uapi-coverage-eligibility-response
type: StructureDefinition
node role: treeRoot
id:
  v: uapi-coverage-eligibility-response
meta:
  last updated:
    v: 2020-12-11T05:00:00.000+00:00
text:
  status:
    v: extensions
  div: Generated Narrative: StructureDefinition uapi-coverage-eligibility-response Last updated: 2020-12-11 05:00:00+0000 Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> CoverageEligibilityResponse CoverageEligibilityResponse #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:gpfShipmentMethod 0..1 CodeableConcept UAPI CoverageEligibilityResponse Shipment Method URL: https://fhir.developer.gene.com/StructureDefinition/gpf-shipment-method Binding: UAPI Value Set - Shipment Method (required) #xD; extension:statusOutcome 0..1 CodeableConcept UAPI CoverageEligibilityResponse Status URL: https://fhir.developer.gene.com/StructureDefinition/statusOutcome Binding: UAPI Value Set - Coverage Outcome (required) #xD; extension:priorAuthTAT 0..1 string UAPI Prior Auth Est. TAT URL: https://fhir.developer.gene.com/StructureDefinition/priorAuthTAT #xD; extension:predAuthTAT 0..1 string UAPI PreD Est. TAT URL: https://fhir.developer.gene.com/StructureDefinition/predAuthTAT #xD; extension:pcpReferralRequired 0..1 string UAPI PCP Referral Required? URL: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired #xD; extension:preReferralEffectiveDate 0..1 string UAPI PCP Referral Effective Date URL: https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate #xD; extension:pcpReferralOnFile 0..1 string UAPI PCP Referral On-file? URL: https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile #xD; extension:pcpReferralRecertificationDate 0..1 string UAPI PCP Referral Recertification Date URL: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate #xD; extension:spendDownFrequency 0..1 string UAPI Spend Down Frequency URL: https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency #xD; extension:peerToPeerAvailable 0..1 string UAPI Peer to Peer Available URL: https://fhir.developer.gene.com/Structu…
url:
  v: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage-eligibility-response
version:
  v: 1.1.20
name:
  v: UapiCoverageEligibilityResponse
title:
  v: UAPI CoverageEligibilityResponse
status:
  v: active
experimental:
  v: false
date:
  v: 2020-12-11T00:00:00-05:00
contact:
  name:
    v: Krzysztof Wilczek
  telecom:
    system:
      v: email
description:
  v: This profile constrains the CoverageEligibilityResponse resource to be used in sharing service request results in UAPI
fhir version:
  v: 4.3.0
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: cdanetv4
  uri:
    v: http://www.cda-adc.ca/en/services/cdanet/
  name:
    v: Canadian Dental Association eclaims standard
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: CoverageEligibilityResponse
base definition:
  v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
  link: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
    value: string
      v: 4.3.0
  element:
    id:
      v: CoverageEligibilityResponse
    path:
      v: CoverageEligibilityResponse
    short:
      v: CoverageEligibilityResponse resource
    definition:
      v: This resource provides eligibility and plan details from the processing of an CoverageEligibilityRequest resource.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: CoverageEligibilityResponse
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: 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
      expression:
        v: contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
      xpath:
        v: not(exists(for $contained in f:contained return $contained[not(exists(parent::*/descendant::f:reference/@value=concat('#', $contained/*/f:id/@value)) or exists(descendant::f:reference[@value='#']))]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:security))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      extension:
        value: boolean
      extension:
        value: markdown
      key:
        v: dom-6
      severity:
        v: warning
      human:
        v: A resource should have narrative for robust management
      expression:
        v: text.`div`.exists()
      xpath:
        v: exists(f:text/h:div)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    must support:
      v: false
    is modifier:
      v: false
    is summary:
      v: false
    mapping:
      identity:
        v: rim
      map:
        v: Entity. Role, or Act
    mapping:
      identity:
        v: workflow
      map:
        v: Event
    mapping:
      identity:
        v: w5
      map:
        v: financial.support
  element:
    id:
      v: CoverageEligibilityResponse.id
    path:
      v: CoverageEligibilityResponse.id
    short:
      v: Logical id of this artifact

boolean
v: true

markdown
v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.

