Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id		1..1	id	Item
meta		1..1	Meta	Metadata about a resource
profile		1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for extension		0..*	Extension	Optional Extensions Element Slice: Unordered, Open by value:url
transfer		0..1	boolean	Transfer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
referrer		0..1	Reference(Practitioner | Organization)	Referrer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer
identifier		1..1	Identifier	A business unique identifier for the CoverageEligibilityRequest. This Identifier will be utilized in the CoverageEligibilityResponse prepared by the payer to reference and link the Request with the Response.
status		1..1	code	Financial Resource Status Code Required Pattern: active
priority		1..1	CodeableConcept	Desired processing priority. A coding element defining the system and code of the priority. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
code		1..1	code	Symbol in syntax defined by the system Fixed Value: normal
purpose		1..*	code	EligibilityRequestPurpose
patient		1..1	Reference(SHAPatient)	The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. A reference to the Patient element within the bundle. SHA Patient
Slices for serviced[x]		0..1	date, Period	Estimated date or dates of service Slice: Unordered, Open by type:$this
serviced[x]:servicedDate		0..1	date	The date or dates when the enclosed suite of services were performed or completed. Choice element: Either date or Period required
serviced[x]:servicedPeriod		0..1	Period	The period when the enclosed suite of services were performed or completed.
created		1..1	dateTime	Creation date of this CoverageEligibilityRequest
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request. A reference to the healthcare provider license issed by the regulator and maintained in the Health Worker Registry. Use the reference.identifier for well know identifiers.
insurer		1..1	Reference(Organization)	Coverage issuer. A reference to the payor organization license issed by the regulator and maintained in the Facility Registry.
facility		0..1	Reference(Location)	Servicing Facility. reference to the provider organization resource
insurance		1..*	BackboneElement	An element to include the insurance coverage of the member in case it is known by the provider at the time of preparing the eligiblity request.
coverage		1..1	Reference(SHACoverage)	Insurance information. A Reference to the insurance coverage resource
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id	Σ	1..1	id	Item
meta	Σ	1..1	Meta	Metadata about a resource
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Optional Extensions Element Slice: Unordered, Open by value:url
transfer		0..1	boolean	Transfer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
referrer		0..1	Reference(Practitioner | Organization)	Referrer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	A business unique identifier for the CoverageEligibilityRequest. This Identifier will be utilized in the CoverageEligibilityResponse prepared by the payer to reference and link the Request with the Response.
status	?!Σ	1..1	code	Financial Resource Status Code Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	CodeableConcept	Desired processing priority. A coding element defining the system and code of the priority. Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
code		1..1	code	Symbol in syntax defined by the system Fixed Value: normal
purpose	Σ	1..*	code	EligibilityRequestPurpose Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(SHAPatient)	The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. A reference to the Patient element within the bundle. SHA Patient
Slices for serviced[x]		0..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate		0..1	date	The date or dates when the enclosed suite of services were performed or completed. Choice element: Either date or Period required
serviced[x]:servicedPeriod		0..1	Period	The period when the enclosed suite of services were performed or completed.
created	Σ	1..1	dateTime	Creation date of this CoverageEligibilityRequest
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request. A reference to the healthcare provider license issed by the regulator and maintained in the Health Worker Registry. Use the reference.identifier for well know identifiers.
insurer	Σ	1..1	Reference(Organization)	Coverage issuer. A reference to the payor organization license issed by the regulator and maintained in the Facility Registry.
facility		0..1	Reference(Location)	Servicing Facility. reference to the provider organization resource
insurance		1..*	BackboneElement	An element to include the insurance coverage of the member in case it is known by the provider at the time of preparing the eligiblity request.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage		1..1	Reference(SHACoverage)	Insurance information. A Reference to the insurance coverage resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	example	Pattern: normal http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id	Σ	1..1	id	Item
meta	Σ	1..1	Meta	Metadata about a resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Optional Extensions Element Slice: Unordered, Open by value:url
transfer		0..1	boolean	Transfer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
referrer		0..1	Reference(Practitioner | Organization)	Referrer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	A business unique identifier for the CoverageEligibilityRequest. This Identifier will be utilized in the CoverageEligibilityResponse prepared by the payer to reference and link the Request with the Response.
status	?!Σ	1..1	code	Financial Resource Status Code Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	CodeableConcept	Desired processing priority. A coding element defining the system and code of the priority. Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		0..1	uri	Identity of the terminology system
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: normal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
purpose	Σ	1..*	code	EligibilityRequestPurpose Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(SHAPatient)	The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. A reference to the Patient element within the bundle. SHA Patient
Slices for serviced[x]		0..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate		0..1	date	The date or dates when the enclosed suite of services were performed or completed. Choice element: Either date or Period required
serviced[x]:servicedPeriod		0..1	Period	The period when the enclosed suite of services were performed or completed.
created	Σ	1..1	dateTime	Creation date of this CoverageEligibilityRequest
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request. A reference to the healthcare provider license issed by the regulator and maintained in the Health Worker Registry. Use the reference.identifier for well know identifiers.
insurer	Σ	1..1	Reference(Organization)	Coverage issuer. A reference to the payor organization license issed by the regulator and maintained in the Facility Registry.
facility		0..1	Reference(Location)	Servicing Facility. reference to the provider organization resource
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items
insurance		1..*	BackboneElement	An element to include the insurance coverage of the member in case it is known by the provider at the time of preparing the eligiblity request.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
focal		0..1	boolean	Applicable coverage
coverage		1..1	Reference(SHACoverage)	Insurance information. A Reference to the insurance coverage resource
businessArrangement		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Perfoming practitioner
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
diagnosis[x]		0..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
detail		0..*	Reference(Resource)	Product or service details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
CoverageEligibilityRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
CoverageEligibilityRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	example	Pattern: normal http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Summary

