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 1.1.0 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

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Resource Profile: 長照－核定額度（CoverageEligibilityResponse）

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:

• Use this Profile: 長照 SDK－回傳包（4合1）
• Refer to this Profile: 個案總查詢（CS100 對應版）Case Summary
• Examples for this Profile: CoverageEligibilityResponse/ltc-coverageeligibilityresponse-cs100-example and CoverageEligibilityResponse/ltc-coverageeligibilityresponse-sdk-example

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.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
CoverageEligibilityResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
CoverageEligibilityResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
CoverageEligibilityResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
CoverageEligibilityResponse.purpose	S This element must be supported. Σ This element is included in summaries.	1..1	code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits (extensions allowed)
CoverageEligibilityResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(長期照顧－住民基本資料)	Intended recipient of products and services
CoverageEligibilityResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
CoverageEligibilityResponse.requestor	S This element must be supported.	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
CoverageEligibilityResponse.request	Σ This element is included in summaries.	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
CoverageEligibilityResponse.outcome	Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing.
CoverageEligibilityResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Coverage issuer
CoverageEligibilityResponse.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
CoverageEligibilityResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
CoverageEligibilityResponse.insurance.item	S This element must be supported. C	1..*	BackboneElement	Benefits and authorization details Constraints: ces-1
CoverageEligibilityResponse.insurance.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.category	S This element must be supported.	1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
CoverageEligibilityResponse.insurance.item.benefit	S This element must be supported.	3..*	BackboneElement	Benefit Summary
CoverageEligibilityResponse.insurance.item.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.benefit.type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]		0..1	Money	Benefits allowed
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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse			CoverageEligibilityResponse
CoverageEligibilityResponse.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error
CoverageEligibilityResponse.purpose	S This element must be supported.	1..1	code	auth-requirements | benefits | discovery | validation Required Pattern: benefits (extensions allowed)
CoverageEligibilityResponse.patient	S This element must be supported.	1..1	Reference(長期照顧－住民基本資料)	Intended recipient of products and services
CoverageEligibilityResponse.created	S This element must be supported.	1..1	dateTime	Response creation date
CoverageEligibilityResponse.requestor	S This element must be supported.	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
CoverageEligibilityResponse.insurer	S This element must be supported.	1..1	Reference(Organization)	Coverage issuer
CoverageEligibilityResponse.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
CoverageEligibilityResponse.insurance.item	S This element must be supported.	1..*	BackboneElement	Benefits and authorization details
CoverageEligibilityResponse.insurance.item.category	S This element must be supported.	1..1	CodeableConcept	Benefit classification
CoverageEligibilityResponse.insurance.item.benefit	S This element must be supported.	3..*	BackboneElement	Benefit Summary
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]		0..1	Money	Benefits allowed
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
CoverageEligibilityResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
CoverageEligibilityResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
CoverageEligibilityResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
CoverageEligibilityResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityResponse.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
CoverageEligibilityResponse.contained		0..*	Resource	Contained, inline Resources
CoverageEligibilityResponse.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
CoverageEligibilityResponse.identifier		0..*	Identifier	Business Identifier for coverage eligiblity request
CoverageEligibilityResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
CoverageEligibilityResponse.purpose	S This element must be supported. Σ This element is included in summaries.	1..1	code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits (extensions allowed)
CoverageEligibilityResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(長期照顧－住民基本資料)	Intended recipient of products and services
CoverageEligibilityResponse.serviced[x]		0..1		Estimated date or dates of service
CoverageEligibilityResponse.serviced[x].servicedDate			date
CoverageEligibilityResponse.serviced[x].servicedPeriod			Period
CoverageEligibilityResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
CoverageEligibilityResponse.requestor	S This element must be supported.	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
CoverageEligibilityResponse.request	Σ This element is included in summaries.	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
CoverageEligibilityResponse.outcome	Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing.
CoverageEligibilityResponse.disposition		0..1	string	Disposition Message
CoverageEligibilityResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Coverage issuer
CoverageEligibilityResponse.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
CoverageEligibilityResponse.insurance.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
CoverageEligibilityResponse.insurance.inforce		0..1	boolean	Coverage inforce indicator
CoverageEligibilityResponse.insurance.benefitPeriod		0..1	Period	When the benefits are applicable
CoverageEligibilityResponse.insurance.item	S This element must be supported. C	1..*	BackboneElement	Benefits and authorization details Constraints: ces-1
CoverageEligibilityResponse.insurance.item.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.insurance.item.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.insurance.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.category	S This element must be supported.	1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
CoverageEligibilityResponse.insurance.item.productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
CoverageEligibilityResponse.insurance.item.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.
CoverageEligibilityResponse.insurance.item.provider		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
CoverageEligibilityResponse.insurance.item.excluded		0..1	boolean	Excluded from the plan
CoverageEligibilityResponse.insurance.item.name		0..1	string	Short name for the benefit
CoverageEligibilityResponse.insurance.item.description		0..1	string	Description of the benefit or services covered
CoverageEligibilityResponse.insurance.item.network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
CoverageEligibilityResponse.insurance.item.unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
CoverageEligibilityResponse.insurance.item.term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
CoverageEligibilityResponse.insurance.item.benefit	S This element must be supported.	3..*	BackboneElement	Benefit Summary
CoverageEligibilityResponse.insurance.item.benefit.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.insurance.item.benefit.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.insurance.item.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.benefit.type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]		0..1	Money	Benefits allowed
CoverageEligibilityResponse.insurance.item.benefit.used[x]		0..1		Benefits used
CoverageEligibilityResponse.insurance.item.benefit.used[x].usedUnsignedInt			unsignedInt
CoverageEligibilityResponse.insurance.item.benefit.used[x].usedString			string
CoverageEligibilityResponse.insurance.item.benefit.used[x].usedMoney			Money
CoverageEligibilityResponse.insurance.item.authorizationRequired		0..1	boolean	Authorization required flag
CoverageEligibilityResponse.insurance.item.authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
CoverageEligibilityResponse.insurance.item.authorizationUrl		0..1	uri	Preauthorization requirements endpoint
CoverageEligibilityResponse.preAuthRef		0..1	string	Preauthorization reference
CoverageEligibilityResponse.form		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
CoverageEligibilityResponse.error		0..*	BackboneElement	Processing errors
CoverageEligibilityResponse.error.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.error.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing.
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:

