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Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
ShEx statement for coverageeligibilityrequest
PREFIX fhir: <http://hl7.org/fhir/> PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/> PREFIX xsd: <http://www.w3.org/2001/XMLSchema#> PREFIX rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> IMPORT <code.shex> IMPORT <date.shex> IMPORT <Money.shex> IMPORT <Period.shex> IMPORT <string.shex> IMPORT <Patient.shex> IMPORT <boolean.shex> IMPORT <dateTime.shex> IMPORT <Location.shex> IMPORT <Coverage.shex> IMPORT <Quantity.shex> IMPORT <Resource.shex> IMPORT <Reference.shex> IMPORT <Condition.shex> IMPORT <Identifier.shex> IMPORT <positiveInt.shex> IMPORT <Practitioner.shex> IMPORT <Organization.shex> IMPORT <DomainResource.shex> IMPORT <CodeableConcept.shex> IMPORT <BackboneElement.shex> IMPORT <PractitionerRole.shex> start=@<CoverageEligibilityRequest> AND {fhir:nodeRole [fhir:treeRoot]} # CoverageEligibilityRequest resource <CoverageEligibilityRequest> EXTENDS @<DomainResource> CLOSED { a [fhir:CoverageEligibilityRequest]?;fhir:nodeRole [fhir:treeRoot]?; fhir:identifier @<OneOrMore_Identifier>?; # Business Identifier for coverage # eligiblity request fhir:status @<code> AND {fhir:v @fhirvs:fm-status}; # active | cancelled | draft | # entered-in-error fhir:priority @<CodeableConcept>?; # Desired processing priority fhir:purpose @<OneOrMore_code> AND {fhir:v @fhirvs:eligibilityrequest-purpose}; # auth-requirements | benefits | # discovery | validation fhir:patient @<Reference> AND {fhir:link @<Patient> ? }; # Intended recipient of products and # services fhir:event @<OneOrMore_CoverageEligibilityRequest.event>?; # Event information fhir:serviced @<date> OR @<Period> ?; # Estimated date or dates of service fhir:created @<dateTime>; # Creation date fhir:enterer @<Reference> AND {fhir:link @<Practitioner> OR @<PractitionerRole> ? }?; # Author fhir:provider @<Reference> AND {fhir:link @<Organization> OR @<Practitioner> OR @<PractitionerRole> ? }?; # Party responsible for the request fhir:insurer @<Reference> AND {fhir:link @<Organization> ? }; # Coverage issuer fhir:facility @<Reference> AND {fhir:link @<Location> ? }?; # Servicing facility fhir:supportingInfo @<OneOrMore_CoverageEligibilityRequest.supportingInfo>?; # Supporting information fhir:insurance @<OneOrMore_CoverageEligibilityRequest.insurance>?; # Patient insurance information fhir:item @<OneOrMore_CoverageEligibilityRequest.item>?; # Item to be evaluated for eligibiity } # Patient insurance information <CoverageEligibilityRequest.insurance> EXTENDS @<BackboneElement> CLOSED { fhir:focal @<boolean>?; # Applicable coverage fhir:coverage @<Reference> AND {fhir:link @<Coverage> ? }; # Insurance information fhir:businessArrangement @<string>?; # Additional provider contract number } # Applicable diagnosis <CoverageEligibilityRequest.item.diagnosis> EXTENDS @<BackboneElement> CLOSED { fhir:diagnosis @<CodeableConcept> OR (@<Reference> AND {fhir:link @<Condition> }) ?; # Nature of illness or problem } # Item to be evaluated for eligibiity <CoverageEligibilityRequest.item> EXTENDS @<BackboneElement> CLOSED { fhir:supportingInfoSequence @<OneOrMore_positiveInt>?; # Applicable exception or supporting # information fhir:category @<CodeableConcept>?; # Benefit classification fhir:productOrService @<CodeableConcept>?; # Billing, service, product, or drug # code fhir:modifier @<OneOrMore_CodeableConcept>?; # Product or service billing # modifiers fhir:provider @<Reference> AND {fhir:link @<Practitioner> OR @<PractitionerRole> ? }?; # Perfoming practitioner fhir:quantity @<Quantity>?; # Count of products or services fhir:unitPrice @<Money>?; # Fee, charge or cost per item fhir:facility @<Reference> AND {fhir:link @<Location> OR @<Organization> ? }?; # Servicing facility fhir:diagnosis @<OneOrMore_CoverageEligibilityRequest.item.diagnosis>?; # Applicable diagnosis fhir:detail @<OneOrMore_Reference_Resource>?; # Product or service details } # Event information <CoverageEligibilityRequest.event> EXTENDS @<BackboneElement> CLOSED { fhir:type @<CodeableConcept>; # Specific event fhir:when @<dateTime> OR @<Period> ; # Occurance date or period } # Supporting information <CoverageEligibilityRequest.supportingInfo> EXTENDS @<BackboneElement> CLOSED { fhir:sequence @<positiveInt>; # Information instance identifier fhir:information @<Reference> AND {fhir:link @<Resource> ? }; # Data to be provided fhir:appliesToAll @<boolean>?; # Applies to all items } #---------------------- Cardinality Types (OneOrMore) ------------------- <OneOrMore_Identifier> CLOSED { rdf:first @<Identifier> ; rdf:rest [rdf:nil] OR @<OneOrMore_Identifier> } <OneOrMore_code> CLOSED { rdf:first @<code> ; rdf:rest [rdf:nil] OR @<OneOrMore_code> } <OneOrMore_CoverageEligibilityRequest.event> CLOSED { rdf:first @<CoverageEligibilityRequest.event> ; rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.event> } <OneOrMore_CoverageEligibilityRequest.supportingInfo> CLOSED { rdf:first @<CoverageEligibilityRequest.supportingInfo> ; rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.supportingInfo> } <OneOrMore_CoverageEligibilityRequest.insurance> CLOSED { rdf:first @<CoverageEligibilityRequest.insurance> ; rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.insurance> } <OneOrMore_CoverageEligibilityRequest.item> CLOSED { rdf:first @<CoverageEligibilityRequest.item> ; rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.item> } <OneOrMore_positiveInt> CLOSED { rdf:first @<positiveInt> ; rdf:rest [rdf:nil] OR @<OneOrMore_positiveInt> } <OneOrMore_CodeableConcept> CLOSED { rdf:first @<CodeableConcept> ; rdf:rest [rdf:nil] OR @<OneOrMore_CodeableConcept> } <OneOrMore_CoverageEligibilityRequest.item.diagnosis> CLOSED { rdf:first @<CoverageEligibilityRequest.item.diagnosis> ; rdf:rest [rdf:nil] OR @<OneOrMore_CoverageEligibilityRequest.item.diagnosis> } <OneOrMore_Reference_Resource> CLOSED { rdf:first @<Reference> AND {fhir:link @<Resource> } ; rdf:rest [rdf:nil] OR @<OneOrMore_Reference_Resource> } #---------------------- Value Sets ------------------------ # A code specifying the types of information being requested. fhirvs:eligibilityrequest-purpose ["auth-requirements" "benefits" "discovery" "validation"] # This value set includes Status codes. fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]
Usage note: every effort has been made to ensure that the ShEx files are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Tue, Nov 12, 2024 03:28+0000.
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