Mandatory: 7 elements

Structures

This structure refers to these other structures:

• SHAPatient (https://shr.tiberbuapps.com/fhir/StructureDefinition/SHAPatient)
• SHACoverage (https://shr.tiberbuapps.com/fhir/StructureDefinition/SHACoverage)

Extensions

This structure refers to these extensions:

• https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
• https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityRequest.serviced[x]

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id		1..1	id	Item
meta		1..1	Meta	Metadata about a resource
profile		1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for extension		0..*	Extension	Optional Extensions Element Slice: Unordered, Open by value:url
transfer		0..1	boolean	Transfer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
referrer		0..1	Reference(Practitioner | Organization)	Referrer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer
identifier		1..1	Identifier	A business unique identifier for the CoverageEligibilityRequest. This Identifier will be utilized in the CoverageEligibilityResponse prepared by the payer to reference and link the Request with the Response.
status		1..1	code	Financial Resource Status Code Required Pattern: active
priority		1..1	CodeableConcept	Desired processing priority. A coding element defining the system and code of the priority. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
code		1..1	code	Symbol in syntax defined by the system Fixed Value: normal
purpose		1..*	code	EligibilityRequestPurpose
patient		1..1	Reference(SHAPatient)	The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. A reference to the Patient element within the bundle. SHA Patient
Slices for serviced[x]		0..1	date, Period	Estimated date or dates of service Slice: Unordered, Open by type:$this
serviced[x]:servicedDate		0..1	date	The date or dates when the enclosed suite of services were performed or completed. Choice element: Either date or Period required
serviced[x]:servicedPeriod		0..1	Period	The period when the enclosed suite of services were performed or completed.
created		1..1	dateTime	Creation date of this CoverageEligibilityRequest
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request. A reference to the healthcare provider license issed by the regulator and maintained in the Health Worker Registry. Use the reference.identifier for well know identifiers.
insurer		1..1	Reference(Organization)	Coverage issuer. A reference to the payor organization license issed by the regulator and maintained in the Facility Registry.
facility		0..1	Reference(Location)	Servicing Facility. reference to the provider organization resource
insurance		1..*	BackboneElement	An element to include the insurance coverage of the member in case it is known by the provider at the time of preparing the eligiblity request.
coverage		1..1	Reference(SHACoverage)	Insurance information. A Reference to the insurance coverage resource
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id	Σ	1..1	id	Item
meta	Σ	1..1	Meta	Metadata about a resource
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Optional Extensions Element Slice: Unordered, Open by value:url
transfer		0..1	boolean	Transfer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
referrer		0..1	Reference(Practitioner | Organization)	Referrer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	A business unique identifier for the CoverageEligibilityRequest. This Identifier will be utilized in the CoverageEligibilityResponse prepared by the payer to reference and link the Request with the Response.
status	?!Σ	1..1	code	Financial Resource Status Code Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	CodeableConcept	Desired processing priority. A coding element defining the system and code of the priority. Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
code		1..1	code	Symbol in syntax defined by the system Fixed Value: normal
purpose	Σ	1..*	code	EligibilityRequestPurpose Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(SHAPatient)	The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. A reference to the Patient element within the bundle. SHA Patient
Slices for serviced[x]		0..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate		0..1	date	The date or dates when the enclosed suite of services were performed or completed. Choice element: Either date or Period required
serviced[x]:servicedPeriod		0..1	Period	The period when the enclosed suite of services were performed or completed.
created	Σ	1..1	dateTime	Creation date of this CoverageEligibilityRequest
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request. A reference to the healthcare provider license issed by the regulator and maintained in the Health Worker Registry. Use the reference.identifier for well know identifiers.