v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

v: 0

v: 1

path:
  v: Resource.id
min:
  v: 0
max:
  v: 1

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
  value: url
    v: id
code:
  v: http://hl7.org/fhirpath/System.String

v: false

v: false

v: true

id:
  v: CoverageEligibilityResponse.meta
path:
  v: CoverageEligibilityResponse.meta
short:
  v: Metadata about the resource
definition:
  v: The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.implicitRules
path:
  v: CoverageEligibilityResponse.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
comment:
  v: Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.language
path:
  v: CoverageEligibilityResponse.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
    value: canonical
      v: http://hl7.org/fhir/ValueSet/all-languages
      link: http://hl7.org/fhir/ValueSet/all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Language
  strength:
    v: preferred
  description:
    v: IETF language tag
  value set:
    v: http://hl7.org/fhir/ValueSet/languages|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.text
path:
  v: CoverageEligibilityResponse.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
comment:
  v: Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: CoverageEligibilityResponse.contained
path:
  v: CoverageEligibilityResponse.contained
short:
  v: Contained, inline Resources
definition:
  v: These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
comment:
  v: This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
constraint:
  key:
    v: dom-r4b
  severity:
    v: warning
  human:
    v: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
  expression:
    v: ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
  xpath:
    v: not(f:Citation|f:Evidence|f:EvidenceReport|f:EvidenceVariable|f:MedicinalProductDefinition|f:PackagedProductDefinition|f:AdministrableProductDefinition|f:Ingredient|f:ClinicalUseDefinition|f:RegulatedAuthorization|f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic) or not(parent::f:Citation|parent::f:Evidence|parent::f:EvidenceReport|parent::f:EvidenceVariable|parent::f:MedicinalProductDefinition|parent::f:PackagedProductDefinition|parent::f:AdministrableProductDefinition|parent::f:Ingredient|parent::f:ClinicalUseDefinition|parent::f:RegulatedAuthorization|parent::f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic)
  source:
    v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
    link: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.extension
path:
  v: CoverageEligibilityResponse.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:gpfShipmentMethod
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: gpfShipmentMethod
short:
  v: UAPI CoverageEligibilityResponse Shipment Method
definition:
  v: Describes shipment method for GPF Shipments, currently supported values are 'Upfront' and 'Replacement'
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/gpf-shipment-method
    link: https://fhir.developer.gene.com/StructureDefinition/gpf-shipment-method
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:statusOutcome
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: statusOutcome
short:
  v: UAPI CoverageEligibilityResponse Status
definition:
  v: Provides the updated status of successfully enrolled Service Requests
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/statusOutcome
    link: https://fhir.developer.gene.com/StructureDefinition/statusOutcome
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:priorAuthTAT
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: priorAuthTAT
short:
  v: UAPI Prior Auth Est. TAT
definition:
  v: Prior Authorization Turn Around Time: Estimated time Insurance needs to review a Prior Authorization in business days.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/priorAuthTAT
    link: https://fhir.developer.gene.com/StructureDefinition/priorAuthTAT
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:predAuthTAT
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: predAuthTAT
short:
  v: UAPI PreD Est. TAT
definition:
  v: PreDetermination Turn Around Time: Estimated time Insurance needs to review a PreDetermination in business days.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/predAuthTAT
    link: https://fhir.developer.gene.com/StructureDefinition/predAuthTAT
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:pcpReferralRequired
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: pcpReferralRequired
short:
  v: UAPI PCP Referral Required?
definition:
  v: States whether a referral from a Primary Care Physician is required.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired
    link: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:preReferralEffectiveDate
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: preReferralEffectiveDate
short:
  v: UAPI PCP Referral Effective Date
definition:
  v: States what the first day of an on-file referral from a Primary Care Physician (When it starts)
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate
    link: https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:pcpReferralOnFile
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: pcpReferralOnFile
short:
  v: UAPI PCP Referral On-file?
definition:
  v: States whether a referral from a Primary Care Physician is on-file with the Insurance
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile
    link: https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:pcpReferralRecertificationDate
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: pcpReferralRecertificationDate
short:
  v: UAPI PCP Referral Recertification Date
definition:
  v: States what the last day of a on-file referral from a Primary Care Physician (When it expires)
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate
    link: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:spendDownFrequency
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: spendDownFrequency
short:
  v: UAPI Spend Down Frequency
definition:
  v: States what the Spend down frequency is for Medicaid. Only applies to patients with Medicaid
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency
    link: https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:peerToPeerAvailable
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: peerToPeerAvailable
short:
  v: UAPI Peer to Peer Available
definition:
  v: States whether Peer to Peer is an option for appeals.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable
    link: https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:noOfAppealsAllowed
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: noOfAppealsAllowed
short:
  v: UAPI # of Appeals Allowed
definition:
  v: States how many level of appeals the Insurance allows.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed
    link: https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:appealSubmissionDeadline
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: appealSubmissionDeadline
short:
  v: UAPI Appeal Submission Deadline
definition:
  v: States when the deadline is to submit for an appeal with the Insurance.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline
    link: https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:additionalDocumentsRequired
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: additionalDocumentsRequired
short:
  v: UAPI Additional Documents Required
definition:
  v: States what documents are required to submit for appeal.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired
    link: https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:estimatedAppealTAT
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: estimatedAppealTAT
short:
  v: UAPI Estimated Appeal TAT
definition:
  v: Appeal Turn Around Time: Estimated time Insurance needs to review an appeal in business days.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT
    link: https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:billingInstructions
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: billingInstructions
short:
  v: UAPI BI - Billing Instructions
definition:
  v: Benefit Investigation Billing Instructions
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/billing-instructions
    link: https://fhir.developer.gene.com/StructureDefinition/billing-instructions
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:benefitsSummary
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: benefitsSummary
short:
  v: UAPI BI - Benefits Summary
definition:
  v: Benefit Investigation Benefits Summary
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/benefits-summary
    link: https://fhir.developer.gene.com/StructureDefinition/benefits-summary
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.extension:specialtyPharmacy
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: specialtyPharmacy
short:
  v: UAPI BI - Specialty Pharmacy
definition:
  v: Benefit Investigation Specialty Pharmacy
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/specialty-pharmacy
    link: https://fhir.developer.gene.com/StructureDefinition/specialty-pharmacy
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.modifierExtension
path:
  v: CoverageEligibilityResponse.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.identifier
path:
  v: CoverageEligibilityResponse.identifier
short:
  v: Business Identifier for coverage eligiblity request
definition:
  v: A unique identifier assigned to this coverage eligiblity request.
requirements:
  v: Allows coverage eligibility requests to be distinguished and referenced.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: CoverageEligibilityResponse.status
path:
  v: CoverageEligibilityResponse.status
short:
  v: active | cancelled | draft | entered-in-error
definition:
  v: The status of the resource instance.
comment:
  v: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
requirements:
  v: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: EligibilityResponseStatus
  strength:
    v: required
  description:
    v: A code specifying the state of the resource instance.
  value set:
    v: http://hl7.org/fhir/ValueSet/fm-status|4.3.0
    link: 4.3
    link: .0
mapping:
  identity:
    v: workflow
  map:
    v: Event.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status