• 長期照顧－住民基本資料 (http://ltc-ig.fhir.tw/StructureDefinition/LTCPatient)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
CoverageEligibilityResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
CoverageEligibilityResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
CoverageEligibilityResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
CoverageEligibilityResponse.purpose	S This element must be supported. Σ This element is included in summaries.	1..1	code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits (extensions allowed)
CoverageEligibilityResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(長期照顧－住民基本資料)	Intended recipient of products and services
CoverageEligibilityResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
CoverageEligibilityResponse.requestor	S This element must be supported.	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
CoverageEligibilityResponse.request	Σ This element is included in summaries.	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
CoverageEligibilityResponse.outcome	Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing.
CoverageEligibilityResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Coverage issuer
CoverageEligibilityResponse.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
CoverageEligibilityResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
CoverageEligibilityResponse.insurance.item	S This element must be supported. C	1..*	BackboneElement	Benefits and authorization details Constraints: ces-1
CoverageEligibilityResponse.insurance.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.category	S This element must be supported.	1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
CoverageEligibilityResponse.insurance.item.benefit	S This element must be supported.	3..*	BackboneElement	Benefit Summary
CoverageEligibilityResponse.insurance.item.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.benefit.type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]		0..1	Money	Benefits allowed
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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse			CoverageEligibilityResponse
CoverageEligibilityResponse.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error
CoverageEligibilityResponse.purpose	S This element must be supported.	1..1	code	auth-requirements | benefits | discovery | validation Required Pattern: benefits (extensions allowed)
CoverageEligibilityResponse.patient	S This element must be supported.	1..1	Reference(長期照顧－住民基本資料)	Intended recipient of products and services
CoverageEligibilityResponse.created	S This element must be supported.	1..1	dateTime	Response creation date
CoverageEligibilityResponse.requestor	S This element must be supported.	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
CoverageEligibilityResponse.insurer	S This element must be supported.	1..1	Reference(Organization)	Coverage issuer
CoverageEligibilityResponse.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
CoverageEligibilityResponse.insurance.item	S This element must be supported.	1..*	BackboneElement	Benefits and authorization details
CoverageEligibilityResponse.insurance.item.category	S This element must be supported.	1..1	CodeableConcept	Benefit classification
CoverageEligibilityResponse.insurance.item.benefit	S This element must be supported.	3..*	BackboneElement	Benefit Summary
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]		0..1	Money	Benefits allowed
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CoverageEligibilityResponse		0..*	CoverageEligibilityResponse	CoverageEligibilityResponse resource
CoverageEligibilityResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
CoverageEligibilityResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
CoverageEligibilityResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
CoverageEligibilityResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityResponse.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
CoverageEligibilityResponse.contained		0..*	Resource	Contained, inline Resources
CoverageEligibilityResponse.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
CoverageEligibilityResponse.identifier		0..*	Identifier	Business Identifier for coverage eligiblity request
CoverageEligibilityResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
CoverageEligibilityResponse.purpose	S This element must be supported. Σ This element is included in summaries.	1..1	code	auth-requirements | benefits | discovery | validation Binding: EligibilityResponsePurpose (required): A code specifying the types of information being requested. Required Pattern: benefits (extensions allowed)
CoverageEligibilityResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(長期照顧－住民基本資料)	Intended recipient of products and services
