臺灣長期照顧實作指引(TW LTC IG)
1.0.0 - STU 1.0.0

臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions

Resource Profile: 長照－核定額度（CoverageEligibilityResponse）

Official URL: http://ltc-ig.fhir.tw/StructureDefinition/LTC-CoverageEligibilityResponse Version: 1.0.0
Draft as of 2026-03-01 Computable Name: LTCCoverageEligibilityResponse

此 Profile 說明本 IG 如何進一步定義 FHIR 的 CoverageEligibilityResponse Resource，以呈現長照各服務別之核定額度摘要，包含總額、補助金額、自付額及比率等資料。

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse 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
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) Intended recipient of products and services
... created SΣ 1..1 dateTime Response creation date
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... insurer SΣ 1..1 Reference(Organization) Coverage issuer
... insurance S 1..1 BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... item SC 1..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
..... benefit S 3..* BackboneElement Benefit Summary
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Money Benefits allowed

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 Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍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 **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from CoverageEligibilityResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse CoverageEligibilityResponse
... status S 1..1 code active | cancelled | draft | entered-in-error
... purpose S 1..1 code auth-requirements | benefits | discovery | validation
Required Pattern: benefits
... patient S 1..1 Reference(長期照顧－住民基本資料) Intended recipient of products and services
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... insurer S 1..1 Reference(Organization) Coverage issuer
... insurance S 1..1 BackboneElement Patient insurance information
.... item S 1..* BackboneElement Benefits and authorization details
..... category S 1..1 CodeableConcept Benefit classification
..... benefit S 3..* BackboneElement Benefit Summary
...... allowed[x] 0..1 Money Benefits allowed

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for coverage eligiblity request
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... purpose SΣ 1..1 code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.

Required Pattern: benefits
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) Intended recipient of products and services
... serviced[x] 0..1 Estimated date or dates of service
.... servicedDate date
.... servicedPeriod Period
... created SΣ 1..1 dateTime Response creation date
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... disposition 0..1 string Disposition Message
... insurer SΣ 1..1 Reference(Organization) Coverage issuer
... insurance S 1..1 BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... inforce 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item SC 1..* 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
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... 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 3..* BackboneElement Benefit Summary
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Money Benefits allowed
...... 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 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... 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 Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
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 **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from CoverageEligibilityResponse

Summary

Mandatory: 3 elements
Must-Support: 10 elements

Structures

This structure refers to these other structures:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse 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
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) Intended recipient of products and services
... created SΣ 1..1 dateTime Response creation date
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... insurer SΣ 1..1 Reference(Organization) Coverage issuer
... insurance S 1..1 BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... item SC 1..* BackboneElement Benefits and authorization details
Constraints: ces-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
..... benefit S 3..* BackboneElement Benefit Summary
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Money Benefits allowed

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 Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.benefit.​type Base example Benefit Type Codes 📍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 **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from CoverageEligibilityResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse CoverageEligibilityResponse
... status S 1..1 code active | cancelled | draft | entered-in-error
... purpose S 1..1 code auth-requirements | benefits | discovery | validation
Required Pattern: benefits
... patient S 1..1 Reference(長期照顧－住民基本資料) Intended recipient of products and services
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... insurer S 1..1 Reference(Organization) Coverage issuer
... insurance S 1..1 BackboneElement Patient insurance information
.... item S 1..* BackboneElement Benefits and authorization details
..... category S 1..1 CodeableConcept Benefit classification
..... benefit S 3..* BackboneElement Benefit Summary
...... allowed[x] 0..1 Money Benefits allowed

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CoverageEligibilityResponse 0..* CoverageEligibilityResponse 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for coverage eligiblity request
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... purpose SΣ 1..1 code auth-requirements | benefits | discovery | validation
Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested.

Required Pattern: benefits
... patient SΣ 1..1 Reference(長期照顧－住民基本資料) Intended recipient of products and services
... serviced[x] 0..1 Estimated date or dates of service
.... servicedDate date
.... servicedPeriod Period
... created SΣ 1..1 dateTime Response creation date
... requestor S 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the request
... request Σ 1..1 Reference(CoverageEligibilityRequest) Eligibility request reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The outcome of the processing.
... disposition 0..1 string Disposition Message
... insurer SΣ 1..1 Reference(Organization) Coverage issuer
... insurance S 1..1 BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... inforce 0..1 boolean Coverage inforce indicator
.... benefitPeriod 0..1 Period When the benefits are applicable
.... item SC 1..* 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
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... 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 3..* BackboneElement Benefit Summary
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
...... allowed[x] 0..1 Money Benefits allowed
...... 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 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... 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 Codes 📍4.0.1 FHIR Std.
CoverageEligibilityResponse.​insurance.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
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 **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from CoverageEligibilityResponse

Summary

Mandatory: 3 elements
Must-Support: 10 elements

Structures

This structure refers to these other structures:

 

Other representations of profile: CSV, Excel, Schematron