id:
  v: CoverageEligibilityResponse.purpose
path:
  v: CoverageEligibilityResponse.purpose
short:
  v: auth-requirements | benefits | discovery | validation
definition:
  v: Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or 'now' if not specified.
requirements:
  v: To indicate the processing actions requested.
min:
  v: 1
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.purpose
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: EligibilityResponsePurpose
  strength:
    v: required
  description:
    v: A code specifying the types of information being requested.
  value set:
    v: http://hl7.org/fhir/ValueSet/eligibilityresponse-purpose|4.3.0
    link: 4.3
    link: .0
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: CoverageEligibilityResponse.patient
path:
  v: CoverageEligibilityResponse.patient
short:
  v: Intended recipient of products and services
definition:
  v: The party who is the beneficiary of the supplied coverage and for whom eligibility is sought.
requirements:
  v: Required to provide context and coverage validation.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.patient
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.3.0
    link: 4.3
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.subject
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: C06,C07,C08, C05, C04
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: CoverageEligibilityResponse.serviced[x]
path:
  v: CoverageEligibilityResponse.serviced[x]
short:
  v: Estimated date or dates of service
definition:
  v: The date or dates when the enclosed suite of services were performed or completed.
requirements:
  v: Required to provide time context for the request.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.serviced[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: F09

id:
  v: CoverageEligibilityResponse.created
path:
  v: CoverageEligibilityResponse.created
short:
  v: Response creation date
definition:
  v: The date this resource was created.
requirements:
  v: Need to record a timestamp for use by both the recipient and the issuer.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.created
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.recorded

id:
  v: CoverageEligibilityResponse.requestor
path:
  v: CoverageEligibilityResponse.requestor
short:
  v: Party responsible for the request
definition:
  v: The provider which is responsible for the request.
comment:
  v: Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.requestor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.3.0
    link: 4.3
    link: .0
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.3.0
    link: 4.3
    link: .0
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.3.0
    link: 4.3
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source
mapping:
  identity:
    v: cdanetv4
  map:
    v: B01