CoverageEligibilityResponse.serviced[x]		0..1		Estimated date or dates of service
CoverageEligibilityResponse.serviced[x].servicedDate			date
CoverageEligibilityResponse.serviced[x].servicedPeriod			Period
CoverageEligibilityResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
CoverageEligibilityResponse.requestor	S This element must be supported.	0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request
CoverageEligibilityResponse.request	Σ This element is included in summaries.	1..1	Reference(CoverageEligibilityRequest)	Eligibility request reference
CoverageEligibilityResponse.outcome	Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The outcome of the processing.
CoverageEligibilityResponse.disposition		0..1	string	Disposition Message
CoverageEligibilityResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Coverage issuer
CoverageEligibilityResponse.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
CoverageEligibilityResponse.insurance.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
CoverageEligibilityResponse.insurance.inforce		0..1	boolean	Coverage inforce indicator
CoverageEligibilityResponse.insurance.benefitPeriod		0..1	Period	When the benefits are applicable
CoverageEligibilityResponse.insurance.item	S This element must be supported. C	1..*	BackboneElement	Benefits and authorization details Constraints: ces-1
CoverageEligibilityResponse.insurance.item.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.insurance.item.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.insurance.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.category	S This element must be supported.	1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
CoverageEligibilityResponse.insurance.item.productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
CoverageEligibilityResponse.insurance.item.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.
CoverageEligibilityResponse.insurance.item.provider		0..1	Reference(Practitioner | PractitionerRole)	Performing practitioner
CoverageEligibilityResponse.insurance.item.excluded		0..1	boolean	Excluded from the plan
CoverageEligibilityResponse.insurance.item.name		0..1	string	Short name for the benefit
CoverageEligibilityResponse.insurance.item.description		0..1	string	Description of the benefit or services covered
CoverageEligibilityResponse.insurance.item.network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
CoverageEligibilityResponse.insurance.item.unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
CoverageEligibilityResponse.insurance.item.term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
CoverageEligibilityResponse.insurance.item.benefit	S This element must be supported.	3..*	BackboneElement	Benefit Summary
CoverageEligibilityResponse.insurance.item.benefit.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.insurance.item.benefit.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.insurance.item.benefit.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.insurance.item.benefit.type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
CoverageEligibilityResponse.insurance.item.benefit.allowed[x]		0..1	Money	Benefits allowed
CoverageEligibilityResponse.insurance.item.benefit.used[x]		0..1		Benefits used
CoverageEligibilityResponse.insurance.item.benefit.used[x].usedUnsignedInt			unsignedInt
CoverageEligibilityResponse.insurance.item.benefit.used[x].usedString			string
CoverageEligibilityResponse.insurance.item.benefit.used[x].usedMoney			Money
CoverageEligibilityResponse.insurance.item.authorizationRequired		0..1	boolean	Authorization required flag
CoverageEligibilityResponse.insurance.item.authorizationSupporting		0..*	CodeableConcept	Type of required supporting materials Binding: CoverageEligibilityResponseAuthSupportCodes (example): Type of supporting information to provide with a preauthorization.
CoverageEligibilityResponse.insurance.item.authorizationUrl		0..1	uri	Preauthorization requirements endpoint
CoverageEligibilityResponse.preAuthRef		0..1	string	Preauthorization reference
CoverageEligibilityResponse.form		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
CoverageEligibilityResponse.error		0..*	BackboneElement	Processing errors
CoverageEligibilityResponse.error.id		0..1	string	Unique id for inter-element referencing
CoverageEligibilityResponse.error.extension		0..*	Extension	Additional content defined by implementations
CoverageEligibilityResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
CoverageEligibilityResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The error codes for adjudication processing.
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:

• 長期照顧－住民基本資料 (http://ltc-ig.fhir.tw/StructureDefinition/LTCPatient)

Other representations of profile: CSV, Excel, Schematron