Profile Comparison between https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse vs https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
copyright
date	2024-11-13T10:50:55-06:00	2024-11-22T13:00:48+00:00	Values Differ
description	The FAIS CoverageEligibilityResponse profile to be used as the response to the [FAIS CoverageEligibilityRequest $submit](OperationDefinition-IHE.FAIS.CoverageEligibilityRequest.Submit.html)
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	http://unstats.un.org/unsd/methods/m49/m49.htm#001
kind	resource
name	FAISCoverageEligibilityResponse
publisher	IHE IT Infrastructure Technical Committee
purpose
status	active
title	FAIS CoverageEligibilityResponse Profile
type	CoverageEligibilityResponse
url	https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.CoverageEligibilityResponse
version	1.0.0	1.0.1-current	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	R Type	R Description & Constraints	Comments
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
id	Σ	0..1	id	Logical id of this artifact	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..0			?!Σ	0..0
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..0			?!	0..0
identifier		0..*	Identifier	Business Identifier for coverage eligiblity request		0..*	Identifier	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
purpose	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: ?? (required): A code specifying the types of information being requested.	Σ	1..*	code	auth-requirements | benefits | discovery | validation Binding: ?? (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(Patient)	Intended recipient of products and services	Σ	1..1	Reference(Patient)	Intended recipient of products and services
serviced[x]		0..1	date, Period	Estimated date or dates of service		0..1	date, Period	Estimated date or dates of service
created	Σ	1..1	dateTime	Response creation date	Σ	1..1	dateTime	Response creation date
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
request	Σ	1..1	Reference(FAIS CoverageEligibilityRequest Profile)	Eligibility request reference	Σ	1..1	Reference(FAIS CoverageEligibilityRequest Profile)	Eligibility request reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ?? (required): The outcome of the processing.	Σ	1..1	code	queued | complete | error | partial Binding: ?? (required): The outcome of the processing.
disposition		0..1	string	Disposition Message		0..1	string	Disposition Message
insurer	Σ	1..1	Reference(Organization)	Coverage issuer	Σ	1..1	Reference(Organization)	Coverage issuer
insurance		0..*	BackboneElement	Patient insurance information		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage	Σ	1..1	Reference(Coverage)	Insurance information	Σ	1..1	Reference(Coverage)	Insurance information
inforce		0..1	boolean	Coverage inforce indicator		0..1	boolean	Coverage inforce indicator
benefitPeriod		0..1	Period	When the benefits are applicable		0..1	Period	When the benefits are applicable
item	C	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both.	C	0..*	BackboneElement	Benefits and authorization details ces-1: SHALL contain a category or a billcode but not both.
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision etc.		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision etc.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		0..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
excluded		0..1	boolean	Excluded from the plan		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services.		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: ?? (example): Unit covered/serviced - individual or family.		0..1	CodeableConcept	Individual or family Binding: ?? (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime.		0..1	CodeableConcept	Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime.
benefit		0..*	BackboneElement	Benefit Summary		0..*	BackboneElement	Benefit Summary
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc.		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1	unsignedInt, string, Money	Benefits allowed		0..1	unsignedInt, string, Money	Benefits allowed
used[x]		0..1	unsignedInt, string, Money	Benefits used		0..1	unsignedInt, string, Money	Benefits used
authorizationRequired		0..1	boolean	Authorization required flag		0..1	boolean	Authorization required flag
authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: ?? (example): Type of supporting information to provide with a preauthorization.		0..*	CodeableConcept	Type of required supporting materials Binding: ?? (example): Type of supporting information to provide with a preauthorization.
authorizationUrl		0..1	uri	Preauthorization requirements endpoint		0..1	uri	Preauthorization requirements endpoint
preAuthRef		0..1	string	Preauthorization reference		0..1	string	Preauthorization reference
form		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.
error		0..*	BackboneElement	Processing errors		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The error codes for adjudication processing.		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The error codes for adjudication processing.
Documentation for this format