id:
  v: CoverageEligibilityResponse.request
path:
  v: CoverageEligibilityResponse.request
short:
  v: Eligibility request reference
definition:
  v: Reference to the original request resource.
requirements:
  v: Needed to allow the response to be linked to the request.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.request
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityRequest|4.3.0
    link: 4.3
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.basedOn
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.why[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: A02|G01

id:
  v: CoverageEligibilityResponse.outcome
path:
  v: CoverageEligibilityResponse.outcome
short:
  v: queued | complete | error | partial
definition:
  v: The outcome of the request processing.
comment:
  v: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
requirements:
  v: To advise the requestor of an overall processing outcome.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.outcome
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: RemittanceOutcome
  strength:
    v: required
  description:
    v: The outcome of the processing.
  value set:
    v: http://hl7.org/fhir/ValueSet/remittance-outcome|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.disposition
path:
  v: CoverageEligibilityResponse.disposition
short:
  v: Disposition Message
definition:
  v: A human readable description of the status of the adjudication.
requirements:
  v: Provided for user display.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.disposition
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.note

id:
  v: CoverageEligibilityResponse.insurer
path:
  v: CoverageEligibilityResponse.insurer
short:
  v: Coverage issuer
definition:
  v: The Insurer who issued the coverage in question and is the author of the response.
requirements:
  v: Need to identify the author.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurer
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.3.0
    link: 4.3
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.insurance
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint
  value: string
    v: 380;0
path:
  v: CoverageEligibilityResponse.insurance
short:
  v: Patient insurance information
definition:
  v: Financial instruments for reimbursement for the health care products and services.
comment:
  v: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
requirements:
  v: There must be at least one coverage for which eligibility is requested.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.id
path:
  v: CoverageEligibilityResponse.insurance.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.extension
path:
  v: CoverageEligibilityResponse.insurance.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.modifierExtension
path:
  v: CoverageEligibilityResponse.insurance.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.insurance.coverage
path:
  v: CoverageEligibilityResponse.insurance.coverage
short:
  v: Insurance information
definition:
  v: Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
requirements:
  v: Required to allow the adjudicator to locate the correct policy and history within their information system.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.coverage
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Coverage|4.3.0
    link: 4.3
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true

id:
  v: CoverageEligibilityResponse.insurance.inforce
path:
  v: CoverageEligibilityResponse.insurance.inforce
short:
  v: Coverage inforce indicator
definition:
  v: Flag indicating if the coverage provided is inforce currently if no service date(s) specified or for the whole duration of the service dates.
requirements:
  v: Needed to convey the answer to the eligibility validation request.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.inforce
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.benefitPeriod
path:
  v: CoverageEligibilityResponse.insurance.benefitPeriod
short:
  v: When the benefits are applicable
definition:
  v: The term of the benefits documented in this response.
requirements:
  v: Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.benefitPeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint
  value: string
    v: 340;120
path:
  v: CoverageEligibilityResponse.insurance.item
short:
  v: Benefits and authorization details
definition:
  v: Benefits and optionally current balances, and authorization details by category or service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ces-1
  severity:
    v: error
  human:
    v: SHALL contain a category or a billcode but not both.
  expression:
    v: category.exists() xor productOrService.exists()
  xpath:
    v: exists(f:category) or exists(f:productOrService)
  source:
    v: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
    link: http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.id
path:
  v: CoverageEligibilityResponse.insurance.item.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.extension
path:
  v: CoverageEligibilityResponse.insurance.item.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.modifierExtension
path:
  v: CoverageEligibilityResponse.insurance.item.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.insurance.item.category
path:
  v: CoverageEligibilityResponse.insurance.item.category
short:
  v: Benefit classification
definition:
  v: Code to identify the general type of benefits under which products and services are provided.
comment:
  v: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
requirements:
  v: Needed to convey the category of service or product for which eligibility is sought.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: BenefitCategory
  strength:
    v: example
  description:
    v: Benefit categories such as: oral, medical, vision etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: This contains the product, service, drug or other billing code for the item.
comment:
  v: Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI).
requirements:
  v: Needed to convey the actual service or product for which eligibility is sought.
alias:
  v: Drug Code
alias:
  v: Bill Code
alias:
  v: Service Code
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.productOrService
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-uscls|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.id
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: id
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.extension
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slicing:
  discriminator:
    type:
      v: value
    path:
      v: system
  rules:
    v: closed
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 1
max:
  v: *
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding:productService
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slice name:
  v: productService
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-prod-service
    link: https://fhir.developer.gene.com/ValueSet/uapi-prod-service
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding:jcode
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slice name:
  v: jcode
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-product-jcode
    link: https://fhir.developer.gene.com/ValueSet/uapi-product-jcode
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding:preDetermination
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slice name:
  v: preDetermination
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-pre-determination
    link: https://fhir.developer.gene.com/ValueSet/uapi-pre-determination
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.text
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.text
short:
  v: Plain text representation of the concept
definition:
  v: A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
comment:
  v: Very often the text is the same as a displayName of one of the codings.
requirements:
  v: The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.9. But note many systems use C*E.2 for this
mapping:
  identity:
    v: rim
  map:
    v: ./originalText[mediaType/code="text/plain"]/data
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