insurer	Σ	1..1	Reference(Organization)	Coverage issuer. A reference to the payor organization license issed by the regulator and maintained in the Facility Registry.
facility		0..1	Reference(Location)	Servicing Facility. reference to the provider organization resource
insurance		1..*	BackboneElement	An element to include the insurance coverage of the member in case it is known by the provider at the time of preparing the eligiblity request.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
coverage		1..1	Reference(SHACoverage)	Insurance information. A Reference to the insurance coverage resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	example	Pattern: normal http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest		0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource
id	Σ	1..1	id	Item
meta	Σ	1..1	Meta	Metadata about a resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Optional Extensions Element Slice: Unordered, Open by value:url
transfer		0..1	boolean	Transfer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
referrer		0..1	Reference(Practitioner | Organization)	Referrer URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	A business unique identifier for the CoverageEligibilityRequest. This Identifier will be utilized in the CoverageEligibilityResponse prepared by the payer to reference and link the Request with the Response.
status	?!Σ	1..1	code	Financial Resource Status Code Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	CodeableConcept	Desired processing priority. A coding element defining the system and code of the priority. Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: STAT, normal, Deferred. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		0..1	uri	Identity of the terminology system
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: normal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
purpose	Σ	1..*	code	EligibilityRequestPurpose Binding: EligibilityRequestPurpose (required): A code specifying the types of information being requested.
patient	Σ	1..1	Reference(SHAPatient)	The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. A reference to the Patient element within the bundle. SHA Patient
Slices for serviced[x]		0..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate		0..1	date	The date or dates when the enclosed suite of services were performed or completed. Choice element: Either date or Period required
serviced[x]:servicedPeriod		0..1	Period	The period when the enclosed suite of services were performed or completed.
created	Σ	1..1	dateTime	Creation date of this CoverageEligibilityRequest
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the request. A reference to the healthcare provider license issed by the regulator and maintained in the Health Worker Registry. Use the reference.identifier for well know identifiers.
insurer	Σ	1..1	Reference(Organization)	Coverage issuer. A reference to the payor organization license issed by the regulator and maintained in the Facility Registry.
facility		0..1	Reference(Location)	Servicing Facility. reference to the provider organization resource
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items
insurance		1..*	BackboneElement	An element to include the insurance coverage of the member in case it is known by the provider at the time of preparing the eligiblity request.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
focal		0..1	boolean	Applicable coverage
coverage		1..1	Reference(SHACoverage)	Insurance information. A Reference to the insurance coverage resource
businessArrangement		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Perfoming practitioner
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
diagnosis[x]		0..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
detail		0..*	Reference(Resource)	Product or service details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
CoverageEligibilityRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
CoverageEligibilityRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	example	Pattern: normal http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Summary

Mandatory: 7 elements

Structures

This structure refers to these other structures:

• SHAPatient (https://shr.tiberbuapps.com/fhir/StructureDefinition/SHAPatient)
• SHACoverage (https://shr.tiberbuapps.com/fhir/StructureDefinition/SHACoverage)

Extensions

This structure refers to these extensions:

• https://shr.tiberbuapps.com/fhir/StructureDefinition/transfer
• https://shr.tiberbuapps.com/fhir/StructureDefinition/referrer

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityRequest.serviced[x]