
    <include> 
      <system value="http://snomed.info/sct"/> 
      <filter> 
        <property value="concept"/> 
        <op value="is-a"/> 
        <value value="71388002"/> 
      </filter> 
    </include> 
  </compose> 

Definition
The
insurer
may
provide
both
the
details
for
the
requested
coverage
as
well
as
details
for
additional
coverages
known
to
the
insurer.
Control


</

ValueSet


>

0..*



EligibilityResponse.insurance.coverage
Definition

A suite of updated or additional Coverages from Usage note: every effort has been made to ensure that the Insurer. Control 0..1 Type Reference ( Coverage ) EligibilityResponse.insurance.contract Definition The contract resource which may provide more detailed information. Control 0..1 Type Reference ( Contract ) EligibilityResponse.insurance.benefitBalance Definition Benefits examples are correct and optionally current balances by Category. Control 0..* EligibilityResponse.insurance.benefitBalance.category Definition Dental, Vision, Medical, Pharmacy, Rehab etc. Control 1..1 Terminology Binding Benefit Category Codes ( Example ) Type CodeableConcept EligibilityResponse.insurance.benefitBalance.subCategory Definition Dental: basic, major, ortho; Vision exam, glasses, contacts; etc. Control 0..1 Terminology Binding Benefit SubCategory Codes ( Example ) Type CodeableConcept EligibilityResponse.insurance.benefitBalance.excluded Definition True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage. Control 0..1 Type boolean EligibilityResponse.insurance.benefitBalance.name Definition A short name or tag for the benefit, for example MED01, or DENT2. Control 0..1 Type string EligibilityResponse.insurance.benefitBalance.description Definition A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major useful, but exclused Ortho, Implants and Costmetic services'. Control 0..1 Type string EligibilityResponse.insurance.benefitBalance.network Definition Network designation. Control 0..1 Terminology Binding Network Type Codes ( Example ) Type CodeableConcept EligibilityResponse.insurance.benefitBalance.unit Definition Unit designation: individual or family. Control 0..1 Terminology Binding Unit Type Codes ( Example ) Type CodeableConcept EligibilityResponse.insurance.benefitBalance.term Definition The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'. Control 0..1 Terminology Binding Benefit Term Codes ( Example ) Type CodeableConcept EligibilityResponse.insurance.benefitBalance.financial Definition Benefits Used to date. Control 0..* EligibilityResponse.insurance.benefitBalance.financial.type Definition Deductable, visits, benefit amount. Control 1..1 Terminology Binding Benefit Type Codes ( Example ) Type CodeableConcept EligibilityResponse.insurance.benefitBalance.financial.allowed[x] Definition Benefits allowed. Control 0..1 Type unsignedInt | string | Money [x] Note See Choice of Data Types for further information about how to use [x] EligibilityResponse.insurance.benefitBalance.financial.used[x] Definition Benefits used. Control 0..1 Type unsignedInt | Money [x] Note See Choice of Data Types for further information about how to use [x] EligibilityResponse.form Definition The form to be used for printing the content. Control 0..1 Terminology Binding Form Codes ( Example ) Type CodeableConcept EligibilityResponse.error Definition Mutually exclusive with Services Provided (Item). Control 0..* EligibilityResponse.error.code Definition An error code,from they are not a specified code system, which details why normative part of the eligibility check could not be performed. specification.

Control 1..1 Terminology Binding Adjudication Error Codes ( Example ) Type CodeableConcept