id:
  v: CoverageEligibilityResponse.insurance.item.modifier
path:
  v: CoverageEligibilityResponse.insurance.item.modifier
short:
  v: Product or service billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
requirements:
  v: To support provision of the item or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.provider
path:
  v: CoverageEligibilityResponse.insurance.item.provider
short:
  v: Performing practitioner
definition:
  v: The practitioner who is eligible for the provision of the product or service.
requirements:
  v: Needed to convey the eligible provider.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.provider
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.3.0
    link: 4.3
    link: .0
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.3.0
    link: 4.3
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source
mapping:
  identity:
    v: cdanetv4
  map:
    v: B01

id:
  v: CoverageEligibilityResponse.insurance.item.excluded
path:
  v: CoverageEligibilityResponse.insurance.item.excluded
short:
  v: Excluded from the plan
definition:
  v: True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.
requirements:
  v: Needed to identify items that are specifically excluded from the coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.excluded
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.name
path:
  v: CoverageEligibilityResponse.insurance.item.name
short:
  v: Short name for the benefit
definition:
  v: A short name or tag for the benefit.
comment:
  v: For example: MED01, or DENT2.
requirements:
  v: Required to align with other plan names.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.name
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.description
path:
  v: CoverageEligibilityResponse.insurance.item.description
short:
  v: Description of the benefit or services covered
definition:
  v: A richer description of the benefit or services covered.
comment:
  v: For example 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.
requirements:
  v: Needed for human readable reference.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.description
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.network
path:
  v: CoverageEligibilityResponse.insurance.item.network
short:
  v: In or out of network
definition:
  v: Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.
requirements:
  v: Needed as in or out of network providers are treated differently under the coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.network
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: BenefitNetwork
  strength:
    v: example
  description:
    v: Code to classify in or out of network services.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-network|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.unit
path:
  v: CoverageEligibilityResponse.insurance.item.unit
short:
  v: Individual or family
definition:
  v: Indicates if the benefits apply to an individual or to the family.
requirements:
  v: Needed for the understanding of the benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.unit
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: BenefitUnit
  strength:
    v: example
  description:
    v: Unit covered/serviced - individual or family.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-unit|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.term
path:
  v: CoverageEligibilityResponse.insurance.item.term
short:
  v: Annual or lifetime
definition:
  v: The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.
requirements:
  v: Needed for the understanding of the benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.term
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: BenefitTerm
  strength:
    v: example
  description:
    v: Coverage unit - annual, lifetime.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-term|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.benefit
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint
  value: string
    v: 340;320
path:
  v: CoverageEligibilityResponse.insurance.item.benefit
short:
  v: Benefit Summary
definition:
  v: Benefits used to date.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.id
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.extension
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.modifierExtension
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type
short:
  v: Benefit classification
definition:
  v: Classification of benefit being provided.
comment:
  v: For example: deductible, visits, benefit amount.
requirements:
  v: Needed to convey the nature of the benefit.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: BenefitType
  strength:
    v: example
  description:
    v: Deductable, visits, co-pay, etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/benefit-type|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.id
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: id
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.extension
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.id
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: id
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.extension
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.system
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.system
short:
  v: Identity of the terminology system
definition:
  v: The identification of the code system that defines the meaning of the symbol in the code.
comment:
  v: The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
requirements:
  v: Need to be unambiguous about the source of the definition of the symbol.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coding.system
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
pattern: uri
  v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.3
mapping:
  identity:
    v: rim
  map:
    v: ./codeSystem
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.version
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.version
short:
  v: Version of the system - if relevant
definition:
  v: The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
comment:
  v: Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coding.version
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.7
mapping:
  identity:
    v: rim
  map:
    v: ./codeSystemVersion
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.code
extension:
  url:
    v: http://hl7.org/fhir/build/StructureDefinition/no-binding
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.code
short:
  v: Symbol in syntax defined by the system
definition:
  v: A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
requirements:
  v: Need to refer to a particular code in the system.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coding.code
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-benefit-type
    link: https://fhir.developer.gene.com/ValueSet/uapi-benefit-type
mapping:
  identity:
    v: v2
  map:
    v: C*E.1
mapping:
  identity:
    v: rim
  map:
    v: ./code
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.display
short:
  v: Representation defined by the system
definition:
  v: A representation of the meaning of the code in the system, following the rules of the system.
requirements:
  v: Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coding.display
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.2 - but note this is not well followed
mapping:
  identity:
    v: rim
  map:
    v: CV.displayName
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.userSelected
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.userSelected
short:
  v: If this coding was chosen directly by the user
definition:
  v: Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
comment:
  v: Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
requirements:
  v: This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coding.userSelected
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: Sometimes implied by being first
mapping:
  identity:
    v: rim
  map:
    v: CD.codingRationale
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.text
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.text
short:
  v: Plain text representation of the concept
definition:
  v: A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
comment:
  v: Very often the text is the same as a displayName of one of the codings.
requirements:
  v: The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.9. But note many systems use C*E.2 for this
mapping:
  identity:
    v: rim
  map:
    v: ./originalText[mediaType/code="text/plain"]/data
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
short:
  v: Benefits allowed
definition:
  v: The quantity of the benefit which is permitted under the coverage.
requirements:
  v: Needed to convey the benefits offered under the coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit.allowed[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: unsignedInt
type:
  code:
    v: string
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.used[x]
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.used[x]
short:
  v: Benefits used
definition:
  v: The quantity of the benefit which have been consumed to date.
requirements:
  v: Needed to convey the benefits consumed to date.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.benefit.used[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: unsignedInt
type:
  code:
    v: string
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationRequired
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationRequired
short:
  v: Authorization required flag
definition:
  v: A boolean flag indicating whether a preauthorization is required prior to actual service delivery.
requirements:
  v: Needed to convey that preauthorization is required.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.authorizationRequired
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
short:
  v: Type of required supporting materials
definition:
  v: Codes or comments regarding information or actions associated with the preauthorization.
requirements:
  v: Needed to inform the provider of collateral materials or actions needed for preauthorization.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: AuthSupporting
  strength:
    v: example
  description:
    v: Type of supporting information to provide with a preauthorization.
  value set:
    v: http://hl7.org/fhir/ValueSet/coverageeligibilityresponse-ex-auth-support|4.3.0
    link: 4.3
    link: .0

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.id
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: id
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.extension
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.id
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: id
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.extension
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.system
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.system
short:
  v: Identity of the terminology system
definition:
  v: The identification of the code system that defines the meaning of the symbol in the code.
comment:
  v: The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
requirements:
  v: Need to be unambiguous about the source of the definition of the symbol.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coding.system
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
pattern: uri
  v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-authorization-supporting
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.3
mapping:
  identity:
    v: rim
  map:
    v: ./codeSystem
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.version
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.version
short:
  v: Version of the system - if relevant
definition:
  v: The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
comment:
  v: Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coding.version
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.7
mapping:
  identity:
    v: rim
  map:
    v: ./codeSystemVersion
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.code
extension:
  url:
    v: http://hl7.org/fhir/build/StructureDefinition/no-binding
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.code
short:
  v: Symbol in syntax defined by the system
definition:
  v: A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
requirements:
  v: Need to refer to a particular code in the system.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coding.code
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-authorization-supporting
    link: https://fhir.developer.gene.com/ValueSet/uapi-authorization-supporting
mapping:
  identity:
    v: v2
  map:
    v: C*E.1
mapping:
  identity:
    v: rim
  map:
    v: ./code
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.display
short:
  v: Representation defined by the system
definition:
  v: A representation of the meaning of the code in the system, following the rules of the system.
requirements:
  v: Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coding.display
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.2 - but note this is not well followed
mapping:
  identity:
    v: rim
  map:
    v: CV.displayName
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.userSelected
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.userSelected
short:
  v: If this coding was chosen directly by the user
definition:
  v: Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
comment:
  v: Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
requirements:
  v: This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coding.userSelected
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: Sometimes implied by being first
mapping:
  identity:
    v: rim
  map:
    v: CD.codingRationale
mapping:
  identity:
    v: orim
  map:
    v: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.text
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.text
short:
  v: Plain text representation of the concept
definition:
  v: A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
comment:
  v: Very often the text is the same as a displayName of one of the codings.
requirements:
  v: The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.9. But note many systems use C*E.2 for this
mapping:
  identity:
    v: rim
  map:
    v: ./originalText[mediaType/code="text/plain"]/data
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationUrl
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationUrl
short:
  v: Preauthorization requirements endpoint
definition:
  v: A web location for obtaining requirements or descriptive information regarding the preauthorization.
requirements:
  v: Needed to enable insurers to advise providers of informative information.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.insurance.item.authorizationUrl
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.preAuthRef
path:
  v: CoverageEligibilityResponse.preAuthRef
short:
  v: Preauthorization reference
definition:
  v: A reference from the Insurer to which these services pertain to be used on further communication and as proof that the request occurred.
requirements:
  v: To provide any preauthorization reference for provider use.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.preAuthRef
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: cdanetv4
  map:
    v: F03
mapping:
  identity:
    v: rim
  map:
    v: 23

id:
  v: CoverageEligibilityResponse.form
path:
  v: CoverageEligibilityResponse.form
short:
  v: Printed form identifier
definition:
  v: A code for the form to be used for printing the content.
comment:
  v: May be needed to identify specific jurisdictional forms.
requirements:
  v: Needed to specify the specific form used for producing output for this response.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.form
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Forms
  strength:
    v: example
  description:
    v: The forms codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/forms|4.3.0
    link: 4.3
    link: .0
mapping:
  identity:
    v: cdanetv4
  map:
    v: G42

id:
  v: CoverageEligibilityResponse.error
path:
  v: CoverageEligibilityResponse.error
short:
  v: Processing errors
definition:
  v: Errors encountered during the processing of the request.
requirements:
  v: Need to communicate processing issues to the requestor.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CoverageEligibilityResponse.error
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children unless an empty Parameters resource
  expression:
    v: hasValue() or (children().count() > id.count()) or $this is Parameters
  xpath:
    v: @value|f:*|h:div|self::f:Parameters
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false

id:
  v: CoverageEligibilityResponse.error.id
path:
  v: CoverageEligibilityResponse.error.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.error.extension
path:
  v: CoverageEligibilityResponse.error.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: CoverageEligibilityResponse.error.modifierExtension
path:
  v: CoverageEligibilityResponse.error.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4B/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: CoverageEligibilityResponse.error.code
path:
  v: CoverageEligibilityResponse.error.code
short:
  v: Error code detailing processing issues
definition:
  v: An error code,from a specified code system, which details why the eligibility check could not be performed.
requirements:
  v: Required to convey processing errors.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: CoverageEligibilityResponse.error.code
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: AdjudicationError
  strength:
    v: example
  description:
    v: The error codes for adjudication processing.
  value set:
    v: http://hl7.org/fhir/ValueSet/adjudication-error|4.3.0
    link: 4.3
    link: .0

element:
  id:
    v: CoverageEligibilityResponse.extension
  path:
    v: CoverageEligibilityResponse.extension
  slicing:
    discriminator:
      type:
        v: value
      path:
        v: url
    ordered:
      v: false
    rules:
      v: open
element:
  id:
    v: CoverageEligibilityResponse.extension:gpfShipmentMethod
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: gpfShipmentMethod
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/gpf-shipment-method
      link: https://fhir.developer.gene.com/StructureDefinition/gpf-shipment-method
element:
  id:
    v: CoverageEligibilityResponse.extension:statusOutcome
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: statusOutcome
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/statusOutcome
      link: https://fhir.developer.gene.com/StructureDefinition/statusOutcome
element:
  id:
    v: CoverageEligibilityResponse.extension:priorAuthTAT
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: priorAuthTAT
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/priorAuthTAT
      link: https://fhir.developer.gene.com/StructureDefinition/priorAuthTAT
element:
  id:
    v: CoverageEligibilityResponse.extension:predAuthTAT
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: predAuthTAT
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/predAuthTAT
      link: https://fhir.developer.gene.com/StructureDefinition/predAuthTAT
element:
  id:
    v: CoverageEligibilityResponse.extension:pcpReferralRequired
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: pcpReferralRequired
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired
      link: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRequired
element:
  id:
    v: CoverageEligibilityResponse.extension:preReferralEffectiveDate
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: preReferralEffectiveDate
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate
      link: https://fhir.developer.gene.com/StructureDefinition/preReferralEffectiveDate
element:
  id:
    v: CoverageEligibilityResponse.extension:pcpReferralOnFile
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: pcpReferralOnFile
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile
      link: https://fhir.developer.gene.com/StructureDefinition/pcpReferralOnFile
element:
  id:
    v: CoverageEligibilityResponse.extension:pcpReferralRecertificationDate
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: pcpReferralRecertificationDate
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate
      link: https://fhir.developer.gene.com/StructureDefinition/pcpReferralRecertificationDate
element:
  id:
    v: CoverageEligibilityResponse.extension:spendDownFrequency
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: spendDownFrequency
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency
      link: https://fhir.developer.gene.com/StructureDefinition/spendDownFrequency
element:
  id:
    v: CoverageEligibilityResponse.extension:peerToPeerAvailable
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: peerToPeerAvailable
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable
      link: https://fhir.developer.gene.com/StructureDefinition/peerToPeerAvailable
element:
  id:
    v: CoverageEligibilityResponse.extension:noOfAppealsAllowed
  path:
    v: CoverageEligibilityResponse.extension
  slice name:
    v: noOfAppealsAllowed
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
    profile:
      v: https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed
      link: https://fhir.developer.gene.com/StructureDefinition/noOfAppealsAllowed

id:
  v: CoverageEligibilityResponse.extension:appealSubmissionDeadline
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: appealSubmissionDeadline
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline
    link: https://fhir.developer.gene.com/StructureDefinition/appealSubmissionDeadline

id:
  v: CoverageEligibilityResponse.extension:additionalDocumentsRequired
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: additionalDocumentsRequired
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired
    link: https://fhir.developer.gene.com/StructureDefinition/additionalDocumentsRequired

id:
  v: CoverageEligibilityResponse.extension:estimatedAppealTAT
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: estimatedAppealTAT
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT
    link: https://fhir.developer.gene.com/StructureDefinition/estimatedAppealTAT

id:
  v: CoverageEligibilityResponse.extension:billingInstructions
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: billingInstructions
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/billing-instructions
    link: https://fhir.developer.gene.com/StructureDefinition/billing-instructions

id:
  v: CoverageEligibilityResponse.extension:benefitsSummary
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: benefitsSummary
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/benefits-summary
    link: https://fhir.developer.gene.com/StructureDefinition/benefits-summary

id:
  v: CoverageEligibilityResponse.extension:specialtyPharmacy
path:
  v: CoverageEligibilityResponse.extension
slice name:
  v: specialtyPharmacy
min:
  v: 0
max:
  v: 1
type:
  code:
    v: Extension
  profile:
    v: https://fhir.developer.gene.com/StructureDefinition/specialty-pharmacy
    link: https://fhir.developer.gene.com/StructureDefinition/specialty-pharmacy

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService
must support:
  v: true

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slicing:
  discriminator:
    type:
      v: value
    path:
      v: system
  rules:
    v: closed
min:
  v: 1

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding:productService
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slice name:
  v: productService
min:
  v: 1
max:
  v: 1
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-prod-service
    link: https://fhir.developer.gene.com/ValueSet/uapi-prod-service

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding:jcode
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slice name:
  v: jcode
min:
  v: 0
max:
  v: 1
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-product-jcode
    link: https://fhir.developer.gene.com/ValueSet/uapi-product-jcode

id:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding:preDetermination
path:
  v: CoverageEligibilityResponse.insurance.item.productOrService.coding
slice name:
  v: preDetermination
min:
  v: 0
max:
  v: 1
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-pre-determination
    link: https://fhir.developer.gene.com/ValueSet/uapi-pre-determination

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type
must support:
  v: true

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.system
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.system
min:
  v: 1
pattern: uri
  v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-benefit-type

id:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.code
path:
  v: CoverageEligibilityResponse.insurance.item.benefit.type.coding.code
min:
  v: 1
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-benefit-type
    link: https://fhir.developer.gene.com/ValueSet/uapi-benefit-type

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting
max:
  v: 1
must support:
  v: true

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.system
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.system
min:
  v: 1
pattern: uri
  v: http://terminology.gene.com/fhir/usix/uapi/CodeSystem/uapi-authorization-supporting

id:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.code
path:
  v: CoverageEligibilityResponse.insurance.item.authorizationSupporting.coding.code
min:
  v: 1
binding:
  strength:
    v: required
  value set:
    v: https://fhir.developer.gene.com/ValueSet/uapi-authorization-supporting
    link: https://fhir.developer.gene.com/ValueSet/uapi-authorization